Proposal Form (R09 - HIV/AIDS) (VTN-R09-HA)

Transcription

PROPOSAL FORM – ROUND 9
(SINGLE COUNTRY APPLICANTS)
Applicant Name
Viet Nam CCM
Country
Viet Nam
Income Level
(Refer to list of income levels
by economy in Annex 1 to the
Round 9 Guidelines)
Applicant Type
Low-income country
X CCM
Sub-CCM
Non-CCM
Round 9 Proposal Element(s):
Disease
Title
Government – Civil Society
partnership in responding to HIV
epidemic in Viet Nam and
moving towards Universal
Access and a sustainable
National AIDS Program
HIV 1
Tuberculosis
1
Scaling up Technical
Components and Partnerships
for Expanded Impact in TB
Control
Does this disease include
cross-cutting Health
Systems Strengthening
interventions in part 4B?
(include in one disease only)
Is this a 're-submit'
of the same disease
proposal not
recommended in
Round 8?
NO
NO
NO
NO
Malaria
1
Different HIV and tuberculosis activities are recommended for different epidemiological situations. For further
information: see the ‘WHO Interim policy on collaborative TB/HIV activities’ available at:
http://www.who.int/tb/publications/tbhiv_interim_policy/en/
1
If this is a Round 8 proposal being re-submitted, have the TRP Review Form comments
been clearly addressed in s.4.5.2?
Are there major new objectives compared to the Round 8 proposal that is being resubmitted? If yes, please provide a summary of the changes in the box below by each disease
re-submission and section number.
Currency
X
USD
Deadline for submission of proposals:
or
X
Yes
No
Yes
No
EURO
12 noon, Local Geneva Time,
Monday 1 June 2009
2
INDEX OF SECTIONS and KEY ATTACHMENTS FOR PROPOSALS
'+' = A key attachment to the proposal. These documents must be submitted with the completed Proposal
Form. Other documents may also be attached by an applicant to support their program strategy (or
strategies if more than one disease is applied for) and funding requests. Applicants identify these in
the 'Checklists' at the end of s.2 and s.5.
1.
Funding Summary and Contact Details
2.
Applicant Summary (including eligibility)
Attachment C: Membership details of CCMs or Sub-CCMs
+
Complete the following sections for each disease included in Round 9:
3.
Proposal Summary
4.
Program Description
4B.
HSS cross-cutting interventions strategy **
5.
Funding Request
5B.
HSS cross-cutting funding details **
** Only to be included in one disease in Round 9. Refer to the Round 9 Guidelines for detailed
information.
+ Attachment A: 'Performance Framework' (Indicators and targets)
+ Attachment B: 'Preliminary List of Pharmaceutical and Health Products'
+ Detailed Work Plan: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5
+ Detailed Budget: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5
IMPORTANT NOTE:
Applicants are strongly encouraged to read the Round 9 Guidelines fully before completing a
Round 9 proposal. Applicants should continually refer to these Guidelines as they answer
each section in the proposal form. All other Round 9 Documents are available here.
A number of recent Global Fund Board decisions have been reflected in the Proposal Form. The Round 9
Guidelines explain these decisions in the order they apply to this Proposal Form. Information on these
decisions is available at:
http://www.theglobalfund.org/documents/board/16/GF-BM16-Decisions_en.pdf.
Since Round 7, efforts have been made to simplify the structure and remove duplication in the Proposal
Form. The Round 9 Guidelines therefore contain the majority of instructions and examples that will assist in
the completion of the form.
3
Proposal checklist - Section 1 and 2
1.
FUNDING SUMMARY AND CONTACT DETAILS
1.1.
Funding summary
Total funds requested over proposal term
Disease
HIV
Tuberculosis
Year 1
Year 2
Year 3
Year 4
Year 5
Total
12,948,131
14,550,682
24,223,125
25,426,372
26,838,382
103,986,692
6,449,993
12,674,984
12,901,149
13,266,590
14,099,492
59,392,208
Malaria
HSS crosscutting
interventions
section 4B
and 5B
within [insert
name of the
one disease
which
includes
s.4B. and
s.5B. only if
relevant]
Total Round 9 Funding Request
1.2.
:
163,378,899
Contact details
Contact details – TB proposal
Primary contact
Secondary contact
Name
Dinh Ngoc Sy
Nguyen Viet Nhung
Title
Director
Vice Director
Organization
National Hospital of Tuberculosis
and Respiratory Diseases /
National TB Program
National Hospital of Tuberculosis
and Respiratory Diseases /
National TB Program
Mailing address
463 Hoang Hoa Tham Street,
Hanoi, Vietnam
463 Hoang Hoa Tham Street,
Hanoi, Vietnam
Telephone
+84-(0)4-37614890
+84-(0)4-37614673
Fax
+84-(0)4-37614901
+84-(0)4-38326162
E-mail address
[email protected],
[email protected]
[email protected]
Alternate e-mail address
[email protected]
[email protected]
4
Contact details – HIV/AIDS Proposal
Primary contact – Government
Track
Name
Title
Organization
Mailing address
Telephone
Fax
E-mail address
Alternate e-mail address
Dr Nguyen Lan Huong
Project Officer
Global Fund Project Office
7th Floor, 14 Lang Ha, Hanoi
+ 84 4 3772 2993
+ 84 4 3772 2994
[email protected]
NA
Primary contact – Civil Society
Track
Dr Vladanka Andreeva
Monitoring and Evaluation Adviser
UNAIDS
No 24, Lane 11, Trinh Hoai Duc St,
Hanoi
+ 84 4 3734 2824
+84 4 3734 2825
[email protected]
[email protected]
5
1.3.
List of Abbreviations and Acronyms used by the Applicant
Acronym/
Abbreviation
Meaning
ADB
Asian Development Bank
ACSM
Advocacy, Communication and Social Mobilization
AFB
Acid-fast bacilli
AIDS
Acquired Immune Deficiency Syndrome
ANC
Antenatal Clinic
ART
Antiretroviral therapy
ARV
Antiretroviral (medicines)
ASEAN
Association of South East Asian Nations
AusAID
Australian Agency for International Development
BCC
Behavioral Change Communication
BSS
Behavior Surveillance Survey
CBO
Community-Based Organization
CEPHAD
Centre for Public Health and Community Development
CERAC
Center for Research and Action for Community
CHP
Centre for Health Promotion
CIHP
Consulting for Investment in Health Promotion
COHED
Center for Community Health and Development
CSO
Civil Society Organization
CCM
Country Coordinating Mechanism
CCP
Community of Concerned Partners
CCS
Comprehensive Care Site
CDC
Center for Disease Control and Prevention (US)
CPRGS
Comprehensive Poverty Reduction and Growth Rate Strategy
CHAI
Clinton HIV/AIDS Initiative
CHS
Commune Health Station
CIDA
Canadian International Development Agency
6
COHED
Centre for Community Health and Development
CPC-1
Central Pharmaceutical Company Number 1
CPMU
Central Project Management Unit
CSS
Community Systems Strengthening
CUP
Condom Use Program
DAV
Drug Administration of Viet Nam
DfID
Department for International Development (UK)
DG
Development Goals
DHC
District Health Center
DHS
Demographic and Health Surveys
DOH
Department of Health
DOLISA
Department of Labor, Invalids and Social Affairs
DOPS
Department of Public Security
DPMC
District Preventive Medicine Center
DPS
Department of Public Security
DSVP
Department of Social Vice Prevention
DOT
Directly observed therapy
DOTS
Directly observed therapy short-course
DRS
Drug resistance survey
EE
Entertainment Establishment
EoI
Expression of Interest
EID
Early Infant Diagnosis
ESTHER
Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau
FHI
Family Health International
FDC
Fixed dose combination
FU
Farmers Union
GF
Global Fund
GF-1
Global Fund Round 1 (HIV)
GF-6
7
GF-8
GF-9
GFATM
Global Fund for HIV/AIDS, Tuberculosis and Malaria
GTZ
German Agency for Technical Cooperation
GDF
Global Drug Facility
GLC
Green Light Committee
GVN
Government of Viet Nam
HAART
Highly Active Antiretroviral Therapy
HAIVN
Harvard Medical School AIDS Initiative in Viet Nam
HARP
Harm Reduction Platform (Netherlands)
HBC
Home-Based care
HBC
high burden country
HCBC
Home- and Community-Based Care
HCW
Health Care Worker
HIV
Human Immunodeficiency Virus
HR
Harm Reduction
HSS
HIV/AIDS Sentinel Surveillance OR Health Systems Strengthening
IBBS
Integrated Biological and Behavioral Surveillance
IDU
Injecting Drug User
IEC
Information Education and Communication
IMAI
Integrated Management of Adolescent and Adult Illnesses
INGO
International NGO
INH
Isoniazid
ISDS
Institute for Social Development Studies
IUATLD
International Union Against TB and Lung Disease
KAP
knowledge, attitude, practice
KNCV
Royal Netherlands TB Association / KNCV TB Foundation
LIFE-GAP
Leadership & Investment in Fighting an Epidemic – Global AIDS Program, CDC
8
MARPS
Most At Risk Populations
M&E
Monitoring and Evaluation
MCH
Maternal and Child Health
MDR-TB
Multi drug resistant tuberculosis
MCNV
Medical Committee Netherlands - Viet Nam
MDG
United Nations Millennium Development Goals
MDM
Medicines du Monde (France)
MMT
Methadone Maintenance Therapy
MOF
Ministry for Finance
MOH
Ministry of Health
MOLISA
Ministry of Labor, Invalids and Social Affairs
MOPS
Ministry of Public Security
MoU
Memorandum of Understanding
MTDP
Mid-term Development Plan
MPI
Ministry of Planning and Investment
MSM
Men who have Sex with Men
NA
Non-applicable OR Not available
NAP
National AIDS Program
NGO
Non-governmental organization
NIDV
National Institute of Dermatology and Venereology
NIHE
National Institute of Hygiene and Epidemiology
NSP
Needle and Syringe Program
NTP
National Tuberculosis Control Program
OD
Organizational Development
ODA
Official Development Assistance
OI
Opportunistic infection
OVC
Orphans and Vulnerable Children
PAC
Provincial AIDS Center
9
PAL
Practical Approaches to Lung Health
PATH
Program for Appropriate Technology in Health
PEPFAR
President’s Emergency Plan for AIDS Relief
PHS
Provincial Health Services
PITC
Provider Initiated Counseling and Testing
PLHIV
Persons Living With HIV
PMTCT
Prevention of Mother to Child Transmission
PMU
Project Management Unit
POA
Plan of Action
PPMD
Public-private mix DOTS
PPMU
Provincial Project Management Unit
PR
Principal Recipient
RNE
Royal Netherlands Embassy
SARS
Severe Acute Respiratory Syndrome
SOP
Standard Operating Procedures
SDA
Service Delivery Area
SHAPC
STD/HIV/AIDS Prevention Center
SIDA
Swedish International Development Cooperation Agency
SS
Sputum smear
SR
Sub-recipient
SNRL
Supra national laboratory
SWOT
Strengths, weaknesses, opportunities and threats
STI
Sexually Transmitted Infection
SW
Sex Worker
TA
Technical Assistance
TB
Tuberculosis
TBD
To Be Determined
TEC
Treatment and Education Center
10
TORs
Terms of Reference
TRP
Technical Review Panel
TWG
Technical Working Group
UN
United Nations
UNAIDS
Joint United Nations Program on HIV/AIDS
UNFPA
United Nations Population Fund
UNGASS
United Nations General Assembly Special Session
UNICEF
United Nations Children’s Fund
UNODC
United Nations Office on Drug and Crimes
USAID
United States Agency for International Development
VAAC
Viet Nam Administration of HIV/AIDS Control
VMA
Vietnam Medical Association
VRCA
Vietnam Red Cross Association
WHO
World Health Organization
WPRO
Western Pacific Regional Office
11
2.
APPLICANT SUMMARY (including eligibility)
CCM applicants: Only complete section 2.1. and 2.2. and DELETE sections 2.3. and 2.4.
Sub-CCM applicants: Complete sections 2.1. and 2.2. and 2.3. and DELETE section 2.4.
Non-CCM applicants: Only complete section 2.4. and DELETE sections 2.1. and 2.2. and 2.3.
IMPORTANT NOTE:
Different from Round 7, ′income level′ eligibility is set out in s.4.5.1 (focus on poor and key
affected populations depending on income level), and in s.5.1. (cost sharing).
2.1.
Members and operations
2.1.1. Membership summary
Sector Representation
Number of members
x
Academic/educational sector
1
x
Government
x
Non-government organizations (NGOs)/community-based organizations
5
x
People living with the diseases
3
11
People representing key affected populations 2
x
Private sector
1
Faith-based organizations
x
Multilateral and bilateral development partners in country
4
Other (please specify):
Total Number of Members:
(Number must equal number of members in 'Attachment C'' 3 )
2
3
25
Please use the Round 9 Guidelines definition of key affected populations.
Attachment C is where the CCM (or Sub-CCM) lists the names and other details of all current members. This
document
is
a
mandatory
attachment
to
an
applicant's
proposal.
It
is
available
at:
http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_AttachmentC_en.xls
12
2.1.2. Broad and inclusive membership
Since the last time you applied to the Global Fund (and were determined compliant with the minimum
requirements):
(a)
(b)
Have non-government sector members (including any new members
since the last application) continued to be transparently selected by their
own sector; and
Is there continuing active membership of people living with and/or
affected by the diseases.
No
No
x
Yes
x
Yes
13
2.1.3. Member knowledge and experience in cross-cutting issues
Health Systems Strengthening
The Global Fund recognizes that weaknesses in the health system can constrain efforts to respond to the
three diseases. We therefore encourage members to involve people (from both the government and nongovernment) who have a focus on the health system in the work of the CCM or Sub-CCM.
(a)
Describe the capacity and experience of the CCM (or Sub-CCM) to consider how health system
issues impact programs and outcomes for the three diseases.
The CCM contains a diversity of membership from the public, multilateral, donor and NGO sectors that
have experience and demonstrated capacity in health system strengthening.
Membership with specific experience in health system strengthening includes the following:
GVN:
MOH Vice Director of the Department of Planning and Finance
MOH/VAAC Director General
MOH/VAAC Vice Director
National Hospital of Tuberculosis and Lung Diseases/Director
National Institute of Malariology, Parasytology and Entomology/Director
Government members have considerable experience working on national and internationally funded
programs designed to build the capacity of the Ministry of Health and related agencies to prevent and
respond to disease burdens in Vietnam.
Local NGOs/Mass Organizations:
VMA is a public social, professional organization of physicians and health workers that builds the capacity
of its members through training, research, and dissemination and sharing lessons learned. The VMA has
a network of provincial-level associations throughout the country through which provides support in health
sector capacity building
Vietnam’s Women’s Union works nationally on HIV-related community support and linkage with clinical
care services, building Vietnam’s comprehensive response.
Multilateral:
WHO Country Representative
WHO has provided over a decade of assistance to Vietnam to strengthen its health system, including
polio eradication, development of social health insurance coverage schemes, and responding to
tuberculosis and HIV.
International NGOs:
Family Health International Country Director
FHI has considerable experience working with both government and non-government sectors in Vietnam
to strengthen local health systems, from the provincial to the district levels.
Gender awareness
The Global Fund recognizes that inequality between males and females, and the situation of sexual
minorities are important drivers of epidemics, and that experience in programming requires knowledge
and skills in:
•
•
methodologies to assess gender differentials in disease burdens and their consequences
(including differences between men and women, boys and girls), and in access to and the
utilization of prevention, treatment, care and support programs; and
the factors that make women and girls and sexual minorities vulnerable.
(b)
Describe the capacity and experience of the CCM (or Sub-CCM) in gender issues including the
14
number of members with requisite knowledge and skills.
Viet Nam has a large range of organizations which mandates addresses specifically gender related
issues. This expertise is considerably reflected in the current CCM membership with the following
constituencies and representative included:
Government
- Government Office, Department of Science, education, culture and social affairs: Mrs. Hoang Thi
Hien, Vice-Director
- Ministry of Health; Viet Nam Administration of HIV/AIDS Control: Mr. Nguyen Thanh Long, Director
General
- Ministry of Health, Department of International Relations: Mrs. Nguyen Thi Minh Chau: Vice-Director
Mass organizations
- Viet Nam Women Union; Women, AIDS and reproductive health center: Mrs. Nguyen Thi Hoa Binh,
Director
Multilateral organizations
- World Health Organization: Jean-Marc Olive, Representative
- Joint United Nations Programme on HIV/AIDS: Eamonn Murphy, Country Director
National NGOs
- Vietnamese Network of PLHIV (VNP+): Mr. Do Dang Dong, Chief Representative
- Center for Community Health Promotion: Mr. Tran Minh Gioi, Director
INGOs
- Family Health International: Steve Mills, Country Director
Bilateral organizations
- Netherlands Embassy: Mr. Ger Steenburgen, First Secretary
Private sector:
- Huu Hanh Fine Arts Collective: Mrs. Nguyen Thi Huu Hanh, Director
Multi-sectoral planning
The Global Fund recognizes that multi-sectoral planning is important to expanding country capacity to
respond to the three diseases.
(c)
Describe the capacity and experience of the CCM (or Sub-CCM) in multi-sectoral program design.
The CCM Viet Nam has significant capacity in multi-sectoral program and planning development from the
government, bi and multi-lateral organization and the civil society. The members with particular expertise
is this include:
- Government Office, Department of Science, education, culture and social affairs
- Ministry of Planning and Investment; Foreign Economic Relation Department
- Ministry of Finance; Department of Loan Control and External Finance
- Ministry of Health; Viet Nam Administration of HIV/AIDS Control
- Ministry of Health, Department of International Relations
- World Health Organization
- Joint United Nations Programme on HIV/AIDS
- Family Health International
15
2.2.
Eligibility
2.2.1. Application history
'Check' one box in the table below and then follow the further instructions for that box in the right hand column.
X
Applied for funding in Round 7 and/or Round 8 and was
determined as having met the minimum eligibility requirements.
Last time applied for funding was before Round 7 or was
determined non-compliant with the minimum eligibility
requirements when last applied.
Complete all of sections 2.2.2
to 2.2.8 below.
First, go to ′Attachment D′
and complete.
Then also complete sections
2.2.5 to 2.2.8 below (Do not
complete sections 2.2.2 to 2.2.4)
2.2.2. Transparent proposal development processes
Refer to the document 'Clarifications on CCM Minimum Requirements' when completing these questions.
Documents supporting the information provided below must be submitted with the proposal as clearly named
and numbered annexes. Refer to the ′Checklist′ after s.2.
(a)
Describe the process (es) used to invite submissions for possible integration into the proposal from
a broad range of stakeholders including civil society and the private sector, and at the national,
sub-national and community levels. (If a different process was used for each disease, explain each
process.)
HIV proposal:
Following the country commitment (reflected in the Round 8 HIV proposal) to develop the next HIV
proposal based on a dual track principle, the CCM opted to apply to the Global Fund Round 9 HIV and
engage in a dual track financing model including a CSS component. This is seen by all national and
international stakeholders as an important progress and unique opportunity. Thus a call for Expression of
Interest (EoI) for the Civil Society Track was drafted and publicly launched in October 2008 (Please see
Annex 2-1 for the Public Call for EoI). This documented process was considered as a success as 36
proposals were received from a large range of both national and international non-governmental
organizations, before the set dead line of 11 November 2008. Due to the change of the membership of
the CCM and GFATM Round 9 submission deadline from January 2009 to June 2009, the selection
process of the EoI was finalized in April 2009.
For the Government Track, according to the decision of the CCM to seek funding to fill the major gaps in
the areas of harm reduction, HIV care and treatment and surveillance and M&E, Ministry of Public
Security (MOPS) and Ministry of Labor, Invalids and Social Affairs (MOLISA) were invited to work with
VAAC of MOH to develop a joint proposal and a series of meetings among them with and without other
national and international partners were organized to articulate the contributions of MOPS and MOLISA in
the Round 9 proposal.
Tuberculosis Proposal:
This application is an output of a continuous long-term planning process of NTP with partners, rooted in
a series of mid-term development plans, most recently revised for 2007-2011. In that process, and
integrated with other funding streams, including two previous rounds of GF funding, this application is
submitted to a) better respond to health sector reform, new challenges presented by TB-HIV and the
rapid emergence of the private sector and b) fill in gaps in previous plans related to MDR-TB and
laboratory capacity in light of the recent meeting in Beijing in April 2009. This application funds these
needed areas and especially focuses for the first time on involving stakeholders outside the NTP,
including private sector, civil society and community partners.
Following on recommendations of the Technical Advisory Group (TAG) of the Western Pacific Regional
Office (WPRO) of WHO in July 2008 and in anticipation of the proposal development process, the TB
16
sub-CCM appointed a committee to identify priority intervention areas for the proposal, including those
that could be implemented by NTP and those that would benefit from external partner involvement.
Committee members included international sub-CCM members, NTP staff, ministerial representatives,
civil society representatives and technical partners. Committee members identified three priority areas
based on NTP strategy and needs and developed a call for submission for concept papers and
preliminary budgets.
The call for submissions emphasized the need for improving capacity to detect all TB cases (including
implementation of PAL), strengthened management capacity at all levels and partners to address new
challenges such as TB-HIV and interventions that promote public-private mix DOTS (PPMD ) and
approaches in advocacy communication and social mobilization (ACSM). Emphasis was placed on
submission that also strengthened community involvement and civil society capacity to implement
proposed interventions. In all, five concept paper submissions were received and reviewed of which
three were selected for inclusion in the proposal. The three selected focused on PAL, PPMD and
ACSM activities. The timeline followed was:
August-September, 2008: NTP collects concept papers from technical working groups: TB-HIV, PAL,
and TB in closed Settings. NTP places an open call for submissions from potential sub-recipients and
accepts submission from call for concept papers.
October, 2008: Sub-CCM reviews selected submissions. Meetings are held with selected subrecipients, technical focal points and an international proposal writing consultant to discuss strategy
and implementation plans.
November 2008: First draft of proposal is prepared by international proposal writing consultant.
Review is postponed due to change in proposal deadline.
March 2009: First draft of proposals is reviewed by in-country and external reviewers/experts.
Responding to the Beijing “call for action” from the Ministerial meeting of high M/XDR TB burden
countries, inclusion of a MDR-TB component is decided by NTP and developed by the NTP MDR-TB
technical advisory group. The proposal writing consultant is in country to develop the proposal further.
A WHO PPMD consultant is in-country to provide input on proposal and program planning. A KNCV
consultant is in country to provide technical assistance on TB in closed settings and MDR-TB. The
proposal framework was presented in CCM meeting and the NTP was assigned to be the Principle
Recipient of TB round 9 proposal.
April 2009: Draft Proposal is reviewed and discussed by sub-CCM and CCM members. Meetings are
held with sub-recipient partners to discuss the final set of objectives and budgets. The writing
consultant is in country to finalize key sections and assist with budget development. A WHO MDR-TB
consultant is in-country to provide input on proposal and program planning.
May 2009: The final draft is sent to CCM and a team of experts at Stop TB-HQs for comments and
feed-back. The proposal is finalized by NTP and approved by CCM at the meeting dated May
th
27 ,.2009.
Annex 2.2.2 (a)_Process used to invite submissions for possible integration into the proposal
(b)
Describe the process(es) used to transparently review the submissions received for possible
integration into this proposal. (If a different process was used for each disease, explain each process.)
HIV proposal:
In March 2009, the CCM tasked the HIV sub-CCM to start developing the Round 9 HIV proposal that will
have two tracks: 1. Government Track and 2. Civil Society Track. For the Government Track, a series of
meetings with different partners, including CCM and non-CCM members, national and international
organizations, were conducted and set of priorities and activities developed. (Please see Annex 2-2 for
Minutes 23-25 March 2009). In the same meeting, the CCM tasked the HIV sub-CCM to transparently
review the submitted proposals for the Civil Society Track. (Please see Annex 2-3 for Minutes). A set of
clear technical indicators and criteria with a rating mechanism were developed so the review could be as
impartial as possible. (Refer to Annex 2-7 for the Criteria for Selection of EoI). While reviewing, specific
emphasis was also placed on the complementarities with the 8 PoAs and added value the proposals
would bring to the Vietnamese HIV response.
17
In parallel with the work in each track, many intensive discussions were organized to identify subjects and
modes of collaboration as well as division of labors between the Government and Civil Society Track
partners. Sub-CCM meetings played a crucial role to critically review different versions of the entire drafts
and provide recommendations to the writing teams and CCM.
The sub‐recipient proposal review committee consisted of TB sub‐CCM members, NTP and representatives from CDC, MCNV, the coordinating board of the PLWHA association, the Dutch embassy and the Vietnamese Youth Union. Committee members scored each concept paper according to a pre‐
established selection criteria including soundness of the approach, feasibility for implementation, capacity of the submitting organization and overall contribution to the GF‐R9 proposal objectives. Concept papers that best contributed to NTP reaching populations not adequately covered by the current program were prioritized. Two concept papers from PATH and the Farmers Union (one each) were selected for all proposed activities while a concept paper from the Center for Community Health Development (CCHD) was recommended for one proposed intervention only. Selected partners were invited to a joint meeting to determine next steps in developing an expanded implementation plan and correlating budget. Assistance was provided to each organization by the GF proposal writers in preparing objectives, activities, indicators and the budget workplan.
(c)
Describe the process(es) used to ensure the input of people and stakeholders other than CCM (or
Sub-CCM) members in the proposal development process. (If a different process was used for each
disease, explain each process.)
HIV proposal:
Following the review process of the Civil Society Track EoI, the sub-CCM recommended to the CCM that
3 proposals be approved as part of the Community System Strengthening (CSS) component. In addition,
a recommendation was given that the best way to proceed with the selection of PR for the Civil Society
Track was for the HIV sub-CCM to work with the 3 organizations whose proposals were recommended to
form the CSS Track to identify which of the three organizations was best placed to undertake the role of
PR. Since, the formal pre-approval on (see Annex 2-6 for email correspondence) the three selected
organizations, of which non are members of the CCM, have regularly and intensively engaged in a
coordination and planning exercise to adjust their proposal so potential duplication is avoided and a
consistent joint proposal is made. This process was supported by external experts brought on board to
facilitate and guide a group that became the “civil society consortium” of partners. The various working
drafts were also circulated to non CCM members for comments and feed-backs. In addition a writing
team was established to oversee the development of both track components and brief the HIV sub-CCM
on a regular basis.
For the Government Track, a series of meetings with different partners, including CCM and non CCM
members, national and international organizations, were conducted and set of priorities and activities
developed (see Annex 2-2 for Minutes 23-25 March 2009) as stated in 2.2.2 (b).
As described in this section part (a), several external partners were invited to the initial meeting
regarding the identification of proposal priority areas including local community organizations. Some of
these organizations were not part of the selection process as they had submitted concept papers for
consideration but they were responsible for developing their proposed intervention areas and related
budgets once selected.
NTP also requested PATH to provide technical assistance in coordinating the proposal development
process and writing a significant portion of the proposal. As it was a sub-recipient applicant, PATH
hired an external consultant to provide several months of proposal development and writing support.
The writing consultant worked directly with sub-recipient organizations as well as technical focal points
to write key intervention sections.
Several technical consultants also visited Viet Nam in this time and provided support for developing
18
key technical areas including: TB in prisons and other closed settings (KNCV), PPMD (WHO), and
MDR-TB (WHO, KNCV). Additional reviews and comments were collected from various technical
experts outside of Viet Nam including WHO and international PATH staff throughout the writing
process.
Annex 2.2.2 (c)_Process used to ensure the input of people and stakeholders other than CCM members
HIV Proposal:
Annex 2-3 CCM
Minutes 11
March 2009
Annex 2-4 CCM
Minutes 27 May
(d)
Attach a signed and dated version of the minutes of the meeting(s) at
which the members decided on the elements to be included in the proposal
for all diseases applied for.
Annex 2-5 HIV
sub-CCM 31
May 2009
Tuberculosis
proposal:
Annex 2.2.2 (d):
CCM meeting
minutes on 27
May 2009
2.2.3. Processes to oversee program implementation
(a)
Describe the process(es) used by the CCM (or Sub-CCM) to oversee program implementation.
HIV proposal:
The current practice consists in reviewing quarterly progress reports presented by the PR on the
programmatic and financial performance of the grants. CCM members are also invited to visit sites
supported by the Global Fund. Given the potential increase of the portfolio (Round 6 approved and
Round 8 in negotiation) and the dual track model proposed in round 9, the 2 PRs will establish formal
quarterly coordination and harmonization meetings. The current HIV-sub CCM, will also take part in the
meetings. Bi-annual joined supervision visits to the sites covered will be organized and reports presented
to the CCM.
Tuberculosis proposal:
The current practice of regular presentation of progress reports, including performance and financial
disbursement in CCM and Sub-CCM on TB meetings, established during the implementation of the
Round 1 and Round 6 TB and HIV grants will continue. In addition, CCM members are invited to visit
sites supported by GFATM funding. Four visits of CCM to TB sites have been conducted in the last two
years.
Annex 2.2.3 (a)_Process used by the CCM to oversee program implementation_CCM TOR
(b)
Describe the process(es) used to ensure the input of stakeholders other than CCM (or Sub-CCM)
members in the ongoing oversight of program implementation.
At present, the CCM oversees the programmatic and financial grants implementation and addresses
potential bottlenecks. The CCM is highly inclusive with representation from government, mass
organization, bi and multilateral organizations and non-governmental organizations. Since round 8
proposal has been approved, the CCM together with its respective disease specific sub-CCM have been
discussing the most appropriate ways to provide an opportunity for stakeholders that are not currently
19
part of the CCM to provide feed-back on program implementation and services.
It is suggested that an annual HIV partnership forum is organized by the CCM including the beneficiaries
and users, and the main institutional partners.
Annex 2.2.3 (b)_Process used by stakeholders other than CCM to oversee program implementation_NTP M&E
2.2.4. Processes to select Principal Recipients
The Global Fund recommends that applicants select both government and non-government sector Principal
Refer to the Round 9 Guidelines for further explanation of the
Recipients to manage program implementation.
principles. .
(a)
Describe the process used to make a transparent and documented selection of each of the
Principal Recipient(s) nominated in this proposal. (If a different process was used for each
disease, explain each process.)
HIV Proposal:
PR for the Government Track :
CCM members decide that VAAC who has rich experience in managing GFATM grants from previous
rounds, be nominated as the PR for the Government Track of the Viet Nam Round 9 HIV proposal
PR for the Civil Society Track :
Following the bidding process of selecting the main partners to constitute the core group of the CSS
component (see paragraph 2.2.2 c, HIV), the 3 organizations of the “CSS consortium” (VUSTA, Pact,
ISDS) have discussed among them the issue of being PR taking into close consideration the challenges
and the implication of assuming such role. In the context of Viet Nam, VUSTA (see description in 4.9)
which on one hand, is a strongly established national non-governmental organization, and on the other
hand, is benefiting from an immense network of partners all over the country, appeared to be
institutionally the best suited entity to take over this role.
In a meeting in August 2008, CCM approved that the TB Sub‐CCM would take the lead role in the coordination of the TB Round 9 application development process. Based on discussions to identify external implementation partners for the proposal, the sub‐CCM agreed to develop a single‐track proposal with the NTP identified as the principle recipient (PR) – see s 2.2.6. The choice of NTP as PR was formally approved by CCM in a March 2009 meeting and was reconfirmed by the CCM at the meeting on 27 May 2009.
HIV Proposal:
Annex 2-3 CCM
Minutes 11
March
(b)
Attach the signed and dated minutes of the meeting(s) at which the
members decided on the Principal Recipient(s) for each disease.
Tuberculosis
proposal:
Annex 2.2.4:
CCM meeting
minutes on 11
March 2009 and
27 May 2009
20
2.2.5. Principal Recipient(s)
Name
Disease
Sector**
VAAC
HIV
Government
VUSTA
HIV
Civil Society
Tuberculosis
Government
Ministry of Health/ National Hospital of
Tuberculosis and Respiratory Diseases
** Choose a 'sector' from the possible options that are included in this Proposal Form at s.2.1.1.
2.2.6. Non-implementation of dual track financing
Provide an explanation below if at least one government sector and one non-government sector Principal
Recipient have not been nominated for each disease in this proposal.
The CCM has chosen to apply for single-track funding for the GF-R9 TB proposal consistent with advice
from the Sub-CCM. The Sub-CCM on TB has reflected on its understanding of the history and intent of
dual track financing. It notes that there are important considerations in the area of HIV that have not been
thoroughly addressed from a policy perspective for TB in Viet Nam. More importantly, the NTP has a
strong track record of incrementally including and funding sectors intended with the dual track mechanism
Recognizing the emphasis GF places on dual track financing, this proposal seeks to aggressively effect
the perceived intent of GF dual track financing. To accomplish this, the NTP under the guidance of the
CCM, established a process to recruit NGOs that might consider applying as sub-recipients as described
above (s. 2.2.2). As sub-recipients, not only do domestic Vietnamese organizations continue to be
funded but also funding will be substantially increased and, in a novel approach for Vietnam, an efficient
mechanism to fund an international NGO will be put in place. Hence, this application proposes to
accomplish what we see as the intent of dual track financing with a single track mechanism and it has the
added advantage of being better suited for the TB situation in Vietnam and will further elevate the
leadership and management function of NTP to work with external groups.
The sub-CCM assessment to choose for a single track option was based on the following factors:
1. At this stage in the implementation of the TB program to scale-up several technical interventions
(with a high level of medical content), it is important for NTP to maintain strong technical and
implementation oversight to strengthen existing interventions and build technical capacity for new
program areas. NTP staff are competent in the proposed technical components and have
experience with ongoing research and implementation activities that require scale-up.
2. The technical competency of NTP is widely recognized in provinces which facilitates the
expansion of the TB program in the context of decentralization as horizontal collaboration is
imperative at this stage.
3. The TB program has not had active participation of non-governmental organizations at a level
sufficient to warrant dual track funding. Although the TB control program has previously engaged
4
mass organizations such as the Farmer’s Union, Women’s Union and Vietnamese Red Cross in
TB related IEC activities, these organizations have not shown the potential to scale up activities
in line with the technical, financial and management scope of this proposal. However, CCM does
acknowledge that the active engagement of non-governmental and other community based
partners is needed to achieve expanded impact. For example, the capacity of mass
4
Mass organizations are party linked quasi-governmental organizations representing specific constituencies
such as the women, farmers and youth. They serve the interests of the population and act as a link between
the people and the government.
21
organizations to reach communities directly in influencing TB knowledge and treatment seeking
behavior is significant.
4. NTP will undertake specific steps to ensure that sub recipient organizations’ (SR ) capacity is
strengthened for a partnership that is technically sound and productive (see s. 4.9.6 on
strengthening implementation capacity).
Two major results are expected of this approach that could lead to dual track applications in the future: 1)
the sub-recipient selection process was a competitive one, thereby enforcing quality standards and
selection of SR s with the most sound methodology (see s4.4.2), and 2) participating as sub-recipients in
the implementation of priority activities for PPMD, PAL and ACSM builds capacity for future partnership
on a technical level. It is expected that NTP will be able to work with sub-recipients to build their capacity
to plan for, implement and monitor TB control activities in line with the NTP guidelines.
2.2.7. Managing conflicts of interest
(a)
Are the Chair and/or Vice-Chair of the CCM (or Sub-CCM) from the
same entity as any of the nominated Principal Recipient(s) for any of
the diseases in this proposal?
Yes
provide details below
No
go to s.2.2.8.
(b)
If yes, attach the plan for the management of actual and potential
conflicts of interest.
Yes
[Insert Annex
Number]
2.2.8. Proposal endorsement by members
Attachment C – Membership
information and Signatures
Has 'Attachment C' been completed with the signatures
of all members of the CCM (or Sub-CCM)?
Section 2: Eligibility HIV Proposal
xYes
List Annex Name
and Number
CCM and Sub-CCM applicants
Annex 2-1 Public Call
for EOI
2.2.2(a)
Comprehensive documentation on processes used to
invite submissions for possible integration into the
proposal (if different processes used for each disease,
attach as separate annexes).
Annex 2-2 Minutes
23-25 March 2009
Annex 2-3 CCM
Minutes 11 March
2009
Annex 2-4 CCM
Minutes 27 May 2009
Annex 2-5 Email
22
correspondence
Annex 2-6 HIV subCCM Minutes 31 May
2009
Annex 2-7 Criteria for
EOI Selection
2.2.2(b)
review submissions for possible integration into the
proposal (if different processes used for each disease,
attach as separate annexes).
Contained in Annex 21 – 2-7
2.2.2(c)
ensure the input of a broad range of stakeholders in
the proposal development process
Contained in Annex 21 – 2-7
2.2.3(a)
Comprehensive documentation on processes to
oversee grant implementation by the CCM (or SubCCM).
Terms of Reference
of CCM-Viet Nam
(submitted for Round
8)
2.2.3(b)
ensure the input of a broad range of stakeholders in
grant oversight process.
2.2.4(a)
select and nominate the Principal Recipient (such as
the minutes of the CCM meeting at which the PR(s)
was/were nominated). If different processes used for
each disease, then explain.
Annex 2-3
2.2.7
Documented procedures for the management of
potential Conflicts of Interest between the Principal
Recipient(s) and the Chair or Vice Chair of the
Coordinating Mechanism
Not applicable
Minutes of the meeting at which the proposal was
developed and CCM (or Sub-CCM) endorsed.
Contained in Annex 21 - 2-7
Endorsement of the proposal by all CCM (or SubCCM) members.
Attachment C
2.2.8
Sub-CCM applicants only
2.3.3
(CCM Endorsement)
Documented evidence (including minutes of the CCM
meetings) that the CCM in the country reviewed and
endorsed the proposal (as relevant).
Not applicable
2.3.4
Documented evidence justifying the Sub-CCM’s right
to operate without guidance from the CCM.
Not applicable
Non-CCM applicants only
2.4.1
Documentation describing the organization such as
statutes and by-laws (official registration papers) or
other governance documents, documents evidencing
the key governance arrangements of the organization,
Not applicable
23
a summary of the organization, including background
and history, scope of work, past and current activities,
and a summary of the main sources and amounts of
funding.
2.4.2(a)
Documentary evidence justifying the one of the three
exceptional circumstances for submitting a non-CCM
proposal
Not applicable
2.4.2(b)
Documentary evidence of any attempts to include the
proposal in the relevant CCM’s final approved country
proposal and any response from the CCM.
Not applicable
Other documents relevant to sections 1 and 2 attached by applicant:
(add extra rows to this section of the table as required to ensure that documents directly relevant are attached)
Section 2: Eligibility – Tuberculosis Proposal:
List Annex Name and Number
CCM and Sub-CCM applicants
Annex 2.2.2 (a)
• 080717: CCM TB Sub-group
meeting: identify TB gaps and
priorities
2.2.2(a)
Comprehensive
documentation
on
processes used to invite submissions for
possible integration into the proposal (if
different processes used for each
disease, attach as separate annexes).
• 080822: Letter to CCM for TB
Round 9 application
• 080826_CCM meeting minutes
(CCM agreed to let TB Subgroup to go ahead with TB
Round 9 preparation)
• 080829_Sub CCM meeting to
discuss call for concept papers
• 080911_Call for concept papers
in Vietnamese and English
newspaper, NTP website
Annex 2.2.2 (b)
2.2.2(b)
Comprehensive
documentation
on
processes used to review submissions
for possible integration into the proposal
(if different processes used for each
disease, attach as separate annexes).
• 080923_CCM TB Sub-group
meeting minutes on setting up a
selection committee
• 080930_Invitation to participate
in the selection committee for
GFATM Round 9 TB concept
papers
• 081003_Meeting minutes of
selection committee
2.2.2(c)
Comprehensive
documentation
on
processes used to ensure the input of a
broad range of stakeholders in the
Annex 2.2.2 (c)
• Technical assistance in
proposal development (WHO,
24
proposal development process
KNCV, PATH)
• Sharing drafts for comments
(090325, 090410, 090429,
090519, 090520)
• Work schedule with partners
2.2.2 (d)
Minutes of the meeting(s) at which the
members decided on the elements to be
included in the proposal for all diseases
applied for.
Annex 2.2.2 (d): CCM meeting
minutes on 27 May 2009
2.2.3(a)
Comprehensive
documentation
on
processes
to
oversee
grant
implementation by the CCM (or SubCCM).
Annex 2.2.3 (a): CCM TOR
2.2.3(b)
Comprehensive
documentation
on
processes used to ensure the input of a
broad range of stakeholders in grant
oversight process.
Annex 2.2.3 (b): NTP M&E
2.2.4
Comprehensive
documentation
on
processes used to select and nominate
the Principal Recipient (such as the
minutes of the CCM meeting at which the
PR(s) was/were nominated). If different
processes used for each disease, then
explain.
Annex 2.2.4: CCM meeting
minutes on 11 March 2009 and 27
May 2009
2.2.7
Documented
procedures
for
the
management of potential Conflicts of
Interest
between
the
Principal
Recipient(s) and the Chair or Vice Chair
of the Coordinating Mechanism
Annex 2.2.7: CCM’s Plan to
mitigate conflict of interests
Annex 2.2.8
2.2.8
Minutes of the meeting at which the
proposal was developed and CCM (or
Sub-CCM) endorsed.
Minutes of CCM and non-CCM
proposal review meetings
(090113, 090311, 090413,
090421, 090527)
Also see Annex 2.2.2 (a), 2.2.2 (b)
and 2.2.2 (c)
2.2.8
Endorsement of the proposal by all CCM
(or Sub-CCM) members.
Attachment C to the Proposal
Form
Other documents relevant to sections 1 and 2 attached by applicant:
(add extra rows to this section of the table as required to ensure that documents directly relevant are attached)
25
ROUND 9 – HIV
3. PROPOSAL SUMMARY
3.1. Duration of Proposal
Planned Start Date
To
Month and year: (up to 5 years)
January 2011
December 2015
3.2. Consolidation of grants
X
Yes
(go first to (b) below)
(a)
Does the CCM (or Sub-CCM) wish to consolidate any existing HIV Global
Fund grant(s) with the Round 9 HIV proposal?
No
(go to s.3.3. below)
‘Consolidation’ refers to the situation where multiple grants can be combined to form one grant. Under Global Fund
policy, this is possible if the same Principal Recipient (‘PR’) is already managing at least one grant for the same
disease. A proposal with more than one nominated PR may seek to consolidate part of the Round 9 proposal.
Î More detailed information on grant consolidation (including analysis of some of the benefits and areas to consider
is available at: http://www.theglobalfund.org/en/rounds/9/faq/#5
(b)
If yes, which grants are planned to be consolidated with the
Round 9 proposal after Board approval?
(List the relevant grant number(s))
3.3.
Government track of GF-9 will be
consolidated with GF-6 and GF-8
rounds
Alignment of planning and fiscal cycles
Describe how the start date:
(a)
Contributes to alignment with the national planning, budgeting and fiscal cycle; and/or
(b)
In grant consolidation cases, increases alignment of planning, implementation and reporting efforts.
The Government of Viet Nam’s planning and fiscal cycle, including the national HIV strategy, is planned
and budgeted against the calendar year (January to December). Round 6 and Round 8 grants are
planned to be consolidated upon recommendation by the Global Fund Secretariat. The CCM plans to
align the government track of GF-9 to be consolidated with GF-6 and GF-8. The entire Round 9 grant start
date with the Government of Viet Nam fiscal planning cycle, with a starting date of 1st January 2011.
3.4.
Program-based approach for HIV
3.4.1. Does planning and funding for the country's
response to HIV occur through a program-based
approach?
X
Yes. Answer s.3.4.2
No. Î Go to s.3.5.
Yes Î Complete s.5.5 as an
additional section to explain the
financial operations of the common
funding mechanism.
3.4.2. If yes, does this proposal plan for some or all of the
requested funding to be paid into a commonfunding mechanism to support that approach?
X
R9_CCM_VTN_H_PF_s3-5_1Jun09_En
No. Do not complete s.5.5
1/71
ROUND 9 – HIV
3.5.
Summary of Round 9 HIV Proposal
Provide a summary of the HIV proposal described in detail in section 4.
Prepare after completing s.4.
The goal of GF-9 is to reduce the spread of HIV and HIV related morbidity and mortality in
underserved high-prevalence districts and to strengthen community systems in order to enhance
Viet Nam’s response to HIV.
This goal complements the National Strategy on HIV/AIDS Prevention and Control in Viet Nam till 2010
with a Vision to 2020, which serves as the framework for all ministries and their departments, provincial
authorities, and international and local partners. Priorities for GF-9 are based on a robust nation-wide
province and district level gap analysis. The core priorities are i) harm reduction for IDUs (55% of
national target), ii) condom use promotion for female sex workers (SW) (65% of national target), iii) ART
for Adults (22% of national estimated needs), iv) ART for pediatric patients (94% of national target), and
v) PMTCT (40% of national estimated needs ). These priorities have been chosen based on the
epidemiology of HIV in Viet Nam with a focus on increasing access to services for the most affected and
most vulnerable of populations, particularly continuation of ART in Treatment and Education Centers
(TECs) and introduction of ART in prisons as well as condom promotion and STI services for MSM and
primary sexual partners of IDU and PLHIV. GF-9 is Viet Nam’s first dual-track proposal.
Government partners will continue effective interventions and adopt innovative approaches for harm
reduction, condom use promotion and access to treatment and care. Civil society will work through CBOs
to provide harm reduction, condom use promotion and home-based care to marginalized populations, and
at the same time strengthen the organizational and technical capacities of local NGOs and CBOs
The proposed program has been designed by the two Principal Recipients (PR): Viet Nam Administration
of HIV/AIDS Control (VAAC, of the Ministry of Health), and Viet Nam Union of Science and Technology
Associations (VUSTA). The funds will be distributed to five Sub-Recipients (SRs) including The Ministry of
Public Security (MOPS), The Ministry of Labor, Invalids and Social Affairs (MOLISA), Center for
Community Health and Development (COHED), Pact Viet Nam and the Institute for Social Development
Studies (ISDS). Both PRs and their partners will work in a coordinated and collaborative manner at
national and provincial levels, to maximize the positive investment of donor support and achieve the
objectives described here. The total funding request of this 5 year GF-9 proposal is USD 103.9 million,
out of which 46.3 million is for health products, equipment and medicines (including procurement and
supply chain management) to be procured by the government track and distributed by both tracks.
Approximately 40.9 million will go to government partners to cover services and program management in
42 provinces and 16.7 million will go to civil society partners to cover services and program management
in 10 (overlapping) provinces.
The objectives and SDAs of Viet Nam’s GF-9 dual-track proposal are:
1. Scale-up harm reduction activities to reduce HIV transmission through injecting drug use and highrisk sex through harm Reduction activities that includes NSP, MMT, condom use promotion and STI
diagnosis and treatment.
2. Scale-up HIV treatment, care and support services in local health facilities, communities and closed
settings through continuum-of-care, testing and counseling, ARV treatment/monitoring & prophylaxis
and treatment for opportunistic infections, TB/HIV and PMTCT.
3. Address systemic challenges to improve performance in achieving universal access to HIV
prevention, care, treatment and support through health systems strengthening, information systems,
and integration for sustainability.
4. Foster an enabling environment for the development and participation of civil society in the HIV
response through an enabling environment for participation of civil society.
5. Strengthen the organizational capacity of civil society organizations to maximize their contributions to
the HIV response through strengthening of civil society and institutional capacity building.
The GF-9 proposal process included extensive consultations with stakeholders and partners from
different sectors, including government, civil society and international organizations. Lessons learned
2/71
ROUND 9 – HIV
contributed considerably. By targeting marginalized and most-at-risk groups and ensuring that
interventions serve both rural and urban regions, the proposed program will make a substantial
contribution to gender and social equality. Additionally, health systems gaps will be addressed by
improving information systems and M&E functions. At the provincial level, facilitation of multiple projects
will be coordinated by the Provincial Committee on Drugs, AIDS and Prostitution Prevention and Control
under the People’s Committee.
3/71
ROUND 9 – HIV
4.
PROGRAM DESCRIPTION
4.1.
National prevention, treatment, care, and support strategies
(a)

Briefly summarize:
The current HIV national prevention, treatment, and care and support strategies;
How these strategies respond comprehensively to current epidemiological situation in the country;
and
The improved HIV outcomes expected from implementation of these strategies.
The National Strategy: The National Strategy on HIV/AIDS Prevention and Control in Viet Nam till 2010
with a Vision to 2020 was approved in March 2004 (Annex 4-1). This comprehensive strategy serves as
a framework for all 18 ministries and their Departments, the 63 provincial authorities, civil society, and
international partners. Beyond 2010, the Government of Viet Nam will continue to follow the current
national strategy with modifications that reflect changes in the HIV situation.
The National Strategy has two goals: (1) To reduce HIV prevalence among the general population to
below 0.3% by 2010 with no further increase after 2010 and (2) To reduce the adverse impacts of HIV on
socio-economic development. The main objectives under these goals are: (1) To control HIV
transmission among most-at-risk populations and the general population through implementing
comprehensive harm reduction intervention measures, (2) To ensure the provision of care and
appropriate treatment for PLHIV and (3) To improve the management, monitoring, surveillance and
evaluation systems for the HIV prevention and control program.
Programmes of Action: The national programmatic response to the epidemic is organized into eight
Programmes of Action (PoA) that reflect the goals and objectives of the National Strategy, of which the
main prevention, treatment, care and support activities are described below.
The Law on Prevention and Control of HIV/AIDS (The Law) came into effect in January 2007 (Annex
4-2). Formation of this law was mandated under the National Strategy of 2004 a legal framework under
which to implement the strategy. The Law provides for the implementation of HIV harm reduction
programs among IDU, female SW, MSM and other groups. Interventions include, but are not limited to,
needle/syringe programs, condom use promotion and drug substitution therapy (methadone). This Law
significantly strengthens the enabling policy and legal environment for HIV programs and is a
demonstration of the commitment of the Government of Viet Nam to the implementation of evidencebased HIV interventions.
Monitoring and Evaluation: The National HIV Monitoring and Evaluation Framework (Annex 4-3), was
developed in close collaboration with national and international partners, and finalized in January 2007.
The major objectives of this framework are to provide a clear set of indicators, to standardize M&E
procedures, and to incorporate existing forms into one comprehensive reporting form. The framework
defines the structure of the M&E system, delineates responsibilities, establishes standard indicators with
detailed indicator descriptions, specified frequency of data collection, and provides a clear work plan.
HIV Prevention: Viet Nam’s epidemic is concentrated among most-at-risk populations (MARPs). Based
on the 2008 HIV sentinel surveillance data, prevalence among female sex workers (SW) was 3.1% and
among injecting drug users (IDU) was 20.3%. In the highest prevalence provinces, these numbers were
as high as 30% among SW and 70% among IDU. 1 In addition, recent data on HIV prevalence among
men having sex with men (MSM) was reported as high as 9.4% in one major city. As a result, Viet Nam’s
prevention strategy focuses on harm reduction interventions targeting injecting drug use and high-risk
sex. PMTCT activities include counseling and testing for pregnant women and ARV prophylaxis at
national and provincial hospitals. The national HIV prevention strategy aims to achieve, by 2010, 100%
people with HIV risky behaviors covered by intervention measures, 100% condom use when having high
risk sexual relations, and 60% of pregnant women are provided with HIV counseling and testing
1
Ministry of Health, Ministry of Labor, Invalids and Social Affairs, 2007.
4/71
ROUND 9 – HIV
HIV Treatment, Care and Support: HIV treatment, care and support needs in Viet Nam are rapidly
increasing. A growing number of people now have advanced HIV-related illness. The percentage of
women being diagnosed with HIV is also rapidly increasing. To meet these needs, Viet Nam’s strategy
focuses on developing comprehensive clinical HIV treatment, care and support health service delivery
systems at provincial and district government care facilities with direct linkage to community- and homebased care. District health authorities provide and manage the majority of HIV treatment, care and
support for PLHIV, except in provinces with low HIV prevalence, where services are provided and
managed at provincial health facilities. The strategy emphasizes increasing PLHIV access to nonstigmatizing treatment and care services and encourages their active participation in HIV care and
support.
(b)
From the list below, attach* only those documents that are directly relevant to the focus of this
proposal (or, *identify the specific Annex number from a Round 7 or Round 8 proposal when the
document was last submitted, and the Global Fund will obtain this document from our files).
Also identify the specific page(s) (in these documents) that support the descriptions in s.4.1. above.
Document
Proposal Annex
Number
Page References
X
National HIV Control Strategy or Plan
4-1
p. 17
X
The Law on Prevention and Control of HIV/AIDS
4-2
p. 27
4-3
p. 11
Important sub-sector policies that are relevant to the
proposal
(e.g., national or sub-national human resources policy, or
norms and standards)
Most recent self-evaluation reports/technical advisory
reviews, including any Epidemiology report directly
relevant to the proposal
X
National Monitoring and Evaluation Plan (health sector,
disease specific or other)
National policies to achieve gender equality in regard to
the provision of HIV prevention, treatment, and care and
support services to all people in need of services
5/71
ROUND 9 – HIV
4.2.
Epidemiological Background
4.2.1. Geographic reach of this proposal
(a)
Do the activities target:
Whole country
X
Specific Region(s)
X
Specific population groups
See map below
Map: Provinces to be supported by GF-9 by Government and Civil Society partners
(See Annex 4-5 for provincial-level gap analysis)
6/71
ROUND 9 – HIV
(a) Size of population group(s)
Population Groups
Population Size
Total country population (all ages)
Viet Nam GSO
24,204,476
Women 19 – 24 years
3,767,065
Women 15 – 18 years
4,459,859
Men > 25 years
Year of Estimate
Population & Employment,
85,154,900
Women > 25 years
Source of Data
2007
2007
2007
Viet Nam
2007
21,890,322
Government
2007
3,725,122
Statistics
Men 19 – 24 years
Office
Men 15 – 18 years
4,729,649
Girls 0 – 14 years
10,868,200
Boys 0 – 14 years
11,510,208
Number of est. injecting drug users
237,333
Number of est. female sex workers
100,000
2007
2007
2007
2007
2008
Ministry of Labor, Invalids and
Social Affairs
2008
(MOLISA)
Number of est. Treatment and
Education Center* residents
94,000
Number of est. prisoners
90,000
March 2009
Ministry of Public Security
(MOPS)
2009
* The Treatment and Education centers (TEC) are institutions for drug users and female sex workers who are required to
go through treatment, education and occupational training for one to two years
4.2.2 HIV epidemiology of target population(s)
Population Groups
Estimated
Number
Source of Data
Year of Estimate
Whole Country
Number of PLHIV (all ages)
Women living with HIV (all ages)
Pregnant women living with HIV
Men living with HIV (all ages)
Children (0–14 years) with HIV
Number of people (> 14 years) in
need of ARV treatment
2009
242,557
63,548
4,252
179,009
2009
HIV Estimates and Projections in
Viet Nam Report, 2005-2010
(EPP, 2009)
2009
2009
4,719
2009
67,047
2009
7/71
ROUND 9 – HIV
4.2.2 HIV epidemiology of target population(s)
Population Groups
Estimated
Number
Number of HIV + pregnant women
needing ARV for PMTCT
Source of Data
3,615
EPP, 2009
AIDS-related death per year
Number of women (> 14 years) in
Number of men (> 14 years) in
Number of children (0-14 years) in
7,895
14,917
Year of Estimate
2009
2009
Calculation using EPP, 2009
and
52,086
Spectrum Version 3.2
2,907
(based on national HIV sentinel
surveillance data)
2009
2009
2009
Calculation using EPP, 2009
Number of women and men (>14
years) receiving ARV treatment
24,500
and
Q4 2008
Spectrum Version 3.2
Number of children (0-14 years)
receiving ARV treatment
1,479
(based on national HIV sentinel
surveillance data)
Q4 2008
Number of HIV+ incident TB cases
4,218
World Health Organization
2008
4.3.
Major constraints and gaps
(For the questions below, consider government, non-government and community level weaknesses and gaps, and also
any key affected populations 2 who may have disproportionately low access to HIV prevention, treatment, and care and
support services, including women, girls, and sexual minorities.)
4.3.1. HIV program
Describe:
•
The main weaknesses in the implementation of current HIV strategies;
•
How these weaknesses affect achievement of planned national HIV outcomes; and
•
Existing gaps in the delivery of services to target populations.
Despite major efforts that the Government of Viet Nam has made to address the spread of HIV, there
remain a number of weaknesses hindering the implementation of current HIV strategies.
1. Main weaknesses in implementation of current HIV Strategies and how they affect achievement
of planned national HIV outcomes.
1.1 Funding: Although funding for HIV is at its highest level in Vietnamese history, there are still not yet
sufficient funds to bring to scale effective interventions. The financial gap for implementation of
prevention and treatment, care and support components of the national response from 2011-2015 is
estimated at US$619 million. There is wide coverage of prevention, treatment, care and support services
at the provincial level; however many districts still lack essential HIV services. There is substantive need
2
Please refer to the definition in s.2 and found in the Round 9 Guidelines.
8/71
ROUND 9 – HIV
for these services throughout the country, but funding has not yet been committed.
1.2 Policy: Despite provisions in the 2007 HIV Law that enables greater access to prevention services for
MARPs, Viet Nam still faces considerable policy barriers in establishing and scaling-up effective
interventions such as needle syringe programs (NSP) and the 100% Condom Use Program (CUP) at the
local level. There are contradictory priorities between public security measures to control drug use and
sex work and public health measures to reach the populations engaged in these activities. The ‘social
evils’ campaign against drug use and sex work marginalizes and stigmatizes MARPs which prevents
them from accessing prevention, treatment, care and support services. For example, the reinforcement
of the current policy of compulsory confinement of drug users and female sex workers (SW) causes these
populations to avoid public services. It is not possible to implement NSP and condom use promotion in
closed settings, however MOPS and MOLISA are making additional efforts to ensure that there are HIV
treatment, care and support services in Prisons and Treatment and Education Centers (TECs),
respectively.
1.3 Human Resources: Human resource number and capacity limitations inhibit expansion of best
practices at both provincial and district levels. HIV programs have limited incentives to attract health
workers and stigmatization of PLHIV is a disincentive for health workers. At the district level, many HCW
assigned to HIV treatment, care and support, among other responsibilities, do not make HIV services
their highest priority. There is rapid turnover of HIV staff, which creates a cycle of limited technical
capacity. Additionally, there are large numbers of contract workers in large urban facilities who are not
paid within the government cost norms and cause concern for sustainability once donor funding is
withdrawn.
1.4 Program Management: Although national program management and coordination capacity has
improved access to prevention, counseling and testing, treatment, care and support, the limited capacity
of Provincial AIDS Centers (PACs) remains an obstacle and leads to poor coordination of multiple health
services and donor-funded projects. Coordination roles of People’s Committees’ are not yet resourced
sufficiently to coordinate a full multisectoral provincial HIV response.
It is a requirement that vertical
program management units be
established for all donor-projects, which further exacerbates
fragmentation and lack of coordination in between and among different projects and the national program.
This causes inconsistencies and inefficiencies. Efforts are being made to promote decentralization of
HIV program management, although the country’s tradition of centralized planning and budget allocation
hinders tailored responses at the local level because there is less flexibility to adapt to local needs.
2. Existing gaps in the delivery of services to target populations
2.1 HIV Prevention: Results from the 2005-2006 Integrated Biological and Behavioral Survey (IBBS)
found that 12-33% of IDUs reported sharing needles in the last 6 months. The IBBS also showed low
rates of reported condom use among female SWs and regular clients. Female SWs also reported having
unprotected sex with IDUs. In absence of harm reduction to reduce needle sharing and consistent
condom use, HIV will be fueled by these two groups and to their sexual partners.
According to MOLISA, there are 237,333 estimated IDUs nationwide. Currently there are an estimated
44,000 IDU receiving harm reduction interventions according to VAAC. The number of female SW is
estimated to grow from 100,000 in 2008 to 115,000 by 2015 according to VAAC. Currently there are an
estimated 8,280 female SW receiving prevention interventions nationwide, and by 2013, all female SW
nationwide will lack access to donor-supported prevention interventions and commodities. Female SW
and IDU avoid public services because they fear compulsory confinement. When female SW and IDU
are in TECs, they do not access to HIV prevention interventions such as condoms and NSP.
Prevention of sexual transmission among MSM and primary sexual partners of IDU and PLHIV is one of
the biggest gaps in the national response. According to the 2005-2006 IBBS, the HIV prevalence among
a small sample (790) of MSM in Ha Noi and Ho Chi Minh City was reported to be 9% and 5%
respectively. MSM also do not consistently use condoms during anal sex with their partners, and they
also have sex with male sex workers and with females.
A survey, carried out in Hanoi in 2008 by ISDS, among IDU primary sexual partners found that 69% live
in a sero-discordant or unknown HIV status relationship, and yet only 17% of them reported using
condom always. In the same line, a recent survey of 2600 PLHIV conducted in 22 provinces in Viet Nam
9/71
ROUND 9 – HIV
found that 21% of PLHIV have a primary sexual partner with either negative or unknown HIV status, and
25% of those PLHIV reported that never or not always use condoms.
Regarding PMTCT service, only 11% of pregnant women receive both an HIV test and their test results.
It is estimated that 33% of HIV positive pregnant women receive PMTCT to prevent vertical transmission;
links to neonatal follow-up care and ART for the mother are weak.
2.2 HIV Treatment, Care and Support: There are currently 27,100 adults and 1,479 children on ART in
Viet Nam, which meets less than half of the current need. The MOH estimates that 89,000 adults and
5,700 children will require ART in 2011, however, current financial commitments (PEPFAR, GF-6, GF-8,
CHAI) for the same year leave a gap of 43,509 adult and 3,000 pediatric patients. According to a
nationwide district-level gap analysis, more than 26% of PLHIV reside in districts that do not have ART
services. The National AIDS Program funds 4% of those on treatment and will not be able to prevent
treatment interruptions should donor funding fall short. Pediatric ARVs are currently funded by one donor
who has indicated their funding will end in 2010. Additionally, other donors have not been able to commit
funds past 2012.
Efforts are being made to introduce and expand HIV treatment, care and support in TECs where HIV
prevalence rates have been reported up to 50%. And there are currently no services available in prisons
that have reported HIV rates as high as 30% and have a substantive need for services. In addition to
providing PLHIV in closed settings with access to ART, there is a need to establish and strengthen
coordination and linkages between health facilities / community and closed settings to ensure
continuation of treatment, care and support services for those who are moving between closed settings
and the community. Already marginalized IDUs and female SWs face double stigma with HIV infection
and have difficulties in accessing employment, education and social support services. Stigma reduction
interventions in closed settings and communities are essential not only to support PLHIV but also to
ensure that returning residents have greater chances to reintegrate into society.
4.3.2.
Health System
Describe the main weaknesses of and/or gaps in the health system that affect HIV outcomes.
The description can include discussion of:
•
Issues that are common to HIV, tuberculosis and malaria programming and service delivery; and
•
Issues that are relevant to the health system and HIV outcomes (e.g.: PMTCT services), but
perhaps not also malaria and tuberculosis programming and service delivery.
Main weaknesses and gaps in health system
The national health system in Viet Nam has considerable strengths, due in part to its well-organized
infrastructure and capacity to respond in a timely manner (for example, the Vietnamese response to
SARS). However, Viet Nam’s recent rapid economic growth and social changes has resulted in the
identification of several weaknesses. [Refer to UNGASS report, annex 4-4]
1. Health financing: Health financing in Viet Nam relies heavily on private spending, which is largely in
the form of out-of-pocket payments paid to both public and private providers. Official development
assistance (ODA) accounts for just 3% of total health expenditure. Government health insurance
schemes, which are either social health insurance plans that cover formal sector workers or risk
pooling for indigent populations, cover 42% of the population. These insurance schemes only account
for 10% of total health expenditure, indicating that the benefits offered are limited. Out-of-pocket
payments hinder access to care for the poorer populations. Additionally, PLHIV, IDUs and female SW
are unlikely to be covered in the insurance schemes. The high recurring costs of managing HIVrelated illnesses create greater barriers to access for HIV care given that the majority of PLHIV are
poor and marginalized to begin with. The government is committed to expand health insurance
coverage in the next few years. However, even if the coverage is expanded substantially, health
insurance will not be able to generate adequate resources to cover most essential services, including
HIV/AIDS prevention and care.
10/71
ROUND 9 – HIV
2. Human Resources: Human resources continue to be a challenge in the health system of Viet Nam.
Low salaries in the public sector drive health care workers (HCWs) to private practice or to seek
contract employment with donor-funded projects. This leads to a high turnover of public HCWs who
often juggle multiple responsibilities in the healthcare setting. HCWs that remain in the public sector
may request informal payments, which hinders access for poorer populations and can interrupt the
continuity of care. Additionally, there is still discrimination by HCWs against populations at high-risk
and PLHIV, which undermines the quality of care. Human resources at the administrative level are
also a challenge as there is still a lack of management and planning skills that affects quality and
continuity of care at the clinical level.
3. Program Management: Viet Nam’s health system is vertical in nature, even without the existence of
donor-funded interventions. The health system is set up in silos to provide specific expertise, but this
also creates a vacuum between the different therapeutic areas, particularly HIV, TB and MCH.
Collaboration between the HIV and other related health services (such as TB and MCH) is still in its
infancy. Weak coordination can lead to duplication of efforts, delays in reporting, and lack of
production of strategic information needed to inform programs and improve public health services for
community members. Although efforts are being made to decentralize HIV program management,
delegation of authority from the central to a lower level is not always practiced, resulting in vertical
programs that are managed from the top.
4. Information systems: Vertical reporting structures across health programs create inefficiencies,
inconsistencies and administrative burdens. Particularly, programs with multiple-donor funded projects
face more complications because of the introduction of many donor-required indicators/forms that may
not easily be harmonized with the existing health information system.
5. Health Services in closed settings: There are very weak health services in closed settings (both
TECs and prisons) while at the same time there is a very high need for both HIV and TB prevention,
treatment, care and support.
4.3.3. Efforts to resolve health system weaknesses and gaps
Describe what is being done, and by whom, to respond to health system weaknesses and gaps that
affect HIV outcomes.
Many of the constraints and weaknesses of the national health system, especially those related to the
management of the National AIDS program, have been acknowledged, and the government is making
efforts to improve them.
1. Financial and Healthcare costs: The government of Viet Nam is committed to providing more
financial support in health, particularly for the National AIDS Program. Since 2004, the government
has procured domestic ARVs to lower the cost of HIV treatment. Under the 2007 Law, HIV treatment,
care and support including ART are to be covered by the pending health insurance scheme.
2. Human Resources: VAAC has made considerable ground in staffing new PAC in each province to
act as local coordinating bodies. The 2007 Law on HIV requires equitable access to healthcare for
PLHIV. Training on HIV is being integrated into Medical University and Nursing School curricula.
These efforts are not yet enough so in the immediate time horizon, donor funded projects are still
necessary.
3. Program Management: To diffuse the obstacles caused by the vertical nature of the health system,
VAAC has been promoting decentralized planning and management through different projects.
Additionally, HIV and TB programs are beginning to work together as the government has developed a
national TB-HIV operational protocol. HIV and MCH programs are also beginning to integrate HIV into
MCH for relevant populations.
4. Information Systems: To mitigate the administrative burden and transaction costs caused by
multiple and occasionally competing reporting structures, VAAC issues a single national HIV M&E
framework that is progressively being adopted by donors.
11/71
ROUND 9 – HIV
5. Health Services in Closed Settings: To address the lack of access to services in closed settings,
GF-6 and GF-8 HIV projects are establishing health services for PLHIV in TEC and GF-6-TB is
establishing health services for TB patients in closed settings.
12/71
ROUND 9 – HIV
4.4.
Round 9 Priorities
Complete the tables below on a program coverage basis (and not financial data) for three to six areas identified by the applicant as priority interventions for this proposal.
Ensure that the choice of priorities is consistent with the current HIV epidemiology and identified weaknesses and gaps from s.4.2.2 and s.4.3.
Note: All health systems strengthening needs that are most effectively responded to on an HIV disease program basis, and which are important areas of work in this
proposal, should also be included here.
[For a table explaining the basis for coverage targets, please see Annex 4-5.]
Priority No:
1
Harm
Reduction
Intervention for IDUs
A: Country target (from
Historical
2007
2008
Current
2009
2010
annual plans where these
exist)
107,110
132,235
105,563
118,759
B: Extent of need
already planned to be
met
under
other
programs
38,619
40,763
44,839
50,796
C: Expected annual gap
in achieving plans
68491
91472
60,724
67,963
D: Round 9 proposal
contribution
to
total
need
(e.g., can be equal to or less than full gap)
*This target was adjusted from previous years.
Country targets
2011
2012
2013
2014
2015
131,954
145,149
158,345
171,540
184,736
60,477
25,503
47,363
54,403
3,573
71,477
119,647
110,982
117,138
181,163
44,913
71,107
83,148
91,923
100,698
13/71
ROUND 9 – HIV
Priority No:
2
Harm
Reduction
for female
Intervention SWs
A: Country target (from
annual plans where these
exist)
B: Extent of need
met
under
other
programs
C: Expected annual gap
in achieving plans
D: Round 9 proposal
contribution
to
total
need
Priority No:
3
ART for
Intervention Adults
A:
Country target
(from annual plans where
these exist)
B: Extent of need
met under other
programs
C: Expected annual
gap in achieving plans
D: Round 9 proposal
contribution to total
need
Historical
Current
Country targets
2007
2008
2009
2010
2011
2012
2013
2014
2015
81,008
100,010
110242
124022
124022
124022
124022
124022
124,022
7,352
84,000
84,000
84,000
85,325
67,752
3,758
5,293
0
73,656
16,010
26,242
40,022
38,697
56,270
120,264
118,729
124,022
21,928
29,282
56,143
68,106
80,069
2015
Historical
Current
Country targets
2007
2008
2009
2010
2011
2012
2013
2014
19,006
28,434
40,201
54,513
64,328
74,459
84,894
95,674
106,894
16,212
27,100
38,280
41,702
45,491
52,713
42,820
44,648
36,405
2,794
1,334
1,921
12,811
18,837
21,746
42,074
51,026
70,488
2,680
4,025
18,261
20,810
23,641
14/71
ROUND 9 – HIV
Priority No:
4
ART for
Intervention pediatrics
A:
Country target
these exist)
B: Extent of need
met
under
other
programs
C: Expected annual
D: Round 9 proposal
need
Priority No:
5
Intervention PMTCT
A:
Country target
these exist)
B: Extent of need
met
under
other
programs
C: Expected annual
D: Round 9 proposal
need
Historical
2007
Current
2008
2009
Country targets
2010
2011
2012
2013
2014
2015
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
973
1,479
2,000
2,500
0
0
0
0
0
27
21
0
0
3,000
3,500
4,000
4,500
5,000
2,820
3,290
3,760
4,230
4,700
(i.e., can be equal to or less than full gap)
Historical
2007
2008
Current
2009
Country targets
2010
2011
2012
2013
2014
2015
2,423
2,809
3,246
3,748
3,889
4,076
4,137
4,216
4,297
744
1,020
1,398
1,836
2,246
2,611
1,156
1,206
900
1,679
1,789
1,848
1,912
1,643
1,465
2,981
3,010
3,397
194
204
1,727
1,731
1,735
(i.e., can be equal to or less than full gap)
15/71
ROUND 9 – HIV
4.5.
Implementation strategy
4.5.1. Round 9 interventions
Explain: (i) who will be undertaking each area of activity (which Principal Recipient, which Sub-Recipient
or other implementer); and (ii) the targeted population(s). Ensure that the explanation follows the order of
each objective, service delivery area (SDA), activities and indicator in the 'Performance Framework'
(Attachment A). The Global Fund recommends that the work plan and budget follow this same order.
Where there are planned activities that benefit the health system that can easily be included in the HIV
program description (because they predominantly contribute to HIV outcomes), include them in this
section only of the Round 9 proposal.
Note: If there are other activities that benefit, together, HIV, tuberculosis and malaria outcomes (and health outcomes
beyond the three diseases), and these are not easily included in a 'disease program' strategy; they can be included in
s.4B in one disease proposal in Round 9. The applicant will need to decide which disease to include s.4B (but only
once). Î Refer to the Round 9 Guidelines (s.4.5.1.) for information on this choice.
Goal: To reduce the spread of HIV and HIV related morbidity and mortality in underserved highprevalence districts and to strengthen community systems in order to enhance Viet Nam’s
response to HIV.
GF-9 is Viet Nam’s first dual-track proposal including both government and civil society partners. As
stated in a recent comprehensive report on the civil society sector in Viet Nam, civil society organizations
(CSOs) provide the community reach and understanding essential to effectively engage and empower
vulnerable groups and people living with HIV/AIDS (PLHIV) as key actors in the HIV/AIDS response. GF9 funds will enable Viet Nam to address substantial gaps in universal access to HIV prevention,
treatment, care and support services, through strengthening working partnerships between government
and civil society. HIV service needs described here have been identified through a nation-wide provincial
and district-level analysis, which took into account all current and future donor and national commitments.
[Refer to the Work Plan for GF-9, annex 4-6]
The proposed GF-9 program aims to achieve NSP coverage for 100,598 IDUs (55% of the national target
for IDU) and 100% condom use program (CUP) coverage for 80,069 female sex workers (65% of the
national target for female SW) by focusing on 39 provinces where there is the most high-risk behavior.
Methadone Maintenance Therapy (MMT), through District Health Centers (DHCs), will be implemented
by GF-9 in 18 priority provinces that have demonstrated support of local authorities. Civil society
implementers will provide outreach to 70% of IDU and 90% of female sex workers in two of the 10 focus
provinces, and outreach to 40% of the estimated number of MSM and to 12,295 primary sexual partners
of IDU and PLHIV in 10 provinces. After the first two years of GF-9, CSO activities among IDU and
nd
female sex workers will be reviewed for consideration of expansion to other provinces in the 2 phase of
GF-9.
GF-9 will cover 22% of estimated country needs of adult ART through operation in 39 provinces. This
includes continuation of GF-6 ART services as well as services at 23 Treatment and Education centers
(TECs) and introduction of ART in 18 prisons. This will provide 23,641 adult PLHIV with ART by year 5,
which is far greater than the total of 20,916 to be achieved by both GF-6 and GF-8 together. However,
projected national ART coverage, with contribution from the national budget, PEPFAR, GF-6, GF-8 and
GF-9, is only 53% by 2014 due to the continued increase in projected ART needs and uncertainty of
PEPFAR funding after 2012. For pediatric ART and PMTCT, 94% and 40% of the estimated country
needs will be covered, respectively. Civil society will provide community- and home-based care and
support as a complement to government services in 8 focus provinces. [For a table on the SDAs by
Government Track and Civil Society Track, please refer to annex 4-10]
As the government PR, the Viet Nam Administration of HIV/AIDS Control (VAAC) will lead and implement
GF-9 in close partnership with line ministries and departments, provincial coordinating entities, and two
main SRs: the Ministry of Public Security (MOPS) and its prisons, and the Ministry of Labor, Invalids and
Social Affairs (MOLISA) and its TECs. As the civil society PR, the Viet Nam Union of Science and
16/71
ROUND 9 – HIV
Technical Association (VUSTA), will constitute and co-lead a civil society consortium with three main
SRs: the Institute for Social Development Studies (ISDS), Pact and Center for Health Education and
Development (COHED). As a continuation of the established partnership while developing the GF-9
proposal, both PRs will join their efforts and closely collaborate in order to complement each other and
bridge the gaps to reach the population.
Main Impact Indicators:
- Estimated HIV prevalence among IDUs
- Estimated HIV prevalence among FSWs
- Estimated HIV prevalence among MSMs
- % of adults and children with HIV known to be on treatment 12 months after initiation of antiretroviral
therapy
Main Outcome Indicators:
- % of injecting drug users who used syringes and needles which had been used by someone else in
the last month
- % of female sex workers reporting always used condoms with all of their clients in the last month
- % of men reporting the use of condom the last time they had anal sex with a male partner
- Number of existing and newly established CBOs delivering HIV prevention and/or care and support
services
Objective 1: Scale-up harm reduction activities to reduce HIV transmission through injecting drug
use and high-risk sex.
Background: Viet Nam’s current National Strategy on HIV/AIDS Prevention and Control with a Vision to
2020 and the HIV/AIDS Law (2006) and Decree (2007) are specifically supportive of scaling up
comprehensive harm reduction including NSP, 100% CUP and MMT to reduce HIV transmission
associated with high-risk behaviors. Civil society and government will work jointly in 10 provinces, and
government partners will work in 29 additional provinces, to reduce risks associated with injecting drug
use and sex. Viet Nam has established public health services to reach IDU and female SW, mainly
through the DfID and World Bank harm reduction project, implemented in 33 provinces. Both projects
are in the process on pooling their funds into a single joined project that be phased out from late 2011.
PACs support DHCs to implement large-scale evidence-based IDU and female SW interventions.
SDA 1.1: Harm Reduction – NSP and MMT
Program Approach: GF-9 will expand coverage of NSP in 39 provinces, based on evidence from the
World Bank and DfID funded harm reduction projects in Viet Nam. With an eye towards long-term
sustainability, the GF-9 model of NSP will utilize a variety of methods such as needle box model,
pharmacy-coupon scheme, and small business model incorporated with social marketing In 10 provinces,
government partners will focus on enabling outreach to IDUs directly with their Peer Educators (PE)
network while civil society will complement these interventions by accessing sexual partners of IDU to
provide sterile injecting equipment. [Please see Annex 4-9 on NSP models.] In two provinces, civil society
will conduct outreach and NSP directly to IDUs and their sexual partners. Civil society will refer their
clients to public VCT, treatment and care services. Building on successful pilots of MMT in 2 cities, and
anticipating establishment of MMT projects in 10 additional provinces by World Bank and DfID, GF-9
proposes expansion to 18 unserved provinces alongside coordination and support for implementation of
MMT amongst MOPS, DOLISA, provincial health and other authorities and technical staff from district
health services.
Indicators:
- Number of needles and syringes distributed per IDU per six months in GF-9 provinces
- % of IDU regularly reached by needle syringe program in 37 government focus provinces
- % of IDU regularly reached by needle syringe program in 2 civil society focus provinces
- % of SWs reached through outreach activities in 2 civil society focus provinces
- Number of primary sexual partners of IDU and PLHIV reached by the civil society focus 10 provinces
- Number of IDUs currently receiving methadone maintenance therapy (from GF-9 district facilities)
- Number of peer educators trained on comprehensive package for IDU in 10 civil society focus
provinces
17/71
ROUND 9 – HIV
Government Activities:
1.1.1 Establish a pre- and in-service training program on harm reduction (NSP and MMT) for public
security officials in the community (MOPS, VAAC)
1.1.2 Conduct peer-outreach including NSP distribution and collection; expand NSP through creation of
fixed sites and engagement of pharmacies (including marketing of NSP sites and pharmacist
incentives); collect and destroy NSP using safety boxes; conduct district consensus workshops
on harm reduction (NSP and MMT) through pharmacies with focus on NSP; conduct biannual
meetings on harm reduction (NSP and MMT); implement MMT at selected district sites (VAAC:
PAC)
1.1.3 Capacity building for provincial and district sites and teams in MMT and strengthen links between
provincial DOLISA, Public Security, other authorities and district health services; Coordinate
advocacy workshops to raise awareness about MMT (VAAC: PAC, MOPS, MOLISA)
1.1.4 Procurement of methadone (VAAC)
1.1.5 Train technical staff from MOH, MOLISA and DOLISA through study tours of existing MMT sites
(VAAC, MOPS, MOLISA)
Civil Society Activities:
1.1.6 Expand NSP to include sexual partners of IDUs (VUSTA: ISDS, COHED)
SDA 1.2: Harm Reduction – Condom Use Promotion
Program Approach: To address HIV transmission through high-risk sex, GF-9 funds will expand coverage
of the 100% CUP to female SW in 39 provinces and to MSM as well as primary sexual partners of IDU
and PLHIV in the 10 provinces. Government partners will focus on enabling outreach to female SW
directly while civil society will access primary sexual partners of IDU and PLHIV, as well as MSM to
provide condoms and lubricant. In two provinces, civil society will conduct outreach to female SW
directly. In addition to pharmacy-based condom retail, there will be improved access to quality condoms
through STI services and retail outlets such as street stands in hotspots and direct sales to guesthouses,
cafés, and karaoke bars. Condom use promotion to female SW will be done with support of peer-based
HIV prevention outreach and condom promotion and distribution to street-based and entertainment
establishment (EE) female SW. For EE-based female sex workers, VAAC, PAC and DHC will mobilize
EE owners and managers to ensure sufficient coverage of 100% CUP implementation. For street-based
female SW, peers will conduct outreach on 100% CUP. GF-9 funds will expand the links between
condom use promotion peer outreach and VCT and STI services. Civil society will conduct condom use
promotion to MSM and primary sexual partners of IDU and PLHIV through PE who will be trained in HIV
prevention and care, drug addiction, harm reduction, overdose prevention, safe sex, discordant-couple
counseling, and group facilitation to reach out to primary sexual partners and link them to available
services.
Indicators:
- Number of condoms distributed freely by GF-9
- % of SWs reached by condom use program in 37 government focus provinces.
- % of MSM reached trough outreach activities in the civil society focus 10 provinces
- Number of primary sexual partners reached in 10 civil society focus provinces
- Number of peer educators trained on comprehensive service package for MSM in 10 civil society
focus provinces
- Number of peer educators trained on comprehensive package for SW in 10 civil society focus
provinces
- Number of peer educators trained on comprehensive package for primary sexual partners in 10 civil
society focus provinces
- Number of peer outreach prevention technical capacity assessments conducted with VNGO
implementers
1.2.1 Establish a pre- and in-service training program on harm reduction (100% CUP) for public
security officials in the community (MOPS, VAAC)
1.2.2 Expand 100% CUP by engaging EE owners (VAAC: PAC, MOPS)
1.2.3 Expand active PE networks to reach street based female sex workers and promote the principle
of safer sex in venues and at hotspots (VAAC: PAC)
18/71
ROUND 9 – HIV
1.2.4
Support comprehensive, community-based prevention interventions for MSM and primary sexual
partners of IDU and PLHIV; mobilization of community participation to promote and support
condom and lubricant use during high-risk sex; provision of IEC, BCC (peer education, outreach
etc); establishment/strengthening of linkages to MSM-friendly VCT/STI services; and training on
advocacy, program development and management, and peer education for MSM CBOs (VUSTA:
COHED, ISDS)
SDA 1.3: STI Diagnosis and Treatment
Program Approach: GF-9 will further link STI services to HIV prevention interventions through effective
syndromic management and monitoring of STIs through high-risk sex and monitoring the effectiveness of
100% CUP program. STI services in the public sector are provided through the National Institute of
Dermatology and Venereology (NIDV) and its nationwide network that reaches the provincial and district
level. PITC will be established in STI centers and STI centers will promote condom use. VAAC and
NIDV will expand utilization of STI services by making them MSM-friendly. In 10 provinces, civil society
will refer their clients to STI services as appropriate.
Indicator:
Number of people receiving STI treatment (from GF-9 district facilities and closed settings)
-
1.3.1 Strengthen syndromic management, build capacity of STI services to be sensitive and friendly to
MSM; establish PITC in STI service centers for clients and referral to HIV treatment; link STI
services with condom use promotion programs by monitoring condom use, strengthening contact
tracing, and mapping risky venues; and improve STI sentinel surveillance to monitor impact of
condom promotion (VAAC: NIDV)
Objective 2: Scale-up HIV treatment, care and support services in local health facilities,
communities and closed settings
Background: According to a nationwide district-level gap analysis, more than 26% of PLHIV reside in
districts that do not have ART services. There are also a substantial number of individuals in need of HIV
treatment, care and support in TECs and prisons. Access to these services is almost nonexistent in
prisons and is still severely limited in TECs in the focus provinces. Pediatric ART donor funding will end in
2010 with an estimated 2500 children who will still be in need of continued ART. Donor and governmentsupported PMTCT services cover just one third of the estimated number of pregnant women living with
HIV. Treatment and care burden will likely worsen in Viet Nam as major donors providing treatment and
care are expected to plateau or decrease their support by 2012. GF-9 plans to fill these gaps in 39
provinces.
SDA 2.1: Continuum-of-care
Program Approach: PACs are responsible for supporting Comprehensive Care Sites (CCSs) and working
with partners to establish linkages between prisons, TECs and CCSs. CCSs, which are normally located
in District Health Centers (DHCs), play a central role in coordinating the HIV continuum-of-care according
to the National ART Treatment Protocol for People Living with HIV/AIDS and Home/Community-based
Care Guidelines. These CCS will be newly established by VAAC and Provincial Departments of Health
(DOH) in 54 districts (of 31 provinces) without ART services. GF-9 will support continuation of
opportunistic infection (OI) and ART in 69 districts (of 20 provinces) that do have ART services under GF6. In total, there will be CCSs in 122 districts (of 39 provinces) under GF-9.
MOPS will introduce HIV treatment, care and support, including VCT (SDA 2.2), ART and OI
management (SDA 2.3), TB/HIV (SDA 2.4) and PMTCT (SDA 2.5) in 9 prisons (building on TB prison
program of GF-6-TB) and add another 10 prisons, making for a total of 19 prisons that will work in
coordination with GF-9-TB plans. MOLISA will continue these same services from GF-6 in 23 TECs (in
19 provinces) and expand these services in the two most populous cities and heavily affected by HIV and
injecting drug use in Viet Nam: Hanoi (3 new TECs) and Ho Chi Minh City (5 new TECs). Special efforts
will be made to ensure continuity of treatment, care and support between these closed settings and the
CSSs (SDA 2.3). VAAC and PACs will provide technical support to both MOPS and MOLISA.
In ten provinces, community-based organizations (CBOs), including groups of PLHIV, will form teams with
19/71
ROUND 9 – HIV
CCS staff to ensure a continuum of comprehensive services. As a complement to CCS strengthening
activities described in 2.3, civil society will establish home-based care teams and provide communitybased care through comprehensive service packages to PLHIV, family members, caregivers and orphans
and children (OVC) in the 10 selected provinces. In these 10 provinces, civil society will work closely with
MOPS and MOLISA to help the ministries provide HIV prevention, care and support in TECs and prisons,
respectively. Inter-ministry circulars (currently under development) will guide PACs to work with DOLISA
and appropriate authorities to assure continuity of HIV treatment, care and support for clients moving
between TECs, prisons and health facility / community services.
Indicators:
Number of home and community-based care teams established in 10 civil society provinces
Number of PLHIV and their family members provided with livelihoods opportunities in 10 civil society
provinces
-
2.1.1 Strengthen coordination between ministries to develop joint plans, review implementation, and
address coordination and linkage issues; Revise and develop national guidance, tools and
training programs on HIV treatment, care and support at local health facilities, prisons and TEC
based on Integrated Management of Adolescent and Adult Illnesses (IMAI) (VAAC, MOPSPrisons, MOLISA-TEC)
2.1.2 Develop procedures to ensure continuity of ART in the pre-trial detention centers, prisons and
TECs among those who began ART in the community before arrest (VAAC, MOPS, MOLISA)
2.1.3 Establish a pre- and in-service training program on HIV care and support for public security
officials in prisons (MOPS-Prisons, VAAC)
2.1.4 Build capacity of provincial / district staff in program management, coordination, and supervision
of comprehensive treatment and care programs in local health facilities, communities and closed
settings (VAAC: PAC)
2.1.5 Establish and strengthen coordination and referral mechanism across different levels, across
different health services and across different sectors (closed settings, community based
organizations and PLHIV) (VAAC: PAC, MOPS-Prisons, MOLISA-TEC)
2.1.6 Support comprehensive, community-based care and support interventions as part of the
continuum of care for people living with and affected by HIV in 31 government focus provinces
(VAAC: PAC)
2.1.7 Assess and continuously strengthen the technical capacity of CSOs to implement comprehensive
care and support interventions. (VUSTA: Pact, ISDS, COHED)
2.1.8 Support comprehensive, community-based care and support interventions as part of the
continuum of care for people living with and affected by HIV in 8 civil society focus provinces
(VUSTA: ISDS, COHED)
2.1.9 Support provision of care and support to people living with HIV in 8 TECs located in the 10 civil
society focus provinces and upon release to the community (VUSTA: ISDS)
SDA 2.2: Testing and counseling
Program Approach: VAAC and PACs will support confidential VCT as an integral part of CCS services,
and will link with national efforts to scale-up Provider Initiated Testing and Counseling (PITC) to ANC, TB
and STI services at CCS nationwide. Since the National TB Program (NTP) is already present in all
districts nation-wide, NTP will provide HIV provider initiated testing and counseling (PITC) for TB cases in
districts that do not yet have HIV services. VCT uptake will be accelerated through linkages with harm
reduction outreach services and peer support groups. Clients with high-risk behavior and their partners
will be linked to community-support organizations and prevention services and encouraged to retest every
six months. In ten provinces, civil society groups will refer their clients to public STI services. VCT will be
introduced in closed settings as stated in SDA 2.1.
Indicator:
Number of people received HIV testing and counseling and their test results (from GF-9 district
facilities and closed settings)
2.2.1 Establish and strengthen VCT services at CCS and ensure effective referral to and from care,
20/71
ROUND 9 – HIV
2.2.2
2.2.3
treatment, support and harm reduction outreach (VAAC)
Introduce and strengthen provider-initiated testing and counseling at health care settings (TB,
ANC and STI service centers) linked with CCS (VAAC: DHC)
Establish and strengthen VCT services in prisons (MOPS) and in TECs (MOLISA)
SDA 2.3: ARV treatment, monitoring, and prophylaxis and treatment for opportunistic infections
Program Approach: Most ART and OI services for adult will be provided by CCS at district level while
complex cases and second line treatment will be managed at the provincial level (SDA 2.1). These
services will be made available in 19 prisons and 23 TECS with linkages between closed settings and
CCS (SDA 2.1). Pediatric ART sites will initially be established in 22 provinces with greatest need that
have had prior training; and will later be expanded to all 39 provinces. VAAC, MOPS and MOLISA will
jointly procure first- and second-line ARVs. OI and STI drugs, and other commodities and equipment, will
be procured and distributed by PACs, MOPS and MOLISA to their respective entities and civil society
partners. GF-9 will strengthen the quality assurance and monitoring mechanism of HIV treatment
programs by implementing the HIV Drug Resistance Country Plan.
Indicators:
- Number of individuals (adults) with advanced HIV infection who are currently receiving ART (from GF9 district facilities and closed settings)
- Number of individuals (children) with advanced HIV infection who are currently receiving ART (in GF9 provinces)
2.3.1 Build and strengthen capacity to diagnose, manage and prevent opportunistic infections and
provide first and second line ART to clinically eligible PLHIV at CCSs (VAAC-Comprehensive
Care Sites), Prisons (MOPS-Prisons) and TECs (MOLISA-TECs)
2.3.2 Introduce and expand monitoring of cohort-based ART outcomes and HIV Drug Resistance Early
Warning Indicators (VAAC: PAC, Comprehensive Care Sites)
SDA 2.4: TB/HIV
Program Approach: Based on established national TB-HIV collaborative protocols, VAAC together with
the National TB Program will support the introduction and expansion of collaborative activities between
TB and HIV services in health facilities / community services. MOPS and MOLISA will establish these
activities in Prisons and TECs, respectively, with technical support from VAAC and PACs (SDA 2.1). Staff
at all ART treatment sites will be trained to implement the three I’s: Intensified TB case-finding
(particularly symptom-based screening) INH preventive therapy and TB Infection control. VAAC, MOPS
and MOLISA will coordinate with GF-6-TB and GF-9-TB in site selection and joint planning, monitoring
and supervision.
Indicator:
- % of individuals who are currently receiving OI prophylaxis with cotrimoxazole (from GF-9 district
2.4.1 Establish and strengthen TB-HIV coordination mechanisms in DHC (VAAC-PAC, NTP), Prisons
(MOPS-Prisons) and TECs (MOLISA-TECs)
2.4.2 Intensify TB case finding among PLHIV, strengthen TB infection control among PLHIV and
implement INH preventive therapy in CCS in DHC (VAAC-DHC), Prisons (MOPS-Prisons) and
TECs (MOLISA-TEC)
SDA 2.5: PMTCT
Program Approach: PITC will be introduced at ANC sites in districts (of 39 provinces) where ART is
available and referral will be strengthened by civil society in ten of these provinces. Communes with
relatively high HIV prevalence will be chosen for introduction of PITC in commune health stations (CHS);
blood samples will be referred to district level. To address availability of ARV prophylaxis, VAAC
proposes to prepare district level ART sites to dispense ARV for PMTCT as needed. To ensure a
continuum of care across pregnancy, delivery and postnatal care including pediatrics, VAAC proposes to
strengthen linkages between these as well as sexual and reproductive health services. This proposal will
include prisons and TECs for PMTCT following assessment of needs through initial experiences (SDA
21/71
ROUND 9 – HIV
2.1).
Indicators:
- Number of adults with advanced HIV infection who are currently receiving ART and were started on
TB treatment within reporting year (from GF-9 district facilities and closed settings)
- Number of HIV-infected women who received ARV to reduce the risk of mother-to-child transmission
(from GF-9 district facilities and closed settings)
2.5.1 Build capacity and provide PMTCT services including HIV testing, ARV prophylaxis/treatment,
infant feeding, Early Infant Diagnosis, referral to treatment and care for mothers and children as
well as sexual-reproductive health services (VAAC: CCS, ANC, CHS)
Objective 3: Address systemic challenges to improve performance in achieving universal access
to HIV prevention, care, treatment and support
Background: Although national program management and coordination capacity has improved access to
prevention, counseling, testing, treatment and care. At the provincial level, the capacities of the underresourced Provincial Committee on Drugs, AIDS and Prostitution Prevention and Control under the
People’s Committee and the PAC remain an obstacle and leads to poor coordination of multiple health
services, sectors, civil society and donor-funded projects, which require separate program management
units. This exacerbates fragmentation and lack of coordination between and among different projects and
the national program.
Current HIV service delivery, especially treatment and care, heavily relies on contract health workers who
are paid at a higher rate than the government cost norm with certain donor funding to address a large
number of cases in relatively limited number of health facilities. The government is exploring ways to
mobilize existing government health workers by increasing health facilities providing HIV services in order
to improve geographical access and to ease the transition of these projects to a government-owned
program. This is the first step in creating a long-term and sustainable national response to HIV.
SDA 3.1: HSS – Information Systems
Program Approach: GF-9 will address gaps and capitalize from gains made since 2007 by building
capacity in M&E at all levels and standardizing M&E operations. A gap analysis of the national M&E
system was conducted in April 2009 using the Global Fund’s M&E System Strengthening Toolkit in
preparation for the grant negotiations for GF-8. In addition, an assessment of HIV M&E capacity was
conducted by the HIV M&E Technical Working Group using the UNAIDS M&E Reference Group
Organizing Framework for a functional national M&E system, which found that, while great efforts were
made by national and international partners to enhance the national system, there is still a considerable
gap in three specific areas: 1. Human capacity for HIV M&E; 2. Routine HIV program monitoring; 3.
Surveys and surveillance; and 4. Supportive supervision and data auditing.
3.1.1 Human capacity building for better utilization of the national M&E system (VAAC)
3.1.2 Monitor data quality and address obstacles to producing high quality data (VAAC)
3.1.3 Strengthen the routine HIV program monitoring system (VAAC)
3.1.4 Strengthen the national HIV sentinel surveillance system (VAAC)
SDA 3.2: HSS – Integration for sustainability
Program Approach: VAAC will expand capacity building activities of PACs to GF-9 provinces. This will
include expanding the implementation of standard and unified guidance on provincial program planning,
capacity building, and M&E for HIV programming, based on the findings from the GF-8 funded functional
analysis and national guidance, procedures and tools for provincial level planning. VAAC proposes to
establish an annual development and review process for provincial plans on harm reduction and HIV
treatment, care and support in collaboration with relevant ministries, departments within the MOH and
civil society to accelerate integration of different donor funded projects into a single program at the
provincial level. This will include planning to mobilize the existing government healthcare cadre to
increase program sites, expand HIV program coverage and future absorption of donor-funded contract
health workers for when donor funding phases out. These will facilitate the transition of HIV project
22/71
ROUND 9 – HIV
management, now under numerous units, into one single HIV management system.
Indicator:
- Number of provinces with annual provincial plans on harm reduction and HIV treatment, care and
support
3.2.1
Capacity building of PAC to manage, support and coordinate HIV services (VAAC: PAC)
3.2.2 Establish an annual development and review process for provincial plans on harm reduction and
for HIV treatment, care and support involving relevant sectors and civil society (VAAC, People’s
Committee, Regional institutes, PAC, CSO partners, MOPS-Prisons, MOLISA-DOLISA-TECs)
3.2.3 Unify, manage and coordinate provincial programs on harm reduction and HIV treatment, care
and support regardless of funding source, strengthen technical and management capacity of PAC
focal points, pilot unified HIV programming in provinces where multiple donor-funded projects
exist, followed by phased expansion to other provinces (VAAC: PAC)
3.2.4 Develop and implement standard guidance on mobilization of existing government human
resources for HIV programs as well as absorption of donor-funded contract workers when donor
projects phase out in consultation with Ministry of Finance (VAAC)
Objective 4: Foster an enabling environment for the development and participation of civil society
in the HIV response.
Background: Viet Nam recently developed and ratified a comprehensive National HIV Law (2006) that
outlines the legal rights of PLHIV. However, the implementation and enforcement of this and related
policies at the provincial level are less than satisfactory; many PLHIV and those affected by HIV still suffer
unlawful injustices and harsh consequences as a result of stigma and discrimination.
SDA 4.1: Enabling environment for participation of civil society
Program Approach: GF-9 will improve advocacy and protection for the rights of PLHIV and those affected
(including OVC) by raising awareness among local leaders, CBOs, communities and individuals on the
rights of PLHIV according to the Law and related policies. In addition, the civil society consortium of GF-9
will distribute an easy-to-read booklet that outlines individual rights according to the Law and related
policies. CBOs will be trained to develop advocacy programs targeting provincial and (where appropriate)
national leadership, communities and individuals to reduce stigma and discrimination associated with
HIV. In addition the implementation of the existing mechanisms and formulation of a more accessible
legal registration mechanism for existing support groups and other CBOs will be promoted.
Indicator:
- Number of newly established CBOs in 10 civil society provinces
4.1.1 Support the implementation of existing mechanisms and formulation of a more accessible legal
registration mechanism for existing support groups and other CBOs (VUSTA: ISDS)
4.1.2 Support the establishment of CBOs, including support groups for IDU, female SW, MSM, PLHIV,
and their sexual partners (VUSTA: ISDS, COHED)
4.1.3 Raise awareness on the rights and needs of, and reduce stigma against people most at-risk of,
living with, and affected by HIV (VUSTA: ISDS, COHED)
4.1.4 Advocate for greater international and national support for full and meaningful participation of
CSOs in the HIV response (VUSTA: Pact)
4.1.5 Strengthen communication channels to foster dialogue among civil society organizations and
between CSOs and government (VUSTA: COHED, ISDS)
Objective 5: Strengthen the organizational capacity of civil society organizations to maximize their
contributions to the HIV response
Background: A recent comprehensive report on the civil society sector in Viet Nam stresses that CSOs
provide essential services, particularly to disadvantaged groups, but ‘lack vitality in some respects and
areas. While many organizations active in the HIV sector in Viet Nam claim to provide capacity building
support to CSOs, this tends to be closely tied to short-term achievement of project targets and to
23/71
ROUND 9 – HIV
compliance with donor regulations, rather than to the overall strength and viability of these organizations
as key partners in the response to HIV. Furthermore, capacity building support tends to favor one-time
trainings over a more strategic, long-term focus on improvements in core organizational and technical
competencies, structures and processes and to neglect the more nascent CSOs in remote areas.
SDA 5.1: Strengthening of civil society & institutional capacity building
Program Approach: Consortium partners will utilize a Pact-developed organizational capacity assessment
tool to identify core capacity areas for each CSO receiving support under GF-9 and to develop catered
organizational strengthening plans in ten provinces. Both implementation of organizational strengthening
plans and evaluation of progress will be included as part of the overall organizational development
framework. Pact will also provide institutional and management capacity building support to VUSTA and
COHED, while CARE will assist ISDS to strengthen its role as SR. A joint capacity-building plan via
coaching, mentoring and guidance will be developed and implemented.
Indicators:
- Number of organizational capacity building interventions carried out
- Number of trainings conducted for PR and SRs on program management, financial management and
monitoring and evaluation, according to Global Fund standards
5.1.1 Assist CSOs to develop strategic organizational strengthening plans (VUSTA: Pact, ISDS, COHED)
5.1.2 Support implementation of CSO strengthening plans (VUSTA: ISDS, COHED)
5.1.3 Management support to strengthen VUSTA in its role as PR, and training and mentoring on sub
grants for 2 SR (VUSTA: Pact, CARE)
4.5.2. Re-submission of Round 8 (or Round 7) proposal not recommended by the TRP
If relevant, describe adjustments made to the implementation plans and activities to take into account
each of the 'weaknesses' identified in the 'TRP Review Form' in Round 8 (or, Round 7, if that was the last
application applied for and not recommended for funding).
N/A
4.5.3. Lessons learned from implementation experience
How do the implementation plans and activities described in 4.5.1 above draw on lessons learned from
program implementation (whether Global Fund grants or otherwise)?
1. Lessons Learned from Good Practices used to develop this proposal
1.1 Prevention – The health sector has the lead role in implementing targeted HIV prevention for IDU and
female sex workers (SW), building upon lessons learned through small-scale projects on needle syringe
programs (NSP) from the late 1990’s and 100% condom use program (CUP) in 2000. MOH has
expanded targeted HIV prevention projects in Viet Nam (DfID / WB- funded, with technical assistance from
WHO) since 2004, which covers 33 / 63 provinces. The use of peer outreach workers has been the most
effective way to reach MARPs in Viet Nam. With increasing understanding and support from the public
security sector, local health workers managed to establish working relationships with former/current drug
users, entertainment establishment (EE) owners, and former/current female sex workers as peer outreach
workers for NSP and 100% CUP. Through decentralized local planning and cross-fertilization across
provinces, a variety of innovative service models have emerged, e.g., local government instruction to
equip every hotel room with condoms, NSP fixed sites, and drop in centers linking with HIV treatment,
care and support.
Prevention services for MSM will be scaled up based on the experiences and lessons learned by NGOs
(Pact, FHI, STD/HIV/AIDS Prevention Center (SHAPC), Vietnamese Community Mobilization Centre
Vietnamese Community Mobilization Centre (VICOMC) and Centre for Health Promotion (CHP)),
Provincial MSM Working Groups, organized by DOH with technical assistance from UNAIDS, and
24/71
ROUND 9 – HIV
organizations of MSM (Green Pine, Green Belief, Multiple Color, New World, Youth Dream) in Hanoi, Ho
Chi Minh city, Can Tho and Nha Trang. MSM clubs and CBOs, where established, have gain trust and
ensured that MSM benefit from preventions services including condom, lubricant distribution, STI services
and VCT. The first project on HIV prevention for primary sexual partners in Hanoi was implanted by ISDS
and covered thousands of primary sexual partners through peer outreach. Prevention and social services
were offered to primary sexual partners and they were empowered to establish their own groups.
1.2 Counseling and Testing – VCT services in Viet Nam follow international best practice including the
three Cs of counseling, confidentiality and informed consent across different donor-funded projects,
including GF and PEPFAR. These services are based on the National Guidelines for Voluntary HIV
Counseling and Testing, which were issued by the MOH. GF sites have successfully co-located VCT with
treatment, care and support services and this best practice will be continued in GF-9.
1.3 Treatment, Care and Support –The models for treatment, care and support in the GF-9 proposal
were designed in close coordination with the WHO, FHI, Harvard Medical School AIDS Initiative in Viet
Nam (HAIVN), CDC, the Clinton HIV/AIDS Initiative (CHAI) and the VAAC treatment, care and support
team. The GF-9 model draws on experience from the implementation of the national treatment, care and
support program, supported by PEPFAR (and partners), WHO, CHAI, the Global Fund and WB. GF-9 will
expand treatment, care and support to the district level to improve access and coverage. A recent
assessment of cohort-based ART outcomes at 31 nationally representative sites indicated internationally
comparable high survival rates at 12 months: 80% among adults and 90% among children. Viet Nam has
a strong treatment, care and support Technical Working Group comprised of government and
nongovernment international and local organizations providing support for treatment, care and support.
1.4 Monitoring & Evaluation – The National HIV Monitoring and Evaluation Framework (endorsed in
January 2007) incorporates approaches directly correlated with the “National Strategy on HIV Prevention
and Control in Viet Nam till 2010 with a Vision to 2020” and its eight Programs of Action. The unified
framework is based on international best practices, with strong oversight and engagement within the
VAAC. The implementation of the framework and strengthening of the current HIV M&E system is led by
the HIV M&E unit at VAAC, with technical assistance and support from the National HIV M&E Technical
Work Group, comprised of experts from in-country international and national organizations, as well as
UNAIDS, WHO, PEPFAR, and WB.
1.5 Civil Society – There has been increased contribution from Civil Society Organizations to the overall
National AIDS response. The last few years have seen a strong improvement in involvement and
participation of civil society in all aspects, from prevention, care and support, behavioral change
communication, and, to a lesser extent, policy development processes. The newly formed national
network of PLHIV (VNP+) is providing a representative voice for PLHIV to participate in the decisionmaking processes. The establishment of the Viet Nam Civil Society Partnership Platform on HIV/AIDS
(VCSPA) at the end of 2007 signifies the close cooperation in HIV activities amongst civil society
organizations. Founded in 2007 with 2 members only, VCSPA now has 170 members in 38 provinces in
Viet Nam.
2. Lessons Learned from Challenges and Problematic Implementation
2.1 Prevention – Challenges are discordant political commitment and support at the provincial and local
level from peoples’ committees and enforcement authorities and inconsistent project coordination by the
PACs. To address these challenges, GF-9 will promote sharing of experiences from successful provinces
and strengthen the coordination capacity of PACs. The current model for delivering NSP and condom
use promotion harm reduction services relies largely on peer outreach workers, which is expensive.
Emerging alternative approaches include fixed-sites and pharmacies, which are more cost-effective in
certain contexts (for example urban vs. rural settings). As such, GF-9 is proposing a combination of these
approaches for different locations in which they will be more cost-effective, efficient and sustainable.
2.2 Counseling and Testing – VCT services are being improved according to national guidelines,
including quality of counseling and uptake by target populations. Access to VCT is being expanded in
conjunction with new treatment, care and support sites. PITC, however, is underdeveloped as there is
currently no guidance for health workers in general healthcare settings, particularly TB and MCH centers.
MOH is currently developing guidelines for PITC; and GF-9 proposes to support implementation and
25/71
ROUND 9 – HIV
increase uptake and quality of PITC in healthcare settings.
2.3 Treatment, Care and Support – There are four main challenges in scaling up treatment, care and
support for HIV. One is the concentration of patients in selected urban areas, which is forcing many
patients to travel long distances to access treatment, care and support, and contributing to long waiting
times at point of care. Secondly, services provided in large bilateral donor-funded sites are largely
provided by contract workers. This poses the question of sustainability when donor funding is phased out.
GF-9 proposes to expand HIV treatment, care and support sites to improve access and to mobilize
existing government health workers for HIV treatment, care and support to foster sustainability in light of
declining donor resources.
Thirdly, rapid turnover of healthcare workers in public settings requires
frequent and repeated refresher trainings, close monitoring and supervision and mentoring support.
Finally, there is a lack of treatment, care and support in prisons. GF-9-HIV will introduce HIV treatment,
care and support into prisons building on existing TB services established by GF-6-TB.
2.4 Monitoring & Evaluation ‐ Major donor initiatives and the government have encountered the following
challenges in monitoring and evaluation: (1) an M&E system had not been in place, (2) reports were not
submitted in a timely manner, and (3) data quality was poor. There has been an introduction of revised
standard recording and reporting forms for each level and each technical area, in line with the National
M&E framework in addition to recruitment of staff to undertake M&E including data collection and analysis.
There has been training on M&E for provinces and sites, followed by frequent and intensive supportive
supervision. VAAC, National Institute of Hygiene and Epidemiology (NIHE) and four regional institutes
have conducted additional supervision and monitoring visits. GF-9 will further contribute to strengthening
the national M&E system, particularly data collection, analysis, and reporting.
2.5 Civil Society - CSOs are a relatively new phenomenon in Viet Nam and vary greatly in size, focus,
affiliations and aspirations. Civil society assessments – including a review conducted by Pact Viet Nam as
part of it’s CSO capacity building strategy development process -- indicate that priority capacity gaps for
CSOs in the HIV/AIDS sector include: technical expertise in the areas of HIV/AIDS prevention and care;
results-based programming skills; and organizational development skills, including human resource
management, resource mobilization, financial management, monitoring and evaluation (M&E), and
strategic planning, in addition to limitations in basic infrastructure and access to commodities. While CSO
engagement in the HIV/AIDS response is critical – and the potential contribution of CSOs substantial –
their current role is hampered by a lack of technical capacity, inadequate linkages with formal care
services, and weak organizational systems and long-term viability. Thus, GF-9 proposal will strengthen the
capacities of the VNGOs, support establishment of new CBOs representing IDU, female SW and MSM
and offered prevention, care and support services in 10 focus provinces.
4.5.4. Enhancing social and gender equality
Explain how the overall strategy of this proposal will contribute to achieving equality in your country in
respect of the provision of access to high quality, affordable and locally available HIV prevention,
treatment and/or care and support services.
(If certain population groups face barriers to access, such as women and girls, adolescents, sexual
minorities and other key affected populations, ensure that your explanation disaggregates the
response between these key population groups).
The GF-9 proposal carefully addresses social and gender equality through considering the following
areas:
1. Purposeful outreach to assure that social support, protection, information and access to
services are equitable between women and men, and girls and boys
By nature of the epidemic in Viet Nam and its concentration between IDU (primarily men) and their
primary sexual partners, female SW and their clients (young men), equitable access to both prevention
and care/supportive services for women and men is critical to the success of this grant. To address
gender equity in access to services, this proposal includes in particular the following activities: targeted
prevention, referral, and care and supportive services for women in sex work, including building condom
26/71
ROUND 9 – HIV
negotiation, NSP, health seeking behavior, and self-empowerment skills; referral to women’s health clubs
where possible to ensure women have access to HIV-related counseling and IEC, and follow-up care. In
addition, GF-9 will also promote PMTCT services in conjunction with sexual and reproductive health
services to ensure that female PLHIV are aware of PMTCT services and their right to bear children.
2. Prioritized access to services for marginalized and most-at-risk populations
Activities in this proposal seek to reduce the HIV transmission risk associated with behaviors such as
injecting drugs and participating in high-risk sex. This rationale is based on the relatively low HIV
prevalence in the general population (less than 1%), high HIV prevalence among illicit drug injectors
(20.3%) and female sex workers (3.1%) 3 nationwide and MSM living in large urban centers (7.3%) 4 and
reports of continuing high-risk behaviors among these most-at-risk populations. In addition to addressing
the needs of IDU and female SW in the community, treatment, care and support will be provided to men
and women in closed settings i.e. prisons and TECs, who are particularly marginalized. PMTCT services
will be provided to women in closed settings.
3. Strengthening of social equality
Interventions will serve both rural/highland areas and urban settings targeting populations with of injecting
drug use and sexual risk behavior. IDU, female SW, MSM as well as their sexual partners will be targeted
in communities via peer-driven outreach. In addition, all interventions will address IDU, female SW, and
MSM empowerment and promote positive health seeking behaviors. Evidence in Viet Nam has shown
that access to marginalized groups including IDU, female SW and MSM is more easily attained via peers.
A cadre of IDU and female SW peer educators will be trained to approach IDU, and female SW in high
injection zones and in places were sex is bought. Peer educators will also refer target populations to
services where additional peers will participate in trainings and provision of supportive services.
Implementing partners will ensure that there will be no restrictions on target group access to services.
Since this proposal targets marginalized populations, increasing their access to prevention, treatment,
care and support interventions is fundamental to the design.
4. Strategies to address stigma and discrimination
The Government of Viet Nam has expressed strong commitment to fight HIV-related stigma and
discrimination. This is reflected in the National HIV Law, which includes protection for the legal rights of
PLHIV and prohibits HIV stigma and discrimination. This GF-9 proposal will contribute to reducing stigma
and discrimination at the policy, implementation and community levels. Evidence shows that sensitization
and training of policy makers, health and public security staff, local service providers, other local
collaborators and community can help reduce stigma and discrimination towards IDU, female SW, MSM
and PLHIV. 4.5.5
Strategy to mitigate initial unintended consequences
If this proposal (in s.4.5.1.) includes activities that provide a disease-specific response to health system
weaknesses that have an impact on outcomes for the disease, explain:

The factors considered when deciding to proceed with the request on a disease specific basis;
and

The country's proposed strategy for mitigating any potentially disruptive consequences from a
disease-specific approach.
In general, there are no major anticipated disruptive consequences due to this request of funding. The
additional outreach activities provided through this proposal, conducted through peers and most at risk
groups is needed to 1) bridge the gaps the between government health services and MARPs and PLHIV,
3
2009 Results from the Cooperation to Prevent and Control HIV/AIDS, Illicit Drugs and Sex Work in 2008 Looking to
2009, VNMOH
4
2007 UNGASS
27/71
ROUND 9 – HIV
and 2) improve HIV and STI prevention. Linking these groups to existing health services through the
strengthening and expansion of self-help groups among female SW, MSM, IDUs and PLHIV will enhance,
rather than disrupt the delivery of HIV prevention, treatment, care and support services through the
existing health system.
The proposal does also include attention to TB/HIV co-infection and improved HIV prevention among
people with TB and improved TB prevention among people living with HIV, through defining a TB/HIV
minimum package for collaborative activities at district/township level.
However, the CCM has identified and considered potential unintended factors which include:
- Movement of human resources from other sub-divisions in the health and labor sectors
- Impacts on sustainability of human resource needs following completion of the grant
- Overburdening of existing health and labor management staff
1. Movement of human resources
To address potential movement of human resources from other sub-divisions in the health and labor
sectors, Viet Nam is currently examining standardization of salaries and associated remuneration across
donor assistance programs. This process is being led by the Ministry of Planning and Investment and
concerned donors supporting HIV in particular.
2. Impacts on sustainability
Viet Nam is concerned about the possible impacts on sustainability of human resources needed to
support the GF grants and other major donor assistance grants. At this time, Viet Nam is discussing a
strategy for adopting the costs that will remain when donor assistance is withdrawing (assuming program
costs are flat-lined).
3. Overburdening of existing staff
Staff overburdening is a major concern across donor assistance programs in Viet Nam as the majority of
provincial level management staff often have multiple responsibilities and limited human resource
assistance to manage effectively. Viet Nam is currently working with a number of donors supporting HIV
programs to coordinate more effectively at the provincial level, including linking donor initiatives and
human resources where applicable at Provincial AIDS Centers, and providing management training.
4.6.
Links to other interventions and programs
4.6.1. Other Global Fund grant(s)
Describe any link between the focus of this proposal and the activities under any existing Global Fund
grant. (e.g., this proposal requests support for a scale up of ARV treatment and an existing grant
provides support for service delivery initiatives to ensure that the treatment can be delivered).
Proposals should clearly explain if this proposal requests support for the same interventions that are already planned
under an existing grant or approved Round 7 or Round 8 proposal, and how there is no duplication. Also, it is
important to comment on the reason for implementation delays in existing Global Fund grants, and what is being
done to resolve these issues so that they do not also affect implementation of this proposal.
1. The relationship of activities, geographic coverage and target populations of GF-9 to those of
GF-6 and GF-8
GF-9 is the first GF proposal from Viet Nam to include a civil society track. Many activities proposed in
GF-9 were also included in the GF-8 proposal, however there is no geographic duplication. From 201112, there is no geographic overlap between GF-6 and GF-9; however, after GF-6 ends in 2012, GF-9 will
support these treatment, care and support activities.
1.1 Key interventions under the GF-9 Objective 1 that link to GF-6 and GF-8
Harm reduction in the community, under Objective 1 of GF-9, is also included in GF-8. GF-9 proposes
substantial expansion of geographical coverage of interventions to reduce HIV transmission through illicit
28/71
ROUND 9 – HIV
drug injection and through high-risk sex in an additional 39 provinces. These interventions build on and
continue the successful DfID / WB harm reduction interventions (the financing of which ends in 2012). In
particular, there is a new focus on mixed interventions for harm reduction to diversify the approach in
order for the program to be more effective and sustainable. New to GF-9 are activities explicitly for
MSM and primary sexual partners of IDU and PLHIV.
1.2 Key interventions under GF-9 Objective 2 that link to GF-6 and GF-8
Based on a rigorous nationwide district-level gap analysis, GF-9 proposes expansion of geographical
coverage of treatment, care and support activities in communities and health facilities, according to the
models developed in GF-6 and GF-8. The GF-9 treatment, care and support sites in 39 provinces include
continuation of GF-6 treatment, care and support activities. New to GF-9 is prioritizing access to pediatric
ART treatment, care and support. GF-9 will continue the GF-6 treatment, care and support in TECs.
New to GF-9 is the proposal to introduce care, treatment and support services for PLHIV in prisons,
including discharge planning and referral. Prisons will be selected from those that are included in GF-6TB to build on the collaboration between Prisons, TB and HIV services.
1.3 Key interventions under GF-9 Objective 3 that link to GF-8
GF-9 proposes activities to strengthen the capacity building of PAC and the M&E system, including data
collection, analysis and use, such as were included in GF-8. GF-9 will expand these activities to
provinces not covered under GF-8. New to GF-9 is the strengthening of HIV surveillance for data
collection and analysis, as well as facilitation of transition of different HIV project management system
into one single HIV management system.
1.4 Performance issues of earlier Global Fund grants and what has been done, and how GF-9 has
taken this into consideration
Viet Nam has expended the entirety of the GF-1 grant and completed all deliverables. As of May 2009,
the total funds disbursed for GF-6 were US$8,869,180 of the US$10,219,177 that was budgeted. The
implementation rate is 87%.
Counseling & Testing
Issues identified in GF-1, low uptake of counseling and testing and low quality counseling, have been
addressed by GF-6 and the planned GF-8. Introduction and expansion of PITC is a remaining issue that
will be addressed by GF-9.
Treatment, care and support
There has been rapid turnover of healthcare workers in public settings, including sites supported by GF6. GF-6 started to address this through frequent and repeated refresher trainings, close monitoring and
supervision and mentoring support. GF-9 will expand these activities in tandem with the geographic
expansion of treatment, care and support services.
GF-6 plans to introduce treatment, care and support services into TECs. It took some time to establish
formal procedures for collaboration between the TECs and health sector. GF-9, learning from this
experience, will introduce HIV treatment, care and support into prisons building on existing TB services
that were established by R6-TB.
Monitoring & Evaluation
HIV project-based M&E activities, such as site-specific data collection, reporting and analysis, have
improved in between GF-1 and GF-6. However, duplication of reporting efforts and insufficient data use
remain issues. GF-9 proposes unify current project-based reporting and data use through capacity
building of PACs under the national M&E framework.
1.5 Progress of grant signing
GR-8 grant negotiation is currently underway and the grant is expected to start in January 2010 as part of
grant consolidation with GF-6. GF-8 grant total is US$48 million. The expanded GF-8 includes 12
provinces, which were taken into account during the nationwide, district-level gap analysis for GF-9.
29/71
ROUND 9 – HIV
4.6.2. Links to non-Global Fund sourced support
Describe any link between this proposal and the activities that are supported through non-Global Fund
sources (summarizing the main achievements planned from that funding over the same term as this
proposal).
Proposals should clearly explain if this proposal requests support for interventions that are new and/or complement
existing interventions already planned through other funding sources.
30/71
ROUND 9 – HIV
1. Overview of donor assistance programs in the GF-9 districts / provinces
There are four major donor-funded harm reduction / prevention interventions in Viet Nam, including World
Bank-DfID, AusAID, PEPFAR and GF-8. Major donors working in treatment, care and support include
PEPFAR, the CHAI as well as GF-6 and GF-8; the World Bank has four pilot HIV treatment programs in
TECs. Major interventions that work with TECs include those supported by UNODC, PEPFAR, the World
Bank as well as GF-6.
PEPFAR is currently providing support to 30 provinces. Program focus includes HIV treatment, care and
support (including ART, TB/HIV, PMTCT and VCT). PEPFAR is also supporting local and international
NGOs to provide community-based care and support in its seven comprehensive support provinces.
PEPFAR also supports HIV prevention through condom use promotion and STI services as well as peer
outreach, education and referral for IDU. PEPFAR has not yet committed financing for HIV programs in
Viet Nam after 2012.
The World Bank funded HIV prevention project (2006-2012 – phase out commences in late 2011) serves
20 provinces. The World Bank project supports implementation of harm reduction including needle
syringe programs and 100% condom use programs; behavior change interventions targeting female SWs,
their clients, and IDUs; and improvement of STI management and interventions to improve access and
linkages to complementary HIV services including STI and VCT services. Current DfID support will be
integrated into the World Bank project in June 2009; the combined project anticipates a total catchment
area of 33 provinces and will terminate in 2012.
AusAID‘s harm reduction program (2009-2017) serves two districts in each of three provinces with
comprehensive hard reduction interventions including needle syringe programs, 100% CUP and MMT.
SIDA is providing sole support for a comprehensive harm reduction intervention for IDU and female sex
workers in one province, and this funding will end in 2010. The Clinton HIV/AIDS Initiative is providing all
pediatric formulations of ARVs and commodities used for pediatric treatment, care and support (reaching
30 provinces), and this financing will terminate in 2010.
2. Linkages between GF-9 and above mentioned donor funded interventions
The district-level geographic coverage in the 39 GF-9 proposal provinces does not coincide with any
concurrent similar donor-funded initiatives. GF-9 funding proposes to leverage successful intervention
models by expanding and continuing coverage on harm reduction (Objective 1) and treatment, care and
support (ART and OI, HIV/TB, PMTCT, and VCT) (Objective 2). [Please see Annex 4-5 for district level
analysis.]
Systems strengthening activities (Objective 3) promote integration of donor-funded
interventions into the provincial HIV Harm Reduction, Treatment and Care program for long-term
sustainability.
3. Major challenges in implementation of other donor assisted programs and steps to overcome
them
In addition to the challenges and actions to be taken as described in section 4.5.3, many donor-funded
projects have faced some difficulty coordinating the labor, health and public security sectors, as each
sector has responsibility for different aspects of social management. To rectify sector coordination
issues, VAAC has been improving coordination of HIV/AIDS programs at the provincial level in
conjunction with the Provincial Committees for the Prevention and Control of Drugs, HIV and Prostitution
Prevention and Control. In addition, the Government of Viet Nam has consolidated the management of
PMUs for donor-supported programs (WB-DfID, AusAID, and PEPFAR) under VAAC.
31/71
ROUND 9 – HIV
4.6.3. Partnerships with the private sector
(a)
The private sector may be co-investing in the activities in this proposal, or participating in a way
that contributes to outcomes (even if not a specific activity), if so, summarize the main contributions
anticipated over the proposal term, and how these contributions are important to the achievement
of the planned outcomes and outputs.
(Refer to the Round 9 Guidelines for a definition of Private Sector and some examples of the types of financial and
non-financial contributions from the Private Sector in the framework of a co-investment partnership.)
NA
(b)
Identify in the table below the annual amount of the anticipated contribution from this private sector
partnership. (For non-financial contributions, please attempt to provide a monetary value if possible, and at
a minimum, a description of that contribution.)
Population relevant to Private Sector co-investment
(All or part, and which part, of proposal's
targeted population group(s)?) Î
Contribution Value (in USD or EURO)
Refer to the Round 9 Guidelines for examples
Organization
Name
Contribution
Description
(in words)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
NA
NA
4.7.
Program Sustainability
4.7.1. Strengthening capacity and processes to achieve improved HIV outcomes
The Global Fund recognizes that the relative capacity of government and non-government sector
organizations (including community-based organizations) can be a significant constraint on the ability to
reach and provide services to people (e.g., home-based care, outreach prevention, orphan care, etc.).
Describe how this proposal contributes to overall strengthening and/or further development of public,
private and community institutions and systems to ensure improved HIV service delivery and outcomes.
Î Refer to country evaluation reviews, if available.
GF-9 funds will help build institutional and civil society capacity in each of the three objectives outlined in
this proposal.
Harm reduction
Activities under Objective 1 will strengthen the capacity of institutions working in harm reduction, including
PACs, DHC and peer educator networks as well as program representatives of Public Security and
DOLISA. Particular focus will be paid to the development of coordination capacity and the use of data to
inform program decision making for greater achievement (see Health System Strengthening below).
Treatment, care and support
The National Program of Action on HIV treatment, care and support highlights social mobilization and
comprehensive continuum of care as key principles as follows: “Socializing HIV/AIDS care, support and
treatment activities by coordinating with other programs and health care services, and mobilizing the
participation of related branches, sectors, mass organizations, communities, families and HIV infected
people themselves.” The scale-up of HIV treatment, care and support, including those funded by GF-6
32/71
ROUND 9 – HIV
and PEPFAR, has been guided by this principle. Activities under Objective 2 of GF-9 will further expand
and strengthen such service delivery models, and will facilitate referral linkages in the health sector,
especially between HIV services with ANC, TB, STI and family planning services within the facilities and
vertical linkage between provincial and district facilities. Furthermore, as evident in a number of
functioning CCS sites, GF-9 will help catalyze involvement of civil society, especially PLHIV, in delivery
and improvement of health care services.
Counseling and testing
GF-9 will support expansion of testing and counseling at VCT centers, in addition to other health care
settings, including ANC, TB and STI services, based on models which have been piloted at PMTCT,
TB/HIV and STI management projects. GF-9 will build the capacity of health care workers at ANC, TB
and STI services to provide testing and counseling services respecting 3C principles (counseling,
informed consent, confidentiality) and strengthen their operational linkage with HIV services.
Health System Strengthening
Activities in Objective 3 will build programmatic capacity of PACs, which are mandated to execute and
coordinate a wide range of HIV responses. By building capacity to analyze local epidemics, decentralize
planning and coordinating functions, GF-9 will support all major donor initiatives working nationally and in
the GF-9 provinces by boosting coordination of programs and management of data effectively for
program improvement.
4.7.2. Alignment with broader developmental frameworks
Describe how this proposal’s strategy integrates within broader developmental frameworks such as
Poverty Reduction Strategies, the Highly-Indebted Poor Country (HIPC) initiative, the Millennium
Development Goals, an existing national health sector development plan, and other important initiatives,
such as the 'Global Plan to Stop Tuberculosis 2006-2015' for HIV/TB collaborative activities.
The Government of Viet Nam (GVN) recognizes the rising HIV epidemic as a threat to the health and
economic prosperity of the nation. The epidemic’s rapid spread has been associated with increased
demand on the health care system (National Health Accounts – 2006). HIV has the potential to have a
significant impact on the country’s socio-economic development. The GVN accords high priority to
ensuring an effective national HIV response, with long-term commitment and multi-sectoral coordination
linked to broader development frameworks. This is reflected in the Law on Prevention and Control of
HIV/AIDS (2007), which states that a key principle of HIV prevention and control is the integration of HIV
strategies with socio-economic development strategies. The additional support requested in this proposal
is aligned specifically with the following strategies:
1. Comprehensive Poverty Reduction Strategy
In the Viet Nam Comprehensive Poverty Reduction and Growth Strategy, 2003 (CPRGS), which is an
integral part of the government’s approach to socio-economic development, Viet Nam aims to halve the
number of people living in poverty from 32% in 2000 to 16% by 2010. Viet Nam has made great strides in
reducing poverty and will probably achieve its goal of halving poverty by 2010 ahead of time. In 2004,
19.7% of the population was living below the poverty line. The national HIV response is linked to the
CPRGS. HIV-related goals of the CPRGS are to reduce the rate of HIV transmission and minimize the
adverse social and economic effects of HIV.
2. Millennium Development Goals (MDGs)
The GVN is committed to fulfill and adapt the MDGs to the country’s specific conditions. Viet Nam also
established its own development goals, known as the Viet Nam Development Goals (VDGs). One of
these 12 goals is to slow the increase in the spread of HIV by 2005 and halve the rate of increase by
5
2010. The 12 VDGs are included in the country’s targets in the national 2001-2010 socio-economic
development strategies and programs, the 2006-2010 five-year plans (all sectors), and annual national
plans. As stated in the 2005 country report on achieving the Millennium Development Goals, despite
increased spending, there are still significant resource gaps which need to be met to achieve identified
needs in the national HIV program.
3. Universal access
5
Viet Nam Achieving the Millennium Development Goals. Aug. 2005.
33/71
ROUND 9 – HIV
Viet Nam is participating in the WHO/UNAIDS universal access initiative. The Viet Nam Head of State
signed the Political Declaration on HIV, reaffirming the country’s commitment to implement fully the
Declaration of Commitment on HIV made in 2001. The declaration states Viet Nam’s commitment to
achieve the internationally agreed development goals and objectives, including MDGs, and in particular to
halt and begin to reverse the spread of HIV, and to continue scaling up HIV prevention, treatment, care
and support. In May 2006, a high-ranking Vietnamese delegation attended the 87th meeting of the United
Nations’ General Assembly. In preparation for this meeting, the GVN prepared the Report on Scaling-Up
Towards Universal Access to HIV/AIDS Prevention, Treatment, Care and Support in Viet Nam (March,
2006).
4. National Drug Control Master Plan
In conjunction with its HIV epidemic, the GVN recognizes its concomitant drug use epidemic, primarily
driven by heroin. Given the rapid growth in the number of drug users and drug relapse prevention needs
in recent years, the Government of Viet Nam developed the National Drug Control Master Plan to 2010
(approved in 2006). The plan calls for drug treatment for 80% of registered drug users by 2010. Viet Nam
has, in recent years, elicited more support from international donors and partners to assist with drug
prevention programs. Although budgets have increased dramatically both at the central and provincial
levels to tackle drug abuse, drug relapse still remains high (up to 95% after 18 months return from TECs).
The recently revised Law on Narcotics Drug Prevention and Suppression of Viet Nam complements the
Law on HIV and has specific references to harm reduction interventions.
5. Linkages between the Global Fund Round 9 proposal and development frameworks:
The support requested in this GF-9 proposal is linked to Viet Nam’s development frameworks in the
following ways:
•
Proposed prevention and harm reduction interventions will help reduce the prevalence of HIV
infection and contribute toward achievement of related goals in the CPRGS, MDGs and VDGs.
•
Improved HIV prevention, treatment, care and support will provide the poor with better access to the
health care system, improving their mental and physical well being so that they can work more
productively and improve their economic status.
•
Prevention of HIV will minimize the adverse socio-economic effects of the epidemic. The significant
additional costs to PLHIV, coupled with loss-of-income earning ability, are forcing many households
into poverty (National Health Accounts Analysis – 2006). A reduction in HIV prevalence, and
maintenance of the health of those already infected, will minimize the number of people living in
poverty as a direct result of HIV.
•
More effective drug dependence programs, including the use of MMT, will result in a reduction of
relapse rates among IDU. This will improve the productive capacity of former-IDU, and reduce HIV
transmission.
•
Establishment of community-based job-placement programs for drug users and other vulnerable
populations will result in a reduction in poverty.
4.8.
Measuring impact
4.8.1. Impact Measurement Systems
Describe the strengths and weaknesses of in-country systems used to track or monitor achievements
towards national HIV outcomes and measuring impact.
Where one exists, refer to a recent national or external evaluation of the IMS in your description.
34/71
ROUND 9 – HIV
HIV sentinel sero-surveillance has been conducted for over 10 years and is currently performed on a
yearly base including samples collected from female SWs, IDUs, ANC attendees, and national military
recruits. Because the sampling among female SWs and IDUs has been inconsistent and taken from both
TECs and the community, PEPFAR supported the MOH, through FHI, to conduct community-based
integrated HIV bio-behavioral surveillance in 2005 in 7 provinces.
In addition to this, the national routine reporting forms for HIV were recently updated and, harmonized
with the National Monitoring and Evaluation Framework.
The main strengths of the National Monitoring and Evaluation Framework for HIV Prevention and Control
Programs (Annex 4-3) are its foundation in international best practices, alignment with the National HIV
Strategy, and strong oversight and engagement within the VAAC. In addition, the framework incorporates
approaches correlated directly with the “National Strategy on HIV prevention and control in Viet Nam till
2010 with a vision to 2020” and its eight Programs of Action. The eight Programs of Action are grouped
into three core areas: 1) Capacity, Resources, Monitoring and Evaluation, 2) Prevention, 3) Care,
Treatment and PMTCT. The implementation of the framework and strengthening of the current HIV M&E
system is led by the HIV M&E unit at MOH/VAAC, with technical assistance and support from the
National HIV M&E Technical Working Group. This group is chaired by the General Director of the VAAC
and has members from government, universities, the UN, donors and international and national NGOs.
While the overall structure of the HIV M&E system is now in place and national HIV M&E capacity has
improved considerably in recent years, some weaknesses exist primarily at the provincial and district
levels. Based on the assessment of HIV M&E capacity at the provincial level conducted by the HIV M&E
Technical Working Group in September 2007, these gaps include human capacity, both quantitative and
qualitative, as well as a lack of robust systems for reporting. Data collected at the provincial level are not
used in an effective way for planning and improvement. A weakness remains that the size of subpopulations at highest risk of HIV transmission has not been systematically assessed. There is also a
need to gain better understanding of complex networks that most at risk populations have. This includes
the regular and casual sexual partners of the female sex workers and injecting drug users. There also is a
need to better understand the sexual behaviors of MSM, as it is known that many of these men also have
female partners. Qualitative research will be conducted.
4.8.2. Avoiding parallel reporting
To what extent do the monitoring and evaluation ('M&E') arrangements in this proposal (at the PR, SubRecipient, and community implementation levels) use existing reporting frameworks and systems
(including reporting channels and cycles, and/or indicator selection)?
The M&E Plans for this grant is designed as an integral part of the National HIV Monitoring and
Evaluation framework and will use systems already in place, in line with the third of the “Three Ones”
principle.
1. Impact and Outcome
All indicators used in the “Impact and Indicator Matrix” (Attachment A) are also indicators in the National
HIV M&E Framework.
2. Input, process and output indicators
Most of the indicators in the National HIV M&E framework are output, outcome and impact indicators.
Output indicators for the SDAs will be collected through “Decision 28,” the national reporting system for
HIV (where possible) - (see national HIV M&E framework, Annex 4-3). Input and process indicators for
the different SDA will also be collected. Provincial Coordinators in each province will have the overall
responsibility for M&E at the provincial level via the collection of monthly reporting forms from Peer
Educator supervisors, counseling and testing site supervisors. They will consolidate this information in a
monthly progress indicator reporting form, which will be sent to MOH (and MOLISA) via existing reporting
channels. For the CSS component, mentors, coaches and involved community members will report on a
monthly base on a harmonized form that will be developed.
35/71
ROUND 9 – HIV
3. Annual reviews
Annual reviews will be conducted at the provincial land district level, providing opportunities to share and
exchange experiences and lessons learned among provincial partners. The monitoring and evaluation
system, including the annual reviews, will be used for work plan development for each year. This
exercise will be conducted jointly between the 2 PRs.
4.8.3. Strengthening monitoring and evaluation systems
What improvements to the M&E systems in the country (including those of the Principal Recipients and
Sub-Recipients) are included in this proposal to overcome gaps and/or strengthen reporting into the
national impact measurement systems framework?
Î The Global Fund recommends that 5% to 10% of a proposal's total budget is allocated to M&E activities, in order
to strengthen existing M&E systems.
An assessment of HIV M&E capacity at the provincial level was conducted by the HIV M&E Technical
Working Group in September 2007. The results from this assessment formed the basis for both revision
of Decision 28 routine HIV reporting forms, as well as development of a national capacity-building M&E
plan and subsequent national Training of Trainers for basic M&E and provincial trainings (currently
ongoing). In addition, under the Health System Strengthening component of this proposal, a set of
activities have been developed to strengthen the functioning role of the M&E Departments in the
Provincial AIDS Centers of the 10 selected provinces.
4.9.
Implementation capacity
4.9.1 Principal Recipient(s)
Describe the respective technical, managerial and financial capacities of each Principal Recipient to
manage and oversee implementation of the program (or their proportion, as relevant).
In the description, discuss any anticipated barriers to strong performance, referring to any pre-existing assessments
of the Principal Recipient(s) other than 'Global Fund Grant Performance Reports'. Plans to address capacity
needs should be described in s.4.9.6 below, and included (as relevant) in the work plan and budget.
PR 1
Viet Nam Administration of HIV/AIDS Control (VAAC)- MOH
7th floor, 14 Lang Ha, Ba Dinh District, Hanoi, Viet Nam
Address
Tel: (+84) 4 772-2993/ 772-3078/772-3079
Fax: (+84) 4 772-2994
Email: [email protected]
The VAAC has substantial experience managing a number of large donor supported initiatives, including
GF-1, GF-6 and, soon, GF-8. The GF-1 HIV grant was successful in achieving its targets and timely
disbursement of funds, and was recently completed. Significant progress has also been achieved in
management, implementation and expenditure of other concomitant initiatives including the WB / DFID
and PEPFAR, as well as rapid development and expansion of ART service provision beginning in 2006.
Since its establishment, the VAAC has developed significant technical capacity through the oversight of
the National Strategy on HIV/AIDS, the 8 Programmes of Action, and capacity-building initiatives included
as part of the donor-supported programs highlighted above. The VAAC and its technical offices now
serve as focal points for HIV prevention, treatment, care and support, and monitoring/surveillance
elements of major donor initiatives, with dedicated staff for each. Technical staff at the VAAC collaborate
jointly with technical support staff from international implementing agencies to develop strategic plans, to
review current data, and to coordinate programs and donor assistance, providing additional opportunities
for learning and exchange.
Anticipated barriers to strong performance include limited management and technical capacity,
particularly at the provincial and district levels, challenges in coordination of donor initiatives and
resources, and no pre-existing linkage between the MOH- and MOPS-managed components of this
36/71
ROUND 9 – HIV
proposal.
With increasing number and size of donor-funded HIV/AIDS initiatives, coordination of resources (human,
financial and material) has posed a major challenge. Provincial technical expertise, both in management
and in technical oversight, will need to be further developed to ensure services meet international
standards and data are used to inform program decision-making. Provincial program managers will also
need support to examine ways of linking donor initiatives so as to avoid overlap, but more importantly, to
ensure that resources are used to provide a minimum package of essential services as part of the
prevention-to-care continuum. Specific assistance will be needed to ensure that the PR provincial network
collaborates closely with provincial MOPS and MOLISA counterparts to ensure seamless transition from
prisons and TECs to community-based services.
Activities to improve management, coordination, oversight and data monitoring for strategic planning and
program improvement are highlighted in section 4.9.6.
PR 2
Viet Nam Union of Science and Technology Associations (VUSTA)
Address
Associate Professor, Dr. Ho Uy Liem, Acting President
53 Nguyen Du, Hanoi, Viet Nam
Tel: 04-39439658 - Email: [email protected], [email protected]
VUSTA is one of the biggest Non-Governmental Organizations in Viet Nam. Its mission is to gather, unite
and mobilize the potential of the Vietnamese intellectuals in science and technology sphere to contribute
to the industrialization and modernization of the country; to play as a bridge between its members and
governmental authorities; to represent and protect the legitimate rights and interests of its members and
intellectuals in science and technology in Viet Nam.
The main activities of VUSTA and its members include: (1) scientific research and technology
development; (2) participate in socialization of science and technology, education and training, people’s
health care, community development, and poverty elevation; (3) provide consultancy, and social
monitoring activities; (4) promulgate and disseminate scientific and technological knowledge and enhance
public understanding of the state’s guidelines, laws and policies; (5) expand and cooperate
internationally.
Institutional and organization capacity
VUSTA is an independent organization that was established in 1983. Its operations are guided by the
VUSTA Chapter and based on voluntary, democracy and solidarity principles. Currently, the organization
has a national wide network with 68 central science and technology associations and 55 associations in
provinces and cities. VUSTA has given legal status for hundreds of NGOs, which are established and
operate in the field of science and technology, community development, poverty elimination, and
HIV/AIDS prevention. Most of the current national active NGOs operating in the field of HIV/AIDS
prevention in Viet Nam are members, and/or subsidized organizations such as ISDS, COHED, VICOMC,
etc. Besides that, VUSTA has networks of newspapers in many fields of science and technology. The
board of directors is voted by its members every five years in the national congress. VUSTA and its
members are reporting to the Department of Non-Governmental Associations of Ministry of Home Affairs
on an annual basis.
Management and financial capacity
With its nationwide network of members, VUSTA’s role consists in being a bridge between members and
government authorities. VUSTA and its members engage in dissemination of knowledge, government
guidelines, policies, laws to society, at the same time bring the voice of society in responding to the
government authority. In the context of policy advocacy, VUSTA and its members have positive and
effective contributions to main programs, projects and policies of government. The government authorities
consider VUSTA has not only the representative body of its members but also for many NGOs in Viet
Nam.
VUSTA is financed by 3 main sources:
(1) Funds from Government. For approximately USD 2 million each year for scientific research,
technology development, public consultancy and social monitoring;
37/71
ROUND 9 – HIV
(2) International funds from projects for community development, poverty elimination from various
sources including bi lateral organization and multi-lateral organization
(3) Others, including providing services to business community or other organizations.
Î Copy and paste tables above if more than three Principal Recipients
4.9.2 Sub-Recipients
X
(a)
Will sub-recipients
implementation?
be
involved
in
Yes
program
No
(b)
If no, why not?
X
1–6
7 – 20
(b) If yes, how many sub-recipients will be
involved?
21 – 50
More than 50
X
(d)
Are the sub-recipients already identified?
(If yes, attach a list of sub-recipients, including details of the
'sector' they represent, and the primary area(s) of their work
over the proposal term.)
(e)
Yes
[Annex 4-7]
No
Answer s.4.9.4 to explain
If yes, comment on the relative proportion of work to be undertaken by the various sub-recipients.
If the private sector and/or civil society are not involved, or substantially involved, in program
delivery at the sub-recipient level, please explain why.
MOLISA and MOPS will support prevention and support in closed settings, while civil society will support
prevention and care and support activities in the community, along with capacity building of CBOs.
The budget allocation of government and civil society SRs are as follows:
Government SRs
MOLISA 2.7% of the total budget
MOPS
7.7% of the total budget
Civil Society SRs
Pact
ISDS
COHED 5.1% of the total budget
38/71
ROUND 9 – HIV
4.9.3.
Pre-identified sub-recipients
Describe the past implementation experience of key sub-recipients. Also identify any challenges for
sub-recipients that could affect performance, and what is planned to mitigate these challenges.
Following the SR selection process described earlier (paragraph 2.2.2), 5 main sub-recipients have
already been identified by the CCM including MOPS, MOLISA, COHED, Pact and ISDS. [For the
Management Structure, please see Annex 4-8]
The Ministry of Public Security (MOPS)
The Health Department of the Ministry of Public Security (MOPS) is assigned to provide care and
treatment, monitor, support medical services delivery to all public security staffs, detainees and prisoners
nationwide. In order to facilitate this role, a sub-department have been established in the Health
Department to provide health care programs, direct and monitor medicals services in MOPS-managed
closed settings. Currently in each closed setting operated by the MOPS there is one health center and/or
treatment area for prisoners consisting of a medical staff team. The total number of medical staff working
across all MOPS-managed closed settings is approximately 500 people.
In recent years, the MOPS Health Department has been cooperating with the Department of Prison
Management and the VAAC in the implementation of harm reduction activities for injecting drug users
(IDU). This cooperation has been done via a number of projects, such as Project I09 – a UNODC project
on reduction of drug abuse and HIV prevention within closed settings; the HIV Prevention and Control in
Asia – ARHP project sponsored by the Australian Government; and, PEPFAR-funded projects. Based on
this support MOPS has been able to build a policy environment for implementation of HIV prevention
activities among prisoners and Public Security staff. The Health Department of MOPS has also
demonstrated progress in leading and implementing HIV prevention activities funded under Government
programs. It has also established and strengthened an inter-ministerial cooperation mechanism on the
issue of drug use prevention and harm reduction with MOH and MOLISA.
Based on the actual situation and results from implementation of these activities, MOPS has encountered
some difficulties in the implementation of HIV prevention and control activities within the public security
sector and in MOPS-managed closed settings system. With a population of approximately 90,000
prisoners, of whom many engage or have engaged in high-risk behavior, the demand for testing, care and
treatment, prevention education, and advocacy is very high. However, the health system within this
closed settings system has not yet met the demand due to a lack of funding, technical capacity and
equipment to enable widespread and comprehensive coverage. For police officers working inside closed
settings and at the community level where harm reduction activities are implemented, their technical
capacity in this field is also low. The coordination of HIV prevention services between the MOPS closed
settings system and the community is weak. In addition, the availability of universal precaution protective
equipment and training for public security staff is limited.
In response to the need for coordinated management and implementation of HIV prevention programs
and projects, in 2008, MOPS established an Internal Steering Committee for Health programs and
projects in the closed settings system. This committee consists of representatives from the Prison
Management Department, Investigation Bureau, Health Department and other related departments of
which the Health Department is a standing member. This Steering Committee will be a focal point to
coordinate with the PR (MOH) in implementing HIV/AIDS prevention programs under the GF-9 grant.
Additional technical assistance and program management activities will be provided with financial support
from the Global Fund, and other funding sources, along with the participation of civil societies. The MOPS
health centers and their staff will be responsible for the implementation of all activities proposed for
MOPS in the GF-9 proposal. In addition, the implementation of HIV prevention activities in the MOPS
closed settings will be carried out also in coordination with TB prevention activities.
The Ministry of Labor, Invalids and Social Affairs (MOLISA)
The Department of Social Vices Prevention of MOLISA (DSVP) provides management, technical and
financial oversight of the nation’s 84 TECs and has the primary mandate to reduce sex work and drug use
39/71
ROUND 9 – HIV
in all of Viet Nam’s 63 provinces.
MOLISA has significant experience managing national programs on drug and prostitution reduction, and
rehabilitation of drug users and female sex workers. The ministry also has experience managing donor
assistance, but of relatively small-scale. MOLISA is one of Viet Nam’s largest ministries, covering a wide
range of social support services for Vietnamese citizens.
Given the number of residents in TECs nationwide (94,000), the DSVP has substantial experience in the
implementation of institutional-based rehabilitation programs, which run for a duration of 2-5 years. While
community-based rehabilitation falls under the auspices of provincial DSVPs, DSVP staff has less
experience running community-based rehabilitation programs at par with international best practices (with
the exception of UNODC-supported interventions in focus districts in 5 provinces, and the PEPFARsupported transitions program in Ho Chi Minh City).
On average, the ratio of medical staff to residents is small, and technical capacity in the provision of AIDS
care is limited (2005 Report on the Survey Results of Project G22: Reduction of HIV Infection Risk due to
Drug Abuse – Viet Nam). In addition, most DSVP staff has not received training on international best
practices for HIV prevention, care and support, and addictions counseling. The 2005 Report also noted
shortcomings in capacity for HIV counseling and follow-up referral for residents returning to their
communities.
Through GF-6, MOLISA and DOLISA are gaining technical program capacity in supporting TECs to
implement HIV treatment, care and support with substantive technical and clinical assistance from VAAC,
PAC and CSS. UNODC will provide technical and program support to complement support from VAAC,
PAC and CSS.
COHED
COHED has been recognizing as one of leading Vietnamese NGO working in the area of HIV/AIDS and
Reproductive Health areas with 7 years of experience. At present, COHED is implementing 10
projects/programs in HIV/AIDS prevention and care in 9 provinces/cities nationwide, which enables
COHED to reach and provide its support to 2,072 people living with HIV and 1,213 HIV infected and
affected children. COHED has been mentoring and supporting the establishment and operation of 25
CBOs and has been also recognized to take lead in livelihood improvement program with various income
generating activities for People Living with HIV through models of revolving fund and micro credits with a
special focus on HIV positive women and AIDS orphans. COHED has an experienced and dedicated staff
comprising 22 individuals whose diverse academic and professional backgrounds promote project
success.
Pact
Active in Viet Nam since early 1990s, Pact’s Viet Nam’s program aims to enhance the scale, quality and
effectiveness of the civil society response to HIV/AIDS in Viet Nam, providing both technical and
organizational capacity building services to Vietnamese CSOs working across the continuum of
prevention, care, and treatment in Ha Noi, Ho Chi Minh City, Hai Phong, Quang Ninh, Nghe An, Can Tho,
and An Giang. Under this program Pact has developed highly productive partnerships with both CSO
partners and government counterparts, and has prioritized coordination of CSO programs within the
provincial government response in order to ensure client access to a full continuum of services.
Pact has developed or adapted a range of technical capacity building tools, trainings, and approaches for
use in its Viet Nam program. In doing so, Pact has worked closely with its CSO partners to ensure the
relevance and ownership of its approaches, which are now widely used. Available tools and trainings
focus primarily on community-home based care and support, support for children living with/affected by
HIV, and – more recently -- peer outreach program improvement. Pact’s HIV/AIDS monitoring and
evaluation toolkit for HIV/AIDS CSOs has won international recognition and has contributed substantially
to the quality of data reported by CSOs under PEPFAR in Viet Nam, and to the use of data. The Pact
team has 22 staff (international and national) that is managing $10,500,000 worth annual program.
ISDS
40/71
ROUND 9 – HIV
ISDS is known as a leading NGO in translating knowledge gained in social research into development,
and pioneer in challenging areas. Founded in 2002 by a group of researchers who were involved in the
first external Evaluation of the National AIDS Program in 2001, since then ISDS engages in the fight
against HIV through research, advocacy and intervention. It leads the stigma reduction movement – by
translating evidence from its own research to high-level advocacy, mass media campaign, and
development of intervention tools for PLHIV. ISDS has been developing and piloted toolkits tackling
stigma against MSM and IDU.
ISDS was among the first local NGO active in harm reduction advocacy, in which the engagement of
Communist Party and National Assembly along side international organizations led to the legalization of
harm reduction in Viet Nam. It is also the first to address transmission risk among IDU’s primary sexual
partners.
ISDS believes in power of community and has always been a trustful and supportive partner of CBOs. It
partnership with Bright Future Network in a communication project has resulted in a quarterly magazine
for PLHIV with content mostly generated by PLHIV from all over the country, and disseminated nationwide through the same broad network of PLHIV.
Co-founded VCSPA in 2007, ISDS has since committed in supporting the development of VCSPA basing
on the philosophy that the development of civil society is a crucial element for the sustainable
development of a country.
4.9.4. Sub-recipients to be identified
Explain why some or all of the sub-recipients are not already identified. Also explain the transparent,
time-bound process that the Principal Recipient(s) will use to select sub-recipients so as not to delay
program performance.
N/A
4.9.5. Coordination between implementers
Describe how coordination will occur between multiple Principal Recipients, and then between the
Principal Recipient(s) and key sub-recipients to ensure timely and transparent program performance.
Comment on factors such as:
•
How Principal Recipients will interact where their work is linked (e.g., a government Principal
Recipient is responsible for procurement of pharmaceutical and/or health products, and a nongovernment Principal Recipient is responsible for service delivery to, for example, hard to reach
groups through non-public systems); and
•
The extent to which partners will support program implementation (e.g., by providing
management or technical assistance in addition to any assistance requested to be funded through
this proposal, if relevant).
Coordination between the 2 PRs:
MOH and VUSTA as the 2 PRs for this GF-9 proposal are separately accountable to the CCM. In order to
effectively complement activities and ensure no confusion during implementation, the 2 PRs have agreed
to a number of processes to strongly coordinate their activities.
A quarterly meeting will take place between the 2 PRs to coordinate and adjust their programming and
reporting cycle to the Global Fund. A memorandum of understanding (MoU) between the 2 PRs will be
signed underlining the objective and activities of the collaboration.
VUSTA, as the non-government PR and co-lead of the civil society consortium will become a full member
of the CCM as per the Global Fund requirement. The other members of the consortium will be invited as
observers to each CCM meeting.
41/71
ROUND 9 – HIV
Both PRs will take a lead in co-organizing an annual partnership forum involving all the SRs,
implementing partners as well as beneficiaries such as PLHIV and other partner organizations and CCM
members to collect feedback from each other for better grant performance.
Procurement of commodities, such as needles and syringes, condoms, will be performed by VAAC and
its contractors complying with government regulations, and then distributed to government and nongovernment SRs according to the respective work plans.
Governmental partners will implement NSP and condom promotion focusing on injecting drugs and risky
sex in 39 provinces while the civil society consortium will implement condom use promotion interventions
in 10 provinces, focusing on MSM and primary sexual partners of IDU. In two of these 10 provinces, civil
society will take the lead in both NSP and CUP to cover all at-risk populations that are a focus of this
proposal.
Coordination among Government PR (VAAC), SRs (MOPS and MOLISA) and their implementing
partners
VAAC/GF CPMU will work primarily with 2 SRs (MOPS and MOLISA). The three entities will coordinate
closely for programming, planning, implementation and M&E activities. A MoU describing clearly the
expected roles and responsibility of each entity, including coordination mechanism as well as operation
and reporting procedures will be discussed and developed. External non-implementing partners, such as
WHO and UNODC, will be also considered to facilitate the process. Quarterly coordination meetings will
be organized to discuss and adjust plans and activities on an on-going basis. These quarterly meetings
will address program monitoring and reporting. Each of the SRs will also sign grant agreements with their
own SSRs including budgeted work plans and quantified expected results.
VAAC will establish a designated GF-9 bank account in Viet Nam and will transfer funds to the MOPS
and MOLISA, which will manage their accounts separately. The VAAC, MOPS and MOLISA will then
organize training sessions for provincial project staff on financial management. Regular disbursement
requests to the GF will be made by the VAAC after receiving financial and disbursement reports from the
MOPS and MOLISA and implementing partners. Financial guidelines/procedures will be developed based
on GF-6 and GF-8 HIV project guidelines and current regulations of the Government of Viet Nam.
Coordination between Non-Government PR (VUSTA) and the Consortium core group of SRs
(ISDA, COHED, Pact) and their implementing partners
VUSTA will work principally with 3 SRs (Pact, COHED and ISDS). The four entities will constitute the core
group of the civil society consortium and coordinate closely for programming, planning, implementation
and M&E activities. A MoU describing clearly the expected roles and responsibility of each member of the
consortium will be discussed and developed. External non-implementing partners, such as UNAIDS, will
be also considered to facilitate the process.
VUSTA will sign grant agreements with each of the SRs that will include budgeted work plans and
quantified expected results. Monthly coordination meetings will be organized as part of the coordination
duty of the consortium to discuss and adjust plans and activities on an on-going basis.
Each of the SRs will also sign grant agreements with their own SSRs including budgeted work plans and
quantified expected results
4. Extent to which partners will support program implementation
PR 1: Government Track:
As outlined in section 4.5.1 and in 4.9.3, the VAAC, MOPS and MOLISA will be the main implementation
agencies, implementing via their provincial counterparts (PACs, Prisons, TECs, DOLISA). While the
VAAC, MOPS and MOLISA will provide oversight to provincial partners, WHO and UNODC will provide
coordinated technical and program support in developing guidance, tools, and training program and in
monitoring, supporting and supervising local entities. WHO will work mainly through VAAC and UNODC
through MOPS and MOLISA.
PR 2: Civil Society Track:
VUSTA will be supported by Pact to improve its capacity in the areas identified based on the outcomes
42/71
ROUND 9 – HIV
and recommendations of the independent audit (see Section 4.9.6). The concept of the consortium
among VUSTA, ISDS, Pact, and COHED, which has been already worked out successfully during the
proposal development process will be strengthened so any nascent issues will be dealt with in a rational
and result orientated manner.
ISDS and COHED, as responsible for prevention and care and support service delivery in 5 provinces
each, (in total there are 10 CSO focus provinces) will work closely with different VNGOs. In their 5
provinces COHED will engage with VNGOS: Centre for Promotion of Quality of Life (Life Centre), Centre
for Health Promotion (CHP), VICOMC and Centre for Public Health and Community Development
(CEPHAD) and Light Centre, while in the other 5 provinces ISDS will work closely with the following
VNGOS: Women’s AIDS Reproductive Health center, (WARC) Center for Research and Action for
Community, (CERAC) and Consulting for Investment in Health Promotion (CIHP), VICOMC, CEPHAD
and VCSPA.
Pact will assume primary responsibility for development and/or adaptation of technical and organizational
development (OD) capacity assessment and capacity building tools, working in close collaboration with
CARE to ensure availability of a suite of tools appropriate for use at both the VNGO and CBO level.
Facilitated capacity assessments and capacity building (technical and OD) services will be provided by
Pact for all participating VNGO partners, several of which will also be trained as facilitators and trainers.
CARE will then cascade tailored capacity assessments/building for CBOs in provinces overseen by the
ISDS consortium, while COHED and its SSR-VNGO implementers will cascade capacity
assessments/building to CBOs in the additional five Track 2 provinces.
In addition, Pact will provide targeted support to VUSTA (PR) and COHED (SR) to strengthen capacity in
grants management, financial management, and monitoring and evaluation specific to Global Fund
requirements, while CARE will provide this support to ISDS. This support will be most intensive at the
time of PMU establishment, staff recruitment, initial agreement negotiation with sub-recipients and first
round financial/performance reporting, but will continue through the life of the program, decreasing in
intensity as related capacity grows.
4.9.6. Strengthening implementation capacity
The Global Fund encourages in-country efforts to strengthen government, non-government and
community-based implementation capacity.
If this proposal is requesting funding for management and/ or technical assistance to ensure strong
program performance, summarize:
(a)
The assistance that is planned;**
(b)
The process used to identify needs within the various sectors;
(c)
How the assistance will be obtained on competitive, transparent terms; and
(d)
The process that will be used to evaluate the effectiveness of that assistance, and make
adjustments to maintain a high standard of support.
** (e.g., where the applicant has nominated a second Principal Recipient that requires capacity development to fulfill
its role; or where community systems strengthening is identified as a "gap" in achieving national targets, and
organizational/management assistance is required to support increased service delivery.)
1. Planned assistance
For the government track, VAAC, MOPS and MOLISA will provide technical and managerial support to
their local entities and partners via their provincial counterparts (PACs, Prisons, TECs, DOLISA). WHO
and UNODC will build on on-going support and reinforce technical and programmatic capacity of VAAC,
MOPS and MOLISA by supporting the development of guidance, tools, and training programs as well as
monitoring, supporting and supervision of local entities. WHO will work mainly through VAAC and
UNODC will work with MOPS and MOLISA.
43/71
ROUND 9 – HIV
For the civil society track, UNAIDS, and Pact, will provide support to VUSTA to improve its capacity in
areas, if identified, by it’s independent audit (mentioned below) so it will be prepared for the grant start
date.
2. Process used to identify needs in the various sectors
The Programme of Action (PoA) on Capacity Building and International Cooperation Enhancement, one
of the 8 PoA of the National HIV Strategy, identifies systems strengthening and improving human
resource capacity, inclusive of non-health sectors, as priorities. Per this PoA, the government PR
(VAAC) and its SRs (MOPS and MOLISA) have already indentified harm reduction, HIV care and
treatment, and surveillance and M&E, as focus areas that require technical support. The process and
outcome of this technical support during the first two years will be reviewed for planning the technical
assistance for years 3-5.
VUSTA will undertake an independent audit of its current technical, financial, management and M&E
capacity to ensure it has the full capacity to perform its role of a PR for the Civil Society track. The terms
of reference of the audit will be developed with consideration of Global Fund requirements. And follow up
plan for strengthening of specific areas will be developed.
3. How assistance will be obtained
In the government track, technical support, other than assistance from the agencies identified above, will
be obtained via open solicitation from both international and local constituents as outlined in the work
plan. Technical support will be obtained both from individuals and from agencies outsourced directly by
the PRs and SRs. The CCM will monitor disbursements and delivery as per Global Fund regulations.
For the civil society track, the terms of reference for a technical support plan will be developed in Q1 of
Year 1 with the core group of the consortium. VUSTA and Pact will jointly develop and implement a
catered capacity-building plan outlining direct support via coaching, mentoring and guidance to the
VUSTA GF-9 PMU. In the same line, support will be provided to one of the SR. The consortium will also
look at other technical support mechanisms such as the Technical Support Framework supported by
UNAIDS and WHO to tap in according to its needs. Transparency and competitive processes in the
selection of the technical support providers will be ensured. Regarding the specific procedures and Global
Fund requirements, the core group of the consortium will closely work with Government PR to benefit
from its experience in managing GF grants. Special training sessions will be organized and reporting
forms exchanged/adjusted accordingly so there is no duplication of efforts.
4. Process to be used to evaluate effectiveness
For both PRs and their main SRs, specialized unit/staff will be appointed in monitoring and evaluation. A
joint system for monitoring and evaluating external technical and program support received by the PR and
SRs will be developed. Annual reviews will be conducted by the PR and SRs to evaluate effectiveness of
this support. This will be part of the MoU between the 2 PRs.
44/71
ROUND 9 – HIV
4.10.
Management of pharmaceutical and health products
4.10.1. Scope of Round 9 proposal
Does this proposal seek funding
pharmaceutical and/or health products?
for
any
No
Î Go to s.4B if relevant, or direct to s.5.
X
Yes
Î Continue on to answer s.4.10.2.
4.10.2. Table of roles and responsibilities
Provide as complete details as possible. (e.g., the Ministry of Health may be the organization responsible for the
‘Coordination’ activity, and their ‘role’ is Principal Recipient in this proposal). If a function will be outsourced, identify
this in the second column and provide the name of the planned outsourced provider.
Activity
Procurement policies &
systems
Which organizations and/or
departments are responsible for
this function?
(Identify if Ministry of Health, or
Department of Disease Control,
or Ministry of Finance, or nongovernmental partner, or
technical partner.)
In this proposal what is the role
of the organization responsible
for this function?
(Identify if Principal Recipient,
sub-recipient, Procurement
Agent, Storage Agent, Supply
Management Agent, etc.)
Care and Treatment Unit, VAAC,
MOH for procurement policy of HIV
pharmaceuticals and diagnostics
PR in close collaboration with Care
and Treatment Unit, VAAC, MOH,
for ARV, methadone, Condoms,
CD4 reagents and some
equipment.
Department of Planning and
Finance, MOH for general
procurement policy on health
products and equipment
(DAV), MOH for registration and
licensing of pharmaceuticals and
diagnostics
Ministry of Finance for import duty
free status
(UNICEF will act as procurement
agent for ARV drugs. Pooled
procurement service may be
applied by the GFATM).
Does this
proposal
request
funding for
additional
staff or
technical
assistance
Yes
No
Provincial AIDS Center (PAC),
MOH, for OI, STI drugs, HIV testkits, Needle/Syringe, other reagents
and basic equipment
National Office of Intellectual
Property of Viet Nam, Ministry of
Science and Technology
Intellectual property rights
(DAV), MOH
PR in cooperation with DAV, MOH
No
Multilateral Track Policy
Department, Ministry of Trade
Quality assurance and quality
control
(DAV), MOH
PR in cooperation with DAV, MOH
and NIDQC
National Institute of Drug Quality
Control of Viet Nam (NIDQC)
Management and coordination
more details required in
s.4.10.3.
VAAC, MOH
Provincial Department of Health
(DOH) and PAC, MOH
Yes
Yes
No
PR, MOH
Yes
PAC, MOH
No
45/71
ROUND 9 – HIV
VAAC, MOH
Product selection
Therapy Department, MOH
M&E unit and Care and Treatment
Unit, VAAC, MOH
Management Information
Systems (MIS)
Finance, MOH
PR in close collaboration with Care
and Treatment Unit, VAAC, MOH,
based on the National and GFATM
Guidelines
Yes
No
PR, MOH
PAC and District Preventive
Medicine Centers, MOH
Yes
SR, MOLISA
No
Center for Health Information
Technology, MOH
Care and Treatment unit, VAAC,
MOH, for government-funded
services
PR, MOH
PR in cooperation with Care and
Treatment Unit, VAAC, MOH for
GFATM-funded services
Forecasting
Yes
SR, MOPS
SR, MOLISA
No
SCMS/MSH for PEPFAR-funded
services
PR, MOH
VAAC, MOH
Procurement and planning
Storage and inventory
management
more details required in
s.4.10.4
PAC
Finance, MOH
Central Pharmaceutical Company
(CPC) – 1
Yes
SR, MOLISA
SR, MOPS
No
(CPC) – 1
Yes
No
(CPC) – 1
Distribution to other stores and
end-users
More details required in
s.4.10.4
(CPC) – 1
PAC, MOH
MOPS
MOLISA
Ensuring rational use and
patient safety
(pharmacovigilance)
Therapy Department, MOH
PR, MOH
Care and Treatment Unit, VAAC,
MOH
MOPS
MOLISA
PAC, MOH
Yes
No
Yes
No
4.10.3. Past management experience
What is the past experience of each organization that will manage the process of procuring, storing and overseeing
distribution of pharmaceutical and health products?
PR, subrecipient, or
agent?
Organization Name
Total value procured during
last financial year
(Same currency as on cover of proposal)
VAAC, MOH
PR
Over US $1,800,000 of pharmaceuticals
and health products (ARVs, HIV test
kits, medical supplies)
UNICEF
UN agency in charge
of procurement
UNICEF
procures
and
delivers
medicines and healthcare products for
over $700 million annually.
CPC 1
Storage and
distributor
Annual turnover is approximately US $
50 million.
[use the "Tab" key to add extra rows if more
than four organizations will be involved in the
46/71
ROUND 9 – HIV
management of this work]
4.10.4. Alignment with existing systems
Describe the extent to which this proposal uses existing country systems for the management of the
additional pharmaceutical and health product activities that are planned, including pharmacovigilance
systems. If existing systems are not used, explain why.
This proposal will utilize existing country systems for procurement and supply management of
pharmaceuticals and health products. The PR (VAAC, MOH) will be responsible for procurement policies,
intellectual property rights, quality assurance and quality control, management and coordination, and
ARV product selection and forecasting in close collaboration with other VAAC units (e.g. Care and
Treatment unit), the MOH departments (e.g. Drug Administration of Viet Nam and Therapy Departments),
and the other Ministries (e.g. National Office of Intellectual Property of Viet Nam, Ministry of Science and
Technology).
Storage and distribution of ARV drugs are currently contracted to Central Pharmaceutical Company 1
(CPC-1) regardless of the source of drugs (Government, GFATM and PEPFAR). The contractor is
chosen by VAAC, MOH, on behalf of MOPS and MOLISA, through annual tender. GF-9 will work with the
nationally selected contractor for storage and distribution of ARV drugs and methadone.
OI and STI drugs and HIV test kits will be provided and distributed by PAC, MOPS and MOLISA to their
respective entities and civil society partners following the national guidelines and PR’s overall
supervision. Under the decentralized health system in Viet Nam, Provincial AIDS Centers are responsible
to procure and supply medicines, with supplemental support from a number of central, vertical programs
such as National TB Program. Since the majority of the OI medicines are standard, commonly available
medicines and materials already being purchased and provided by provincial health operations, it is not
appropriate to establish duplicate vertical systems of supply.
As for Management Information System (MIS), CPC-1 operates its own drug MIS computer system that
has been in use since 1998 and conforms to ASEAN/Viet Nam GSP certification. The system provides
monitoring of batch numbers and expiry dates throughout all transactions. CPC#1 provides monthly
reports to PR/VAAC, MOPS and MOLISA on its transactions and activities. The reporting on the number
of patients and ARV regimen breakdown from the service delivery sites to PR/VAAC will be done through
the National routine reporting system (National Decision 28 and National Decision 2051) will be used.
Strengthening of pharmacovigilance activities for HIV medicines is currently under discussion at the
VAAC. WHO is providing technical support.
4.10.5. Storage and distribution systems
National medical stores or equivalent
(a)
Which organization(s) have
primary responsibility to
provide
storage
and
distribution services under
this proposal?
Sub-contracted national organization(s)
(specify)
Sub-contracted international organization(s)
(specify)
Other:
(specify)
47/71
ROUND 9 – HIV
(b)
For storage partners, what is each organization's current storage capacity for pharmaceutical
and health products? If this proposal represents a significant change in the volume of products
to be stored, estimate the relative change in percent, and explain what plans are in place to
ensure increased capacity.
Central Pharmaceutical Company Number 1 (CPC-1) was established in April 1971. Its predecessor
was the Central Pharmaceutical State Store, which was founded in 1956. It is fully licensed to act as a
pharmaceutical and medical materials importer, to operate storage facilities and to distribute
pharmaceuticals and medical materials nationally and has been approved to handle public sector
pharmaceutical and medical materials. Today CPC-1 has commercial relationships with over 50 foreign
pharmaceutical enterprises to act as their importer and distributor of products in Viet Nam. CPC-1
employs some 270 staff.
CPC# 1 operates storage space with ASEAN Good Storage Practice (GSP) certification, distribution with
Good Distribution Practice certification (GDP) and quality assurance laboratories with Good Laboratory
Practice (GLP) certification. In Hanoi 5,000 sq m of GSP certified AC storage space is available and in
HCMC, 600 sq m shortly increasing to 2,000 sq m. Area is racked in four tier, pallet size, metal shelving.
CPC-1 is currently acting as the importer and storage agent for all PEPFAR, GFATM, and government
budget funded ARVs.
At recent inspection, roughly 20% free storage space was available in Hanoi. It is estimated that the total
central level storage requirement under this proposal will be less than 5% of the storage space currently
available. CPC1 provides detailed monthly reports of all stock movements to all its clients.
Storage and distribution capacity at the provincial level varies widely and is addressed in various ways by
different provinces. Some provinces have large warehouse stores, others use contracted licensed
pharmaceutical distributors to store and distribute on their behalf.
In summary, this proposal will not pose a significant change in the volume of products to be stored at the
central and provincial levels.
(c)
For distribution partners, what is each organization's current distribution capacity for
pharmaceutical and health products? If this proposal represents a significant change in the
volume of products to be distributed or the area(s) where distribution will occur, estimate the
relative change in percent, and explain what plans are in place to ensure increased capacity.
Central Pharmaceutical Company Number 1 (CPC-1) has annual turnover in excess of US $50 million
with 70% for pharmaceutical products and the remainder for medical supplies such as vaccines,
laboratory diagnostics, and medical/surgical materials. CPC-1 procures and distributes pharmaceutical
materials nationwide on behalf of the government of Viet Nam and regularly serves some 31 provinces
with monthly direct deliveries and other provinces on a less frequent service. CPC-1 operates its own
fleet of 9 air-conditioned large vehicles, plus many smaller vehicles in HCMC (required by traffic
restrictions on use of large vehicles in city limits), and contracted additional transport services. CPC-1 is
currently acting as the distributor for all PEPFAR, GFATM, and Government Budget funded ARVs.
It is estimated that this proposal represents less than a 2% increase in their distribution activities. The
distribution cost of medicines and health products was budgeted in this proposal to cope with the
increased distribution activities.
48/71
ROUND 9 – HIV
4.10.6. Pharmaceutical and health products for initial two years
Complete 'Attachment B-HIV' to this Proposal Form, to list all of the pharmaceutical and health
products that are requested to be funded through this proposal.
Also include the expected costs per unit, and information on the existing 'Standard Treatment Guidelines
('STGs'). However, if the pharmaceutical products included in ‘Attachment B-HIV’ are not included in the
current national, institutional or World Health Organization STGs, or Essential Medicines Lists ('EMLs'),
describe below the STGs that are planned to be utilized, and the rationale for their use.
The National Standard Treatment Guidelines (National Guidelines on HIV Diagnosis and Treatment) have
been reviewed, and the revised Guidelines will be issued in June 2009, fully in line with WHO’s 2006
Guidelines and its additional recommendations (e.g. use of d4T 30 mg regardless of body weight). The
ARV drugs for adult treatment proposed for the first two years (detailed in Attachment B) are based on
the revised National Guidelines. While some of the ARV drugs proposed are not included in the current
version of National Essential Drug List (EML) which was issued in 2005, all the selected ARV items are
on WHO’s Model List of Essential Drugs 15th edition (March 2007) and MOH plans to update the National
EML in the near future to include drugs on the National Standard Treatment Guidelines.
4.10.7. Multi-drug-resistant tuberculosis
Yes
Is the provision of treatment of multi-drugresistant tuberculosis included in this HIV
proposal as part of HIV/TB collaborative
activities?
In the budget, include USD 50,000 per year over the full
proposal term to contribute to the costs of Green Light
Committee Secretariat support services.
No
Do not include these costs
49/71
ROUND 9 – HIV
4B.
PROGRAM DESCRIPTION – HSS CROSS-CUTTING INTERVENTIONS
Optional section for applicants
SECTION 4B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only if:

The applicant has identified gaps and constraints in the health system that have an impact
on HIV, tuberculosis and malaria outcomes;

The interventions required to respond to these gaps and constraints are 'cross-cutting' and
benefit more than one of the three diseases (and perhaps also benefit other health
outcomes); and

Section 4B is not also included in the tuberculosis or malaria proposal
Read the Round
interventions.
9
Guidelines
to
consider
including
HSS
cross-cutting
'Section 4B' can be downloaded from the Global Fund's website here if the applicant
intends to apply for 'Health systems strengthening cross-cutting interventions' ('HSS crosscutting interventions').
50/71
ROUND 9 – HIV
5.
FUNDING REQUEST
5.1.
Financial gap analysis - HIV
Î Summary Information provided in the table below should be explained further in sections 5.1.1 – 5.1.3 below.
Financial gap analysis (same currency as identified on proposal coversheet) - Figures shown in 1000 USD
Note Î Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2007; etc) to align with national planning and fiscal
periods
Actual
2007
Planned
2008
2009
Estimated
2010
2011
2012
2013
2014
2015
HIV program funding needs to deliver comprehensive prevention, treatment and care and support services to target populations
Line A Î
Provide annual
amounts
85,183.00
115,402.10
Line A.1 Î Total need over length of
Round 9 Funding Request
142,059.70
167,563.30
191,135.90
219,009.40
250,000.00
250,000.00
250,000.00
(combined total need over Round 9
proposal term)
Current and future resources to meet financial need
Domestic
source B1:
Loans and
debt relief
(provide
name of source
)
Domestic
source B2
National
funding
resources
NA
NA
NA
State Budget
5,300.00
5,500.00
5,800.00
6,000.00
6,200.00
6,400.00
6,600.00
6,600.00
6,600.00
Local Budget
Domestic
source B3
1,200.00
1,400.00
1,600.00
1,800.00
2,000.00
2,200.00
2,400.00
2,400.00
2,400.00
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
51/71
NA
NA
ROUND 9 – HIV
Private Sector
contributions
(national)
Total of Line
B entries Î
Total current &
planned
DOMESTIC
(including debt
relief)
resources:
6,500.00
6,900.00
7,400.00
7,800.00
8,200.00
8,600.00
9,000.00
9,000.00
9,000.00
DFID/NORAD
6,298.10
6,493.10
11,967.00
11,967.00
11,967.00
0
0
0
0
KfW
830.9
830.9
830.9
830.9
830.9
830.9
0
0
0
PEPFAR
49,000.00
50,000.00
85,000.00
85,000.00
85,000.00
85,000.00
85,000.00
85,000.00
85,000.00
CIDA Canada
1,664.30
1,664.30
0
0
0
0
0
0
0
ESTHER
French
Embassy
947.3
534.6
122
122
0
0
0
0
0
0
96
0
0
0
0
0
0
0
AusAID
1,200.00
800
1,920.00
1,920.00
1,920.00
0
0
0
0
SIDA
External
source C2
Multilateral
donors
0
240
240
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
External
source C 1
Bilateral
donors
World Bank
(WB)
5,743.30
5,743.30
5,743.30
5,743.30
0
0
0
ADB
3,333.30
3,333.30
3,333.30
3,333.30
0
0
0
UNICEF
708
289
274
252.5
0
0
0
WHO (w/o incountry funding)
UNDP and
SIDA
280
200
0
0
0
0
0
826.4
826.4
492.6
100
0
0
0
UNAIDS
66.7
66.7
0
0
0
0
0
UNODC
600
700
600
0
0
0
0
52/71
ROUND 9 – HIV
External
source C3
NGOs
Clinton
Foundation
Ford
Foundation
Medical
Committee
Netherlands
Viet Nam
External
source C4
Other
organizations
1,000.00
1,330.00
1,330.00
1,330.00
0
0
0
0
0
386.2
131.9
0
0
0
0
0
0
0
460
380
0
0
0
0
0
0
0
486
114
0
0
0
0
0
0
0
Other
organizations
External
source C5
Private Sector
contributions
(International)
Total of Line
C entries Î
Total current &
planned
EXTERNAL
(non-Global
Fund grant)
resources:
74,422.20
72,973.50
111,853.10
110,599.00
99,717.90
85,830.90
85,000.00
85,000.00
85,000.00
Line D:
Annual value
of all existing
Global Fund
grants for
same disease:
Include
unsigned
‘Phase 2’
amounts as
“planned”
amounts in
relevant years
4,624.20
5,109.60
5,702.80
6,070.50
12,149.53
10,467.47
9,797.41
11,599.00
12,719.80
NA
NA
NA
NA
NA
NA
53/71
NA
ROUND 9 – HIV
Line E Î
Total current
and planned
resources (i.e.
Line E = Line B
total +
Line C total +
Lind D Total)
85,546.40
84,983.10
124,955.90
124,469.50
120,067.43
104,898.37
103,797.41
105,599.00
106,719.80
Calculation of gap in financial resources and summary of total funding requested in Round 9 (to be supported by detailed budget)
Line F Î
Total funding
gap
(i.e. Line F =
Line A – Line E)
363.40
30,419.00
17,103.80
43,093.80
71,068.47
114,111.03
146,202.59
144,401.00
143,280.20
12,948,131
14,550,682
24,223,125
25,426,372
26,838,382
Line G = Round 9 HIV funding request
(same amount as requested in table 5.3
for this disease)
n/a
n/a
Financial gap analysis (same currency as identified on proposal coversheet) - Figures shown in 1000 USD
Note Î Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2007; etc) to align with national planning and fiscal
periods
Actual
2007
Planned
2008
2009
Estimated
2010
2011
2012
2013
2014
HIV program funding needs to deliver comprehensive prevention, treatment and care and support services to target populations
Line A Î Provide
annual amounts
85,183.00
115,402.10
Line A.1 Î Total need over length of Round
9 Funding Request
142,059.70
167,563.30
191,135.90
219,009.40
250,000.00
(combined total need over Round 9
proposal term)
Current and future resources to meet financial need
54/71
2015
ROUND 9 – HIV
Domestic source
B1:
Loans and debt
relief
(provide name of
source )
Domestic source
B2
National funding
resources
NA
NA
NA
NA
State Budget
5,300.00
5,500.00
5,800.00
6,000.00
6,200.00
6,400.00
6,600.00
Local Budget
Domestic source
B3
Private Sector
contributions
(national)
Total of Line B
entries Î Total
current & planned
DOMESTIC
(including debt
relief) resources:
1,200.00
1,400.00
1,600.00
1,800.00
2,000.00
2,200.00
2,400.00
NA
NA
NA
NA
NA
NA
NA
NA
6,500.00
6,900.00
7,400.00
7,800.00
8,200.00
8,600.00
9,000.00
DFID/NORAD
6,298.10
6,493.10
11,967.00
11,967.00
11,967.00
0
0
KfW
830.9
830.9
830.9
830.9
830.9
830.9
0
PEPFAR
49,000.00
50,000.00
85,000.00
85,000.00
85,000.00
85,000.00
85,000.00
CIDA Canada
1,664.30
1,664.30
0
0
0
0
0
ESTHER
947.3
534.6
122
122
0
0
0
French Embassy
0
96
0
0
0
0
0
AusAID
1,200.00
800
1,920.00
1,920.00
1,920.00
0
0
SIDA
External source
C2
Multilateral
donors
0
240
240
0
0
0
0
External source C
1
Bilateral donors
55/71
NA
NA
NA
NA
ROUND 9 – HIV
World Bank (WB)
5,743.30
5,743.30
5,743.30
5,743.30
0
0
0
ADB
3,333.30
3,333.30
3,333.30
3,333.30
0
0
0
UNICEF
708
289
274
252.5
0
0
0
WHO (w/o incountry funding)
280
200
0
0
0
0
0
UNDP and SIDA
826.4
826.4
492.6
100
0
0
0
UNAIDS
66.7
66.7
0
0
0
0
0
UNODC
External source
C3
600
700
600
0
0
0
0
Clinton Foundation
1,000.00
1,330.00
1,330.00
1,330.00
0
0
0
Ford Foundation
Medical Committee
Netherlands Viet
Nam
External source
C4
Other
organizations
386.2
131.9
0
0
0
0
0
460
380
0
0
0
0
0
486
114
0
0
0
0
0
NGOs
Other
organizations
External source C5
Private Sector
contributions
(International)
Total of Line C
entries Î Total
current & planned
EXTERNAL (nonGlobal Fund grant)
resources:
NA
74,422.20
72,973.50
111,853.10
NA
110,599.00
NA
99,717.90
NA
85,830.90
NA
85,000.00
56/71
85,000.00
85,000.00
ROUND 9 – HIV
Line D: Annual
value of all existing
Global Fund grants
for same disease:
Include unsigned
‘Phase 2’ amounts as
“planned” amounts in
relevant years
4,624.20
5,109.60
5,702.80
6,070.50
12,149.53
10,467.47
9,797.41
85,546.40
84,983.10
124,955.90
124,469.50
120,067.43
104,898.37
103,797.41
11,599.00
12,719.80
Line E Î Total
current and planned
resources (i.e. Line
E = Line B total +
Line C total +
Lind D Total)
105,599.00
106,719.8
0
Calculation of gap in financial resources and summary of total funding requested in Round 8 (to be supported by detailed budget)
Line F Î Total
funding gap
(i.e. Line F = Line
A – Line E)
363.40
30,419.00
17,103.80
43,093.80
Line G = Round 9 HIV funding request
(same amount as requested in table 5.3 for this
disease)
n/a
n/a
71,068.47
114,111.03
146,202.59
144,401.00
12,948,13
1
14,550,68
2
24,223,12
5
25,426,372
57/71
143,280.2
0
26,838,3
82
ROUND 9 – HIV
Part H – 'Cost Sharing' calculation for Lower-middle income and Upper-middle income applicants
In Round 9, the total maximum funding request for HIV in Line G is:
(a)
For Lower-Middle income countries, an amount that results in the Global Fund's overall contribution (all grants) to the national program reaching not more than 65% of
the national disease program funding needs over the proposal term; and
(b)
For Upper-Middle income countries, an amount that results in the Global Fund overall contribution (all grants) to the national program reaching not more than 35% of
the national disease program funding needs over the proposal term.
Line H Î Cost Sharing calculation as a percentage (%) of overall funding from Global Fund
Cost sharing =
(Total of Line D entries over 2010-2014 period + Line G Total) X 100
n/a
Line A.1
58/71
ROUND 9 – HIV
5.1.1. Explanation of financial needs – LINE A in table 5.1
Explain how the annual amounts were:
•
developed (e.g., through costed national strategies, a Medium Term Expenditure Framework
[MTEF], or other basis); and
•
budgeted in a way that ensures that government, non-government and community needs were
included to ensure fully implementation of country's HIV program strategies.
Funds required to achieve the National Strategy objectives through 2010 were estimated for each
component of the 8 Programmes of Action (PoA) by Futures Group International (Futures) using the
Resource Needs Model as shown in the table below. For years 2010-11, estimates were made based
on slope of the financial needs trend generated by Futures.
As the epidemic in Viet Nam matures, the number of AIDS cases will grow substantially in relation to
new HIV cases, requiring a great deal of resources for treatment, care and support. Treatment will
account for the greatest proportion of financial need for the period 2006-12. Most funds needed are
for procurement of ARV drugs, equipment, and supplies for HIV diagnosis, testing, treatment and
monitoring.). The vast majority of resource needs for harm reduction are for implementation of
interventions targeting most-at-risk populations (IDU, SW, MSM) and the partners of IDU and PLHIV,
including peer education, needle and syringe distribution, condom promotion, STI diagnosis and
treatment, counseling and testing, and MMT.
Estimation of funding needs for HIV activities in Viet Nam, 2006-2012
Funding needs for 2006-12 (US$) – High level estimation
8 PoA
2006
2007
2008
2009
2010
2011
2012
IEC/BCC
Harm reduction
PMTCT
STI management and
treatment
16,499,743
11,593,613
3,795,697
19,842,128
13,339,316
4,767,520
23,766,419
15,440,436
5,850,984
28,397,607
17,974,154
7,021,539
32,988,552
20,296,567
8,301,168
35,040,467
22,041,668
8,404,187
37,381,234
23,943,754
8,519,257
1,942,702
2,648,131
3,436,793
4,311,799
5,135,131
5,342,091
5,415,657
Blood safety transfusion
HIV treatment and care
HIV M&E & surveillance
Capacity building and
International cooperation
614,075
35,350,597
4,038,208
621,589
45,982,450
4,859,836
629,230
59,543,640
5,067,705
637,001
76,819,486
5,293,991
644,904
92,893,469
5,541,262
652,119
112,079,275
5,785,141
660,282
135,204,740
6,061,089
1,614,763
1,549,350
1,666,912
1,604,106
1,762,261
1,790,922
1,823,348
Total
75,449,398
93,610,320
115,402,119
142,059,683
167,563,314
191,135,870
219,009,361
Input data for calculating the above estimation included:
•
Demographic data (magnitude, age, gender, and population)
•
Estimated numbers of target populations that need interventions, including most-at-risk
populations (drug users, female sex workers, men having sex with men), and vulnerable groups
(truck drivers, migrant population), youth, women, and street-children
•
Reported, estimated, and projected numbers of HIV infected people and data collected from HIV
sentinel surveillance on the target populations
•
Recently reported and estimated data on sexually transmitted infections
•
Number of residents in TECs
•
Data from Behavioral Surveillance provided by the MOH and studies conducted by NIHE
•
The administrative structure of Viet Nam, such as number of provinces, cities, districts, precincts
and communes
•
Unit costs for interventions, testing services, treatment and care
•
Estimation of specific indicators for different years (estimated by MOH) in order to achieve the
objectives of the National Strategy
59/71
ROUND 9 – HIV
The key resource needs include human resources, equipment and commodities, and capacity
building. Costs for human resources in HIV prevention and control cover training and capacity
building, but exclude pre-service training, incentives given to government employees, social
insurance, health insurance, travel costs, and other administrative fees. Costs for supplies and
equipment in HIV prevention and control activities cover equipment for HIV testing laboratories, but
exclude costs for civil works, maintenance, regular running costs, and travel for program monitoring.
5.1.2. Domestic funding – 'LINE B' entries in table 5.1
Explain the processes used in country to:
•
prioritize domestic financial contributions to the national HIV program (including HIPC [Heavily
Indebted Poor Country] and other debt relief, and grant or loan funds that are contributed
through the national budget); and
•
ensure that domestic resources are utilized efficiently, transparently and equitably, to help
implement treatment, prevention, care and support strategies at the national, sub-national and
community levels.
1. The National AIDS Program (NAP): The annual state budget for HIV is likely to increase
gradually from US$6.1 million in 2006 to US$8.6 million by 2012. The NAP covers all HIV
activities articulated in the 8 PoA. Because this budget is for program implementation by 18
Ministries and Sectors in 63 provinces and cities, the resulting budget for individual programs is
fairly limited. The budget allocation for 2007 is US$6.9 million, and the NAP has requested an
additional US$2.5 million. Of the allocated amount, US$0.3 million is for prevention activities, and
US$1.1 million is for care and treatment, exclusive of ARV drugs (Department of Finance and
Planning – VAAC).
2. Local budget. The National Strategy on HIV requires that activities be integrated into national
and local socio-economic development plans. Local authorities are responsible for the
mobilization of local resources such as budget, human resources, and materials for
implementation of the program. In 2006-2007, the local budget mobilized for HIV was
US$850,000 in 2006, and US$1,000,000 in 2007. In the next 5 years, the MOH is requesting
local authorities to make contributions of up to 25% of the allocated state budget for
implementing HIV activities in their locality. Local capacity to contribute, however, depends on the
social and economic conditions of each province. By 2004, 34 of the country’s 63 provinces and
cities had not provided additional financial support to HIV prevention and control.
3. Debt relief. There is no funding through debt relief for HIV in Viet Nam.
4. Loans. There is no funding through loans for HIV in Viet Nam.
5.1.3. External funding excluding Global Fund – 'LINE C' entries in table 5.1
Explain any changes in contributions anticipated over the proposal term (and the reason for any
identified reductions in external resources over time). Any current delays in accessing the external
funding identified in table 5.1 should be explained (including the reason for the delay, and plans to
resolve the issue(s)).
There has been a steady increase in external support to Viet Nam on HIV in the last 10 years. Major
donors for HIV projects include the Asian Development Bank (ADB), DFID/NORAD, KfW, GF-6 and
GF-8 HIV grants, PEPFAR, and the World Bank. The projects funded by these donors support
interventions in multiple service areas.
HIV Prevention: Major donors providing funding for HIV prevention in the period 2006-2013 include:
AusAID (US$8.7 million), the WB (US$35 million), DFID/NORAD (US$12.8 million), ADB ($US20
60/71
ROUND 9 – HIV
million), PEPFAR (US$ 550 million), KfW (US$4.1 million US$), UNODC (US$3.2 million), CIDA
(US$1.6 million), and the Ford Foundation (US$1.0 million). (Note: PEPFAR funding pending followon initiative).
1. HIV prevention through IEC/BCC activities are conducted by most HIV programs; two major
programs in this service area include the ADB (2005-2010), targeting young people in 20
provinces, and the WB (2006-2011), targeting most-at-risk populations of IDUs and SWs in 20
provinces.
2. Harm reduction, including condom promotion and STI management, is implementing by a
number of projects. There is one key programs working on harm reduction, DfID / WB (2006 2012), in 24 provinces. HIV activities in TECs have been conducted at pilot scale, initially focused
on training and BCC interventions funded by AusAID, the Center for Community Health and
Development (COHED), PEPFAR/FHI, PEPFAR/HAIVN, and UNODC.
3. Blood Safety is mainly supported by the NAP and a WB-supported program, though PEPFAR is
providing limited support through the Department of Defense. The WB program, with total funds
of US$ 38.2 million for the period 2003-2009, aims at building four regional blood banks and
ensuring the safety of blood supply.
4. PMTCT is supported mainly by four donors including PEPFAR/LIFE-GAP, UNICEF, GF-6, GF-8
and Clinton HIV/AIDS Initiative (CHAI). PEPFAR supports PMTCT at the National obstetrics and
gynecology hospital, four provincial hospitals and 13 district sites in four cities and provinces.
UNICEF (2005-2010) supports PMTCT in five districts of five provinces. The GF-6 HIV Project
(2008-2012) plans to expand PMTCT package to 25 districts. CHAI began provincial PMTCT pilot
in Q1 2009.
HIV Testing and Counseling: VCT services are mainly covered by the PEPFAR/CDC/LIFE-GAP
project (2001-2010) in 38 provinces, the GF-6 HIV Project (2008-2012) in 100 districts of 20
provinces and the WB project. The Government of Germany through KfW is assisting Viet Nam
through the procurement of essential testing equipment and condoms.
HIV Care and Treatment: Major donors providing funding for HIV care and treatment in 2006-2012
include: PEPFAR (US$~120 million), ESTHER (US$0.5 million), Clinton Foundation (US$0.5 million).
HIV treatment, care and support is currently funded through the following projects: (Note: PEPFAR
funding pending PEFPAR follow-on initiative).
1. The NAP is providing ARVs for approximately 3,000 patients in all 64 provinces in 2005 and
plans to increase the number of the patients on ART by 10% each year.
2. PEPFAR is supporting LIFE-GAP (2007-2010) outpatient departments in each Provincial General
Hospital in 29 project provinces. PEPFAR is also supporting over 30 organizations including
NGOs, UN and government agencies (2004-2009 with potential extension) to cover HIV care and
ART treatment in seven high-prevalence provinces (Hai Phong, Ho Chi Minh City, Quang Ninh,
Can Tho, An Giang, Can Tho, Nghe An). As of May 2008, the program is providing 11,943 adults
with ARV treatment. PEPFAR also supports one TEC in Ho Chi Minh City with community
reintegration, drug relapse prevention and care follow-up.
3. GF-6 HIV will operate in 20 provinces where approximately 65% of the PLHIV reside, and will
support 10,200 PLHIV with ART by 2012, including those initiating treatment in TECs. ART
targets for 2009 are 5,000.
4. The Clinton Foundation HIV/AIDS Initiative (CHAI) is supporting all the pediatric treatment in
the country: At the end of 2008, there were 1461 HIV infected children on ART with CHAI
support. The CHAI/UNITAID will continue donation of ARV and OI drugs to cover all the pediatric
care and treatment needs until 2010.
5. The WB (2006-2011) is supporting care and treatment for residents of 21 TECs in 4 in Ho Chi
61/71
ROUND 9 – HIV
Minh City, Ha Noi, Hai Phong and Khanh Hoa.
6. WHO serves as a technical focal point among partner agencies in support of the National HIV
treatment, care and support program and collaboration between TB and HIV programs.
Other supportive activities: These include the PoA on HIV surveillance, monitoring and evaluation
and the PoA on capacity building, and international cooperation. Major donor funding to other
supportive activities in the 2006-2010 period include PEPFAR (~US$20 million), UNDP, and SIDA
(US$1.4 million).
1. The HIV Surveillance and M&E Program are mainly supported by the NAP, PEPFAR, UN
(UNAIDS, WHO and UNICEF) and the WB.
2. Capacity building and international cooperation is covered by the NAP.
5.2.
Detailed Budget
For the detailed budget, please see Annex 5-1
62/71
ROUND 9 – HIV
5.3.
Objective
Number
Summary of detailed budget by objective and service delivery area
Service delivery area
(Use the same numbering as in
program description in s.4.5.1.)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
SDA 1.1: Harm reduction
- Needle/Syringes
Program (NSP) and
Methadone Maintenance
Therapy (MMT)
2,189,288
3,183,469
3,616,543
3,864,780
4,131,135
16,985,215
1
SDA 1.2: Harm reduction
- Condom Use Promotion
696,546
1,095,812
1,651,312
1,801,413
1,852,125
7,097,208
1
SDA 1.3: STI Diagnosis
and treatment
121,016
156,946
273,467
357,530
232,482
1,141,441
2
SDA 2.1: Continuum of
care
996,963
1,227,955
2,077,347
2,251,988
2,195,415
8,749,668
2
SDA 2.2: Testing and
counseling
1,220,597
697,116
1,236,492
1,254,302
1,145,761
5,554,268
2
SDA 2.3: ARV treatment,
monitoring & prophylaxis
and treatment for OIs
2,166,195
2,780,409
8,775,985
10,076,162
11,209,360
35,008,111
1
2
SDA 2.4: TB/HIV
97,500
111,202
167,927
185,518
96,101
658,248
2
SDA 2.5: PMTCT
513,799
684,826
1,799,684
1,570,420
1,843,329
6,412,058
3
SDA 3.1: Health system
strengthening Information systems
1,179,132
275,698
627,386
436,482
379,673
2,898,371
323,600.00
312,708.00
322,030.00
194,062.00
198,070.00
3
SDA 3.2: HSS -
63/71
1,350,470.0
ROUND 9 – HIV
Objective
Number
Service delivery area
(Use the same numbering as in
program description in s.4.5.1.)
Year 1
Year 2
Year 3
Year 4
Year 5
integration for
sustainability
4
5
SDA 4.1 Enabling
environment for
participation of civil
society
SDA 5.1 Strengthening of
civil society and
institutional capacity
building
Planning and Management
Round 9 HIV funding request:
Total
0
325,255
1,133,582
423,594
383,403
266,015
2,531,849
73,024
177,908
146,595
141,122
50,348
588,997
3,045,216
2,713,051
3,104,763
2,909,189
3,238,568
15,010,787
12,948,131
14,550,682
24,223,125
25,426,371
26,838,382
103,986,691
64/71
ROUND 9 – HIV
5.4.
Summary of detailed budget by cost category (Summary information in this table should be further explained in sections 5.4.1 – 5.4.3 below.)
Avoid using the "other" category unless
necessary – read the Round 9 Guidelines.
(same currency as on cover sheet of Proposal Form)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
1,815,789
2,773,646
4,307,854.
4,583,920
4,833,718
18,314,927
939,878
1,283,516
1,021,936
1,028,489
1,010,280
5,284,099
Training
3,300,531
2,930,423
2,871,326
2,555,131
2,056,895
13,714,306
Health products and health equipment
2,567,508
2,627,044
5,776,839
5,974,320
6,531,558
23,477,269
Pharmaceutical products (medicines)
788,714
1,735,777
5,762,145
6,859,436
7,726,131
22,872,203
Procurement and supply management costs
179,082
245,850
835,530
1,004,465
1,139,905
3,404,832
1,143,729
300,473
309,270
117,232
84,648
1,955,352
Communication Materials
194,492
439,011
300,037
402,515
228,612
1,564,667
Monitoring & Evaluation
957,395
539,709
1,027,405
722,595
1,030,016
4,277,120
Living Support to Clients/Target
Populations
111,656
330,159
491,860
612,981
627,735
2,174,391
Planning and administration
538,066
716,682
1,148,395
1,194,414
1,239,667
4,837,224
Overheads
165,026
158,404
135,826
148,467
125,165
732,888
246,265
469,988
234,702
222,406
204,052
1,377,413
12,948,131
14,550,682
24,223,125
25,426,371
26,838,382
103,986,691
Human resources
Technical and Management Assistance
Infrastructure and other equipment
Other: (Use to meet national budget planning
categories, if required)
Round 9 HIV funding request
(Should be the same annual totals as table 5.2)
65/71
ROUND 9 – HIV
5.4.1. Overall budget context
Briefly explain any significant variations in cost categories by year, or significant five-year totals for
those categories.
The largest portion of budget is allocated for health products and health equipment (e.g. needles,
syringes, condom for HIV prevention, medical/laboratory/radiology equipment, HIV test kits, laboratory
test cost, consumables such as gloves) and pharmaceutical products (e.g. ARV, OI and STI drugs,
methadone), which combined account for 45% of total 5-year budget. The budget for these items
increases significantly year by year as new sites will be established and an increasing number of patients
will be served.
The majority of infrastructure and equipment costs are allocated during the first three years of the grant
period to enable rapidly scaling-up services (e.g. VCT, HIV care clinics) and renovating and equipping
Provincial AIDS Center offices, the entities newly established by GVN in 2005.
Much of the TA and consensus building (review/update of National guidelines and procedures) costs are
also concentrated in the first three years. It is assumed that early investments in capacity building and
norm setting will produce long-term outcomes through the grant period and beyond, while refresher
trainings and quality improvement activities are budgeted in Year 3 to 5. Technical and management
assistance costs are reduced yearly as the grant activities will be assumed by the Government of Viet
Nam, Provincial and District teams, and community partners gains the capacity.
Annual inflation of 3% is accounted for in all budgeting for the GF-9 proposal except ARV drug costs
5.4.2. Human resources
In cases where 'human resources' represents an important share of the budget, summarize: (i) the basis
for the budget calculation over the initial two years; (ii) the method of calculating the anticipated costs
over years three to five; and (iii) to what extent human resources spending will strengthen service
delivery.
(Useful information to support the assumptions to be set out in the detailed budget includes: a list of the proposed
positions that is consistent with assumptions on hours, salary etc included in the detailed budget; and the proportion
(in percentage terms) of time that will be allocated to the work under this proposal.
Î Attach supporting information as a clearly named and numbered annex
(i) (ii) The basis of calculating human resource cost in the first year is detailed in the Annex 5-2 – Basis
for costing human resources. From the 2nd year, the 3% annual inflation was included in calculation as all
other budget items. The budget allocated to human resources accounts for the steady increase in scale of
the GFATM-supported districts/sites.
(iii) With support for salary and benefits following the Nationally-approved cost norms, newly recruited fulltime professionals at Central management unit of MoH, MOLISA and MOPS offices are expected to plan,
coordinate, implement and monitor the activities funded by GFATM effectively, as demonstrated in the
implementation of Round 1 grant. The modest salary supplement to provincial and district level part-time
staff will also follow the Round 1 and 6 experiences to motivate local MOH, MOLISA and MOPS staff in
managing and delivering services (e.g. HIV prevention, VCT, HIV care/ART, PMTCT) ensuring
effectiveness, quality and safety. Past and on-going project experience shows adequate incentive will
dramatically improves the performance of community-based partners (e.g. harm education peer
educators, home-based care staff, PLHIV group coordinators). GF-9 will support civil society and
community-based organisations following the standard cost norms.
66/71
ROUND 9 – HIV
5.4.3. Other large expenditure items
If other 'cost categories' represent important amounts in the summary in table 5.4, (i) explain the basis for
the budget calculation of those amounts.
Also explain how this contribution is important to
implementation of the national HIV program.
Î Attach supporting information as a clearly named and numbered annex
Health product and equipment
Needles, syringes, condoms and lubricant are vital tools of HIV prevention based on the target number
that the GF-9 activities plan to reach. HIV epidemic being concentrated in IDUs and SWs in Viet Nam,
distribution will target those populations and the calculation for the first two years is shown in Attachment
B. Minimum sets of medical/laboratory equipment will be procured that are necessary to deliver quality
services (testing and counseling, HIV care/ART, TB/HIV, PMTCT) following the National standards and
based on the gap analysis. This will include, in addition to those provided to CCSs and TECs, laboratory
equipment needed to strengthen Provincial laboratories and 5 CD4 count machine to cover several
provinces.
Pharmaceutical products
The National guidelines on HIV care and treatment is the process of revision based on recent
international evidence, which is being finalized. The selection and forecasting of first and second line ARV
drugs is based on the revised National Guidelines, and current clinical practices in Viet Nam.
5.5.
Funding requests in the context of a common funding mechanism
In this section, common funding mechanism refers to situations where all funding is contributed into a
common fund for distribution to implementing partners.
Do not complete this section if the country pools, for example, procurement efforts, but all other
funding is managed separately.
5.5.1. Operational status of common funding mechanism
Briefly summarize the main features of the common funding mechanism, including the fund's name,
objectives, governance structure and key partners.
Î Attach, as clearly named and numbered annexes to your proposal, the memorandum of understanding, joint
Monitoring and Evaluation procedures, the latest annual review, accountability procedures, list of key partners, etc.
N/A
5.5.2. Measuring performance
How often is program performance measured by the common funding mechanism? Explain whether
program performance influences financial contributions to the common fund.
5.5.3
Additionality of Global Fund request
Explain how the funding requested in this proposal (if approved) will contribute to the achievement of
outputs and outcomes that would not otherwise have been supported by resources currently or planned
to be available to the common funding mechanism.
If the focus of the common fund is broader than the HIV program, applicants must explain the process by which they
will ensure that funds requested will contribute towards achieving impact on HIV outcomes during the proposal term.
67/71
ROUND 9 – HIV
5B.
FUNDING REQUEST – HSS CROSS-CUTTING INTERVENTIONS
Applying for funding for HSS cross-cutting interventions is optional in Round 9
SECTION 5B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only if this
disease includes the applicant's programmatic description of HSS cross-cutting interventions
in s.4B.
Read the Round 9 Guidelines to consider including HSS cross-cutting
interventions
Download 'Section 5B' from the Global Fund website here if the applicant intends to
apply for 'Health systems strengthening cross-cutting interventions' ('HSS crosscutting interventions') in Round 9 and has completed section 4B and included that
section in the HIV proposal sections.
68/71
Proposal checklist – Section 3 to 5 HIV
Section 3 and 4: Program Description
4.1
Supporting documentation for National Strategy
List Annex Name
and Number
Annex 4-1 National
strategy on HIV/AIDS
Prevention and
Control to 2010 with
vision to 2020
Annex 4-2 The Law
on Prevention and
Control of HIV/AIDS
Annex 4-3 National
HIV/AIDS Monitoring
and Evaluation
Framework
4.2.1
Map if proposal targets specific region/population group
Map pasted in
Section 4
4.3.2
Any recent report on health system weaknesses and gaps
that impact outcomes for the three diseases (and beyond if it
exists).
Annex 4-4
UNGASS(2008) Third Country Report
on Following Up the
Declaration of
Commitment on
HIV/AIDS, Viet Nam
4.4
Document(s) that explain basis for coverage targets
Annex 4-5
4.5.1
A completed 'Performance Framework' by disease
Refer to the M&E Toolkit for help in completing this table.
Attachment A
4.5.1
A detailed component Work Plan (quarterly information for
the first two years and annual information for years 3, 4 and 5)
by disease.
Annex 4-6 Detailed
Work Plan
4.5.2
A copy of the Technical Review Panel (TRP) Review Form
for unapproved Round 7 or Round 8 proposals (only if
relevant).
Not applicable
4.8.1
A recent evaluation of the ‘Impact Measurement Systems’
as relevant to the proposal (if one exists)
Not applicable
4.9.1
A recent assessment of the Principal Recipient capacities
(other than Global Fund Grant Performance Report).
Not applicable
4.9.1
Document describing the organization such as: official
registration papers, summary of recent history of
organization, management team information
Not applicable
List of sub-recipients already identified (including name,
Annex 4-7 Sub-
(for non-CCM
applicants)
4.9.2
69/71
sector they represent, and SDA(s) most relevant to their
activities during the proposal term)
4.10.6
A completed ‘List of Pharmaceutical and Health Products’
by disease (if applicable).
Section 4B: HSS Cross-cutting (once only in whole country proposal)
4B.2
4B.2
recipients
Attachment B
List Annex Name
and Number
A completed separate HSS cross-cutting 'Performance
Framework' (or add a separate “worksheet” to the
disease ‘Performance Framework’ under which s. 4B is
submitted)
Refer to the M&E Toolkit for help in completing this table.
Not applicable
A detailed separate HSS cross-cutting Work Plan (or add
a separate “worksheet” to the disease Work Plan under
which s. 4B is submitted) (quarterly information for the first
two years and annual information for years 3, 4 and 5).
Not applicable
Section 5: Financial Information
List Annex Name
and Number
5.2
A ‘detailed budget’ (quarterly information for the first two
years, and annual information for years 3, 4 and 5)
5.4.2
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by proposal
(only if relevant)
Annex 5-2
5.4.3
Information on basis of costing for ‘large cost category’ items
Annex 5-3
5.5.1
Documentation describing the functioning of the common
funding mechanism
Not applicable
Most recent assessment of the performance of the common
funding mechanism
Not applicable
(if common
funding
mechanism)
5.5.2
(if common
funding
mechanism)
Section 5B: HSS Cross-cutting financial information
5B.1
5B.4.2
Detailed Budget
List Annex Name
and Number
A separate HSS cross-cutting ‘detailed budget’ (or add a
separate “worksheet” to the disease ‘detailed budget’
under which s. 4B is submitted). Quarterly information for
the first two years, and annual information for years 3, 4
and 5).
Not applicable
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by proposal
(only if relevant)
Not applicable
70/71
5B.4.3
Information on basis of costing for ‘large cost category’ items
Other documents relevant to sections 3, 4 and 5 attached by Applicant:
Not applicable
List Annex Name
and Number
4.9.2
Information on Management Structure of Government Track
and Civil Society Track
Annex 4-8
Management
Structure
4.5.1
Information on Needle and Syringe Program models
Annex 4-9 NSP
models
4.5.1
Table on SDAs by Government Track and Civil Society Track
Annex 4-10 SDAs
table
71/71
Attachment A - HIV Performance Framework
Program Details
Country:
Disease:
Proposal ID:
Viet Nam
HIV
Program Goal, impact and outcome indicators
Goals
1 To reduce the spread of HIV and HIV related morbidity and mortality in underserved high-prevalence districts and to strengthen community systems in order to enhance Vietnam’s response to HIV
2
3
4
5
Impact and outcome Indicators
Indicator
Baseline
value
impact
Targets
Year
Estimated prevalence among IDUs
2008
20%
impact
Estimated prevalence among FSWs
3% 2006
impact
Estimated HIV prevalence among MSMs
9% 2006
Source
VAAC,
Sentinel
surveillance
VAAC,
Sentinel
surveillance
IBBS
outcome
% of injecting drug users who used syringes and needles which had
been used by someone else in the last month
18% 2006
IBBS
outcome
% of female sex workers reporting always used condoms with all of their
clients in the last month
67% 2008
IBBS
t
outcome
ti th
d
th
d anall sex
% off men reporting
the use off condom
the llastt titime th
they h
had
with a male partner
65% 2006
IBBS
impact
% of adults and children with HIV known to be on treatment 12 months
after initiation of antiretroviral therapy
82% 2008
VAAC, ART
cohort data
collection
Special
Survey
outcome
Number of existing and newly established CBOs deliverying HIV
prevention and/or care and support services
55
Year 1
Year 2
Comments*
Year 4
19%
18%
17%
16%
2.8%
2.6%
2.4%
2.2%
Year 5
15%
Identical to R8 indicator
2% Identical to R8 indicator
7% Newly added indicator for R9
This indicator will be collected annually if it is integrated into sentinel surveillance.
5% R8 indicator has been reworded to reduce ambiguity and more accurately match the IBBS survery
instrument.
95% R8 indicator has been reworded to reduce ambiguity and more accurately match the IBBS survery
instrument.
N l added
dd d iindicator
di t ffor R9
98% Newly
82%
83%
83%
84%
85% Identical to R8 indicator
Newly added indicator for R9
60
2009
Year 3
87
111
146
181
* please specify source of measurement for indicator in case different to baseline source
Program Objectives, Service Delivery Areas and Indicators
Objective
Number
Objective description
Comments
1 Scale
Scale-up
up harm reduction activities to reduce HIV transmission through injecting drug use and high-risk
high risk sex
2 Scale-up HIV treatment, care and support services in local health facilities, communities and closed settings
3 Address systemic challenges to improve performance in achieving universal access to HIV prevention, care, treatment and support
4 Foster an enabling environment for the development and participation of civil society in the HIV response
5 Strengthen the organizational capacity of civil society organizations to maximize their contributions to the HIV response
6
7
8
9
10
11
12
13
14
15
R9_CCM_VTN_H_AttA_1Jun09_En
HIV Performance Framework
1/3
Program Details
Viet Nam
Country:
HIV
Disease:
Proposal ID:
Objective / Service Delivery Area
Indicator
Indicator
Number
(e.g.: 1.1,
1.2)
1.1
Baseline (if applicable)
Value
Year
42
Harm reduction - NSP and Number of needles and syringes
MMT
distributed per IDU per six months in
GF9 provinces
Targets for year 1 and year 2
Source
2007 DFID/WB
6 months 12 months
18
months
Annual targets for years 3, 4,
and 5
24
months
Year 3
Year 4
Directly
tied (Y/N)
Baselines
included in
targets (Y/N)
Targets cumulative
(Y-over program
term/Y-cumulative
annually/N-not
cumulative)
Year 5
DTF:
Name of
PR
responsi
ble for
implemen
tation of
Comments, methods and
frequency of data collection
45
50
55
60
70
80
90
Y
N
N - not cumulative
VAAC
GF-8 indicator has been reworded to make
it specific.
Needles and syringes distributed via social
marketing and facilitated retails excluded
excluded.
project report
1.1
Harm reduction - NSP and % of IDU regularly reached by needle Not available
MMT
syringe program in 37 government
focus provinces
40
50
53
55
60
65
70
Y
N
N - not cumulative
VAAC
GF-8 indicator has been reworded
according to WHO/UNODC/UNAIDS
technical guide to set targets for UA for
IDU.
Unique identifier code system to record
number of clients is being developed by
VAAC.
No reliable baseline figure available, but
guestimated to be 30-40%.
1.1
Harm reduction - NSP and % of IDU regularly reached by
MMT
needle syringe program in 2 civil
society focus provinces
Not available
0
7
12
21
63
70
70
Y
N
N - not cumulative
VUSTA
according to WHO/UNODC/UNAIDS
technical guide to set targets for UA for
IDU.
VAAC.
1.1
Harm reduction - NSP and % of SWs reached through outreach Not available
activities in 2 civil society focus
MMT
provinces
Harm reduction - NSP and Number of primary sexual partners of Not available
MMT
IDU and PLHIV reached by the civil
society focus 10 provinces
0
7
12
21
63
70
90
Y
N
Y - cumulative
annually
VUSTA
Newly added indicator for GF-9.
0
1,984
3,176
4,507
8,714
10,841
12,295
Y
N
Y - cumulative
annually
VUSTA
Project Special Report - Quarterly.
500
1000
3500
3750
4500
4500
4500
Y
N
N - not cumulative
VAAC
Identical to GF-8 indicator.
Baseline figure refers to district facilities
other than GF-9 supported ones.
4,147,000 7,687,000 9,440,000 11,159,000
Y
N
Y - cumulative
annually
VAAC
GF-8 indicator has been reworded to
specify.
Baseline figure refers to nationally
reported one.
1.1
1.1
1.2
1,190
Harm reduction - NSP and Number of IDUs currently receiving
MMT
methadone maintenance therapy
(from R9 district facilities)
Condom
Routine
program
monitoring
Number of condoms distributed
freely by GF-9
13 millions
Not available
Condom
% of SWs reached by condom use
program in 37 government focus
provinces.
1.2
Condom
1.3
STI
% of MSM reached through outreach Not available
activities in the civil society focus 10
provinces
85,816
Number of people receiving STI
treatment (from R9 district facilities
and closed settings)
Continuum of care
2.1
Continuum of care
2.2
Testing and counseling
2007 VAAC,
2,921,000
Routine
program
monitoring
1.2
2.1
April 2009 VAAC,
Not available
Number of home and communitybased care teams established in 10
civil society provinces
Not available
Number of PLHIV and their family
members provided with livelihoods
opportunities in 10 civil society
provinces
36,018
Number of people received HIV
testing and counseling and their test
results (from R9 district facilities and
closed settings)
40
50
55
60
70
80
90
Y
N
Y - cumulative
annually
VAAC
according to the narrative of the GF-9
proposal.
VAAC
VAAC.
No reliable baseline figure available but
guestimated to be around 20-30%.
0
4
8
12
32
40
40
Y
N
Y - cumulative
annually
VUSTA
Project Special Report - Quarterly
2,510
9,128
9,660
8,123
Y
N
Y - cumulative
annually
VAAC
Baseline figure refers to nationally
reported one.
2008 VAAC,
1,522
Routine
program
monitoring
2008 GF-6
0
77
79
108
133
133
133
Y
N
Y - over program term VUSTA
0
470
470
570
570
570
570
Y
N
8,833
17,666
12,860
25,720
85,152
85,152
85,152
Y
N
reporting
Y - cumulative
annually
VAAC
GF-8 indicator has been modified to be
specific.
Data will be collected through routine
program monitoring system every 3
months
months.
Baseline refers to GF-6 sites which will
be included from year 3 after GF-6
termination.
2/3
Program Details
C
Country:
t
Disease:
Proposal ID:
2.3
Objective /
Indicator
Number
(e.g.: 1.1,
1.2)
2.3
2.3
2.4
2.5
ARV treatment,
monitoring and
prophylaxis and treatment
for opportunistic infection
Service Delivery Area
Viett N
Vi
Nam
HIV
Indicator
Baseline (if applicable)
Year
ARV treatment,
monitoring and
for opportunistic
infection
pp
Number of individuals (children) with
advanced HIV infection who are
currently receiving ART (in R9
provinces))
p
1,479
ARV treatment,
monitoring and
for opportunistic infection
% of individuals who are currently
receiving OI prophylaxis with
cotrimoxazole (from R9 district
4,095
TB/HIV
Number of adults with advanced HIV
infection who are currently receiving
ART and were started on TB
treatment within reporting year (from
R9 district facilities and closed
settings)
595
Number of HIV-infected women who
received ARV to reduce the risk of
mother-to-child transmission (from
R9 district facilities and closed
settings)
182
PMTCT
HSS - Integrated for
sustainability
4.1
Number of newly established CBOs
Enabling enviroment for
participation of civil society in 10 civil society provinces
2008 GF-6
1,340
2,680
3,352
4,205
18,261
20,810
23,641
Y
Y
N - not cumulative
Directly
tied (Y/N)
Baselines
included in
targets (Y/N)
Targets cumulative
(Y-over program
term/Y-cumulative
annually/N-not
cumulative)
VAAC
reporting
Value
3.2
7,124
Number of individuals (adults) with
advanced HIV infection who are
currently receiving ART (from R9
district facilities and closed settings)
Targets for year 1 and year 2
Source
2008 VAAC,
6 months 12 months
18
months
Annual targets for years 3, 4,
and 5
24
months
Year 3
Year 4
Year 5
DTF:
Comments, methods and
Name of
frequency of data collection
PR
responsi
ble for
implemen
tation of
GF-8 indicator has been broken down
VAAC
into adults and children
program
monitoring
every
p
g
g system
y
y3
months
2,660
2,820
3,055
3,290
3,760
4,230
4,700
Y
Y
N - not cumulative
1,975
3,950
7,100
10,250
26,590
28,690
31,090
Y
Y
N - not cumulative
VAAC
GF-8 indicator has been reworded to be
specific.
months.
termination.
1,373
1,564
1,783
2,025
Y
N
Y - cumulative
annually
VAAC
GF-8 indicator reworded to be specific.
months.
termination.
204
1,727
1,731
1,735
Y
N
Y - cumulative
annually
VAAC
GF-8 indicator reworded to reflect global
guidance.
months.
termination.
20
30
39
39
Y
N
Y - over program term VAAC
Newly added for GF-9
13
24
35
35
Y
N
Newly added for GF-9.
Routine
program
monitoring
g
2008 GF-6
reporting
2008 GF-6
230
reporting
2008 GF-6
97
194
199
reporting
0 2008
Number of provinces with annual
provincial plans on harm reduction
and HIV treatment, care and support
Not available
GF-8 indicator has been broken down
into adults and children.
months.
termination.
VAAC
10
0
5
9
3/3