Proposal Form (R02 - ) (KGZ-R02-HA)

Transcription

The Global Fund to Fight AIDS, Tuberculosis
and Malaria
Geneva, July 2002
For the use of the Global Fund Secretariat:
Date Received:
ID No:
PROPOSAL FORM
Before starting to fill out this proposal form, please read the Guidelines for Proposals carefully. When
completing each question in the proposal form, please note the reference given to the corresponding
section of the guidelines.
This form is divided into 4 main parts:
SECTION I is an executive summary of the proposal and should be filled out only AFTER the rest of the
form has been completed.
SECTION II asks for information on the applicant.
SECTION III seeks summary information on the country setting.
SECTIONS IV to VIII seek details on the content of the proposal by different components.
How to use this form:
1. Please read ALL questions carefully. Specific instructions for answering the questions are provided.
2. Where appropriate, indications are given as to the approximate length of the answer to be provided.
Please try, as much as possible, to respect these indications.
3. All answers, unless specified otherwise, should be provided in the form. If submitting additional
pages, please mark clearly on the pages which section and numbered question this relates to.
4. To avoid duplication of efforts, we urge you to make maximum use of existing information (e.g., from
programme documents written for other donors/funding agencies).
5. When using tables, all cells are automatically expanded as you write in them. Should you wish to add a
new row, place the cursor on the outside of the cell at the bottom right-hand corner of the table and press
ENTER.
To copy tables, select all cells in the table and press CTRL+C. Place cursor where you would like the
new table to begin and press CTRL+V.
Please DO NOT fill in shaded cells.
Application Form for Proposals to the Global Fund
Page 1 of 111
1
SECTION I: Executive summary of Proposal
Please note: The Executive Summary will be used to present an overview of the proposal to various members
of the Secretariat, the Technical Review Panel and the Board of the Global Fund.
TO BE COMPLETED AFTER THE OTHER SECTIONS HAVE BEEN FILLED OUT
General information:
Proposal title (Title
should reflect scope of
proposal):
Country
or
region
covered:
Name of applicant:
Constituencies
represented in CCM
(write the number of
members from each
Category):
Table I.a
Development of preventive programmes on HIV/AIDS, tuberculosis and
malaria aimed at reduction of social and economic consequences of their
spread
Kyrgyz Republic
Coordination Committee of the
Tuberculosis and Malaria
5 Government – Health
ministry
4 Government
–
Other
ministries
3 NGO/Community-based
organizations
3 Private Sector
1
People
living
HIV/TB/Malaria*
Kyrgyz Republic on Control of HIV/AIDS,
4
UN/Multilateral agency
5
Bilateral agency
2
Academic/Educational Organizations
2
Religious/Faith groups
with
Other (please specify):
If the proposal is NOT
submitted through a
CCM, briefly state
why:
Specify which component(s) this proposal is targeting and the amount requested from the Global
Fund**:
Table I.b
Amount requested from the GF (USD thousands)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
2669597
3311186
3957417
4846664
17073306
Component(s)
HIV/AIDS
2288441
(mark with X):
Tuberculosis
633367
579468
527345
541062
489840
2771067
Malaria
362600
307600
219100
175600
115600
1180500
HIV/TB
0
0
0
0
0
0
Total
3360884
3674297
3950173
4386276
5754892
19126492
1220400
1191863
945004
732700
760000
2500000
2500000
2100000
2100000
2100000
75000
75000
55000
50000
30000
4858967
AIDS
11300000 TB
285000
Malaria
Total funds from other sources for
activities related to proposal
Please specify how you would like your proposal to be evaluated*** (mark with X):
The Proposal should be evaluated as a whole
The Proposal should be evaluated as separate components
*
According to national epidemiological profile/characteristics
If the proposal is fully integrated, whereby one component cannot be separated from another, and where splitting budgets
would not be realistic or feasible, only fill the “Total” row.
***
This will ensure the proposal is evaluated in the same spirit as it was written. If evaluated as a whole, all components will
be considered as parts of an integrated proposal. If evaluated as separate components, each component will be considered
as a stand-alone component.
2
Page 2 of 111
**
Brief proposal summary (1 page)(please include quantitative information where possible):
Describe the overall goals, objectives and broad activities per component, including expected
results and timeframe for achieving these results:
HIV/AIDS
Goal: To contain the spread of HIV in the Kyrgyz Republic at the initial stage of the epidemic through
targeted interventions among the vulnerable groups and organization of support to people living with HIV
and AIDS patients.
Objectives:
1. Strengthening political and legal support to AIDS prevention programmes based on multisectoral approach
2. Reducing vulnerability of young people
3. Containing HIV infection among vulnerable populations
3.1 Reducing vulnerability of injecting drug users
3.2 Reducing vulnerability of sex workers
3.3 Reducing vulnerability of prison inmates
3.4 Reducing vulnerability of MSM
4. Ensuring safety of donors blood
5. Provision of medical and social support to people living with HIV/AIDS and affected by them
The component will be implemented throughout the whole country and will be focused on further building
institutional capacity of government organizations and NGOs based on multisectoral approach to
implementation of the HIV/AIDS prevention programmes. The key strategies for attaining the goal will be
consensus building on the issues of national policy for HIV/AIDS prevention; improvement of legislation and
law implementation practice; involving the people affected by HIV; and AIDS servicing NGOs in political
actions for HIV/AIDS prevention at the decision-making level. Main activities will involve establishing
graduate and post-graduate training of various specialists (doctors, teachers, army servicemen, law
enforcement officials), education of trainers for development of peer educational programmes and
implementation of compulsory educational programmes on fostering healthy lifestyle in all educational
establishments. More than one million students and at least 5,000 trainers and specialists will be exposed to
such programmes. Moreover, preventive programmes for the vulnerable populations will be expanded and
strengthened to cover: 33,000 injecting drug users (IDU), about 9,000 of estimated number of sex workers
(SW) and 500,000 of SW clients by 2007; 10,000 men having sex with men (MSM), 17,000 prison inmates,
and others. Harm reduction programmes will be strengthened to such level where they actually can impact the
further development of HIV spread. These will include: syringe exchange programmes from 4 to 60% of the
estimated IDU number, methadone substitution treatment from 2% to 80% of the officially reported IDU;
increasing access to condoms from 10% to 50%, and venereologic aid for MSM from 0.7% to 50%;
prevention programmes for sex workers from 60 to 80 %. Educational programmes on fostering healthy
lifestyle will be promoted for schoolchildren and students from 30 to 90%. Interventions will be expanded on
the basis of peer education and information support for nonschool youth from single events to regular
sustainable programmes in 6 regions of the country. The number of NGOs providing support to people living
with HIV/AIDS will increase. Access to antiretroviral therapy for people living with HIV will be ensured to
fully cover all people living with HIV/AIDS who need it.
All these activities will be implemented with appropriate support and participation of government
representatives at all levels both in the capital and the regions of the country. Role, technical qualifications
and partnership networks of governmental, nongovernmental, international, community-based organizations
and people living with HIV/AIDS and affected by it will be enhanced.
Outputs:
In 2005, multisectoral committees on AIDS prevention will function sustainably on the national and local
levels.
By 2003, people living with HIV/AIDS and affected by it, and representatives of NGOs will be included in
the multisectoral committees on HIV/AIDS at oblast and local levels and exert their influence on decisionmaking in AIDS prevention.
The country’s laws and existing legal practice related to people living with HIV and representatives of
vulnerable groups will be reviewed, documented and harmonized with norms of international law.
Institutions based on government structures and NGOs will be established to provide juridical and legal aid to
people living with HIV and representatives of vulnerable groups.
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Public opinion and supportive environment will be formed to oppose stigmatisation and discrimination of
people living with HIV and representatives of vulnerable groups.
By 2007, national experts in 6 key agencies (health, education, defence, law and order, social security,
information, etc.) will be trained and a training base for these in said agencies established.
By 2007, 60% of the estimated number of IDUs will be involved in the syringe exchange programmes.
By 2005, 80% of sex workers will be covered by the peer education programmes.
By 2004, 90% of students from 10 to 24 will be exposed to training within the framework of compulsory
educational programmes on Healthy Lifestyle.
100% of the reported pregnant women living with HIV will be exposed to training and preventive treatment
to prevent pre-natal HIV transmission.
Starting from 2003, all people living with HIV who need proper treatment against HIV/AIDS with
immunological tests and viral load control will have access to it.
By the end of 2007, the estimated number of HIV cases will not exceed 2%, and the estimated number of
AIDS patients will not be more than 0.5% of the adult population of the country.
•
Specify the beneficiaries of the proposal per component and the benefits expected to accrue to them
(including target populations and their estimated number):
Principal beneficiaries of this proposal will be the entire population of Kyrgyzstan (total 5 million with 41
percent aged 10 to 29). On the whole, women as well as men and children will benefit by reduced morbidity
and mortality rates and alleviation of human, social and economic difficulties caused by HIV epidemic.
Immediate beneficiaries of the project will be government organizations, community-based and
nongovernmental organizations (CBO/NGO) involved in the activity on fighting STI, injecting drug use and
HIV/AIDS. Special target beneficiaries will be schoolchildren and youth in the age bracket from 11 to 25
(31% of the population – 1.55 million). Sexually active men and women are also of great importance, in
particular those who are especially susceptible to STI and HIV. Among these there are injecting drug users,
sex workers, men having sex with men, prison inmates and others (about 550,000). Benefits to them will be
developed owing to increased community capacity to respond to HIV/AIDS/STI epidemics and easier access
to required services and resources, first of all, to medicines and counseling through expansion of effective
preventive programmes. Both the Government and the civil society sector will assume responsibility for
reduction of the factors of vulnerability of the target populations. This will ensure a guaranty for observation
of human rights and respect for human dignity while implementing HIV/AIDS prevention programmes.
•
If there are several components, describe the synergies, if any, expected from the combination of
different components (By synergies, we mean the added value the different components bring to each
other, or how the combination of these components may have effects beyond the effects of each
component taken individually):
A combination of components on HIV/AIDS and TB prevention is especially urgent in the penitentiary and
correction system. Increase in the number of cases of HIV infection in prisons and correction facilities will
increase morbidity and mortality rates of tuberculosis as well as corresponding costs of TB treatment.
Besides, it will create additional difficulties for the people who provide care for AIDS patients since it will
expose them to a danger of tuberculosis infection. In connection with this, inclusion in the AIDS prevention
programme of issues of TB preventive treatment will enable increase of its effectiveness. In addition, it will
result in a drop in TB morbidity and mortality rates as well as increase the life expectancy and improve the
quality of life for people living with HIV/AIDS, and the AIDS-induced mortality rate will also drop.
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4
TUBERCULOSIS
Describe the overall goals, objectives and broad activities per component, including expected results
and timeframe for achieving these results:
The overall goal of this component is to reduce morbidity and mortality caused by TB in the Kyrgyz
Republic. To achieve this goal three major objectives are set:
1. Improve detection and diagnosis of smear positive TB patients
2. Uninterrupted supply of TB drugs
3. Raising effectiveness of DOTS treatment
To implement all objectives of this component the following activities should be carried out:
Health promotion among the population to bring their awareness about the initial TB symptoms to 90%
by the end of 2007;
Provision of binocular microscopes and reagents as well as laboratory personnel training to help achieve
70% microscopic confirmation of the diagnosis by the end of 2007;
Integration of TB programmes with the primary health facilities network will permit to bring the
proportion of completely cured patients to 87% by 2007.
By 2007 the morbidity rate is to be reduced to 120 cases per 100,000 population and mortality rate to 10.2
cases per 100,000 population.
•
Beneficiaries of this proposal will be 8000 annually diagnosed TB patients, about 40,000 members of their
families, about 50,000 medical personnel and general public.
Expected benefits to them:
- Achieving clinical convalescence of 6,400 TB patients, successful treatment of 87%;
- Improving social situation of the population;
- Raising effectiveness of medical personnel work.
MALARIA
Describe the overall goals, objectives and broad activities per component, including expected results and
timeframe for achieving these results:
The goal of this component is to contain/prevent malaria outbreaks, reduce the incidence of malaria, prevent
its further spread across the country, and minimize socio-economic load of this disease through the
progressive strengthening of the capacities and capabilities of health services and mobilizing community
actions in Kyrgyzstan. Sustaining component activities beyond 2007 could reduce the impact of malaria to
sufficiently low level so that it n longer represents public health problem:
Objective: 1. To strengthen institutional capacities of the national malaria control programme, general health
services and enhanced capacity for decision-making related to malaria and its control and prevention
Objective: 2. To improve capacities and access to early diagnosis and radical treatment of malaria cases
Objective: 3. To improve capacities for timely response to and prevention of malaria outbreaks.
Objective: 4. To strengthen malaria surveillance mechanisms
Objective: 5. To increase community awareness and participation in malaria control and prevention activities
The component will be implemented during 2003-2007 by the Ministry of Health in cooperation with other
counterparts and potential donors. A specific feature of this period is that the generation of medical specialists
who were familiar with malaria is replaced by the generation of specialists with insufficient skills in the area
of malaria control. But the component will have a strong and flexible management structure for
implementation of efficient and technically sound and sustainable programme of malaria control adapted to
national conditions and meeting local needs. The component will strengthen the national capacity in health
service area engaged in containment of the malaria outbreak, reduction of its incidence rate and preventing its
further spread over the country. The project will focus the efforts of the Government and Ministry of Health
on solution of malaria issues through build-up of the respective service capacity, increase of opportunities for
and access to early recognition/correct treatment and timely response to and prevention of malaria outbreaks,
strengthening surveillance mechanisms and raising public awareness and participation in malaria prevention
activities.
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5
500 students and 1,800 medical personnel will be trained annually in programme management to build up the
capacity for project activities planning and implementation; a system of graduate and post-graduate training
of medical personnel will be established as well as 400 Regional/District Medical Officers trained in existing
approaches to disease management, epidemic control and community mobilization.
The broad activities will be aimed at setting up a supervision system including 3 reference laboratories for
quality control of laboratory services and ensuring their functionality as well as 3 reference centers for
assessment of quality of care and ensuring its functionality. 250 laboratory staff will be trained in malaria
microscope. 75 laboratories in select health centers will be upgraded.
It is necessary to develop/modify/produce training/learning materials on disease management and prevention,
to upgrade laboratory facilities in select health centers. Insecticides and equipment for spraying project
transportation, laboratory equipment/supplies and drugs/other items required for disease management will be
procured and delivered to malaria-prone zones as well as equipment and supplies to improve supervision and
monitoring of project activities at all levels. Emergency preparedness of specialized health service for and
response to malaria epidemics in project areas where outbreaks are a recurring problem will be improved.
Strengthening community and family care and prevention practices trough provision of IEC materials,
awareness raising sessions, community support, skills building and mass media will be attached much
attention. Efficient monitoring mechanism for detection/assessment epidemic situations will be developed for
operational response. Social mobilization of communities for prevention and response to malaria should be
undertaken.
Expected outputs:
Health service personnel and managerial staff at all levels of malaria prevention and control trained. Physical
plant for malaria laboratory diagnosis properly equipped. The country developed its capacity for effective
control of the malaria vector as well as its resources for radical treatment and chemoprophylaxis to have
achieved epidemic containment and decrease in the incidence and mortality rates in the southern region of the
republic. An improved system of epidemiological surveillance established.
The main beneficiaries of this proposal will be the population of the southern regions of the country (Osh,
Jalal-Abad and Batken oblasts) with the total population of 2.5 million including children below 14.
Chemoprohylaxis will annually cover 10,000 strong population of the malaria-prone populated areas
bordering with Tajikistan. Furthermore, additional beneficiaries will be the people who have come to the
republic from malaria-prone countries (ethnic Kyrgyz, refugees, army servicemen, road maintenance workers,
joint ventures employees, seasonal workers etc.).
Expected benefits:
- Reduced social-economic burden of malaria on the population;
- Prevention of mortality among children and pregnant women due to a tropical form of malaria (Pl.
falciparum);
- Population trained in malaria prevention and control activities.
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SECTION II: Information about the applicant
Application
mechanism
National CCM
Regional CCM
Sub-national CCM
Non-CCM
Regional Non-CCM
Type of proposal
Country-wide proposal (Guidelines para. 14–15)
Coordinated Regional proposal from multiple countries
reflecting national CCM composition (Guidelines para.
24–25)
Small Island States proposal with representation from all
participating countries but without need for national CCM
(Guidelines para. 24 and 26)
Sub-national proposal (Guidelines para. 27)
In-country proposal (Guidelines para. 28–30)
Regional proposal (Guidelines para. 31)
Country Coordinating Mechanism (CCM),
Preliminary questions
a). Has the CCM applied to the Fund in previous rounds?
b). Has the composition of the CCM changed since the last submission?
c). If composition of CCM has changed, briefly outline changes (e.g., list of new
members or sector representatives):
Table IIa
Questions
to
answer
1–9
1–9 and 10
1–9 and 11
12 – 16
12 – 15 and 17
Table IIb
(Yes/No)
No
No
1. Name of CCM
Coordination Committee of the Kyrgyz Republic on Control of HIV/AIDS, Tuberculosis and Malaria
2. Date of constitution of the current CCM: August 10, 2002
3.Describe
the
background
and
the
process
of
forming
the
CCM:
Guided by the Global Fund requirements, members of the existing collective coordinating bodies (National
Multisectoral Coordinating Committee on Prevention of HIV/AIDS, STI and Infections Transmitted by
Injections under the Government of the Kyrgyz Republic; National Coordinating Committee on TB Control
under the Presidential Administration of the Kyrgyz Republic; National Emergency Epidemics Control
Commission of the Kyrgyz Republic) as well as members of the technical expert groups under them held a
meeting on August 10, 2002, (Minutes No.1 – Attachment 5.1) and formed by consensus a single Country
Coordinating Mechanism (CCM) to fight HIV/AIDS, TB and malaria with 29 members. Prime Minister of
the Kyrgyz Republic approved the structure of CCM in September 2002 (Attachment 5.2).
The procedures in operation in the country are used in the following way:
The existing National Multisectoral Coordinating Committee on Prevention of HIV/AIDS, STI and Infections
Transmitted by Injections under the Government of the Kyrgyz Republic has been functioning since 1997. Its
new improved structure with 39 members was approved by the Government of the Kyrgyz on 13 December
2001 through the Governmental Decree #785. First Vice Prime Minister of the Kyrgyz Republic heads it. The
committee includes 27 representatives of central and local government, 4 representative of NGOs, 2
representatives of religious faiths, 5 representatives of mass media and 1 representative of an international
organization (Attachment 2.4).
The “Healthy Nation” National Coordinating Commission under the Government of the Kyrgyz Republic had
been coordinating the activities on implementation of the National Programme “Tuberculosis” according to
Decree of the Government of the Kyrgyz Republic dated December 15, 1995. Due to the reform of
government, Presidential Ordinance RP No. 270 dated August 8, 1998 transferred the functions of the
“Healthy Nation” Commission to the Commission on Health and Medical Insurance Reform under the
Presidential Administration of the Kyrgyz Republic. The latter comprises of representatives of government
including Ministry of Health officials (Attachment 3.1).
Page 7 of 111
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The issues of malaria prevention and control are dealt with by the Emergency Anti-epidemic Commission of
the Kyrgyz Republic headed by Vice Prime Minister. The Commission comprises officials from the Prime
Minister’s Office, the Ministry of Health, and the Ministry of Agriculture, and others.
3.1. If the CCM is or includes an already existing body, briefly describe the work previously done,
programmes
implemented
and
results
achieved
(1
paragraph):
As stated above, the CCM was established on the basis of abovementioned coordinating committees and
members of the Emergency Anti-epidemic Commission. Through efforts of Coordinating Committee for
control of HIV/AIDS, the present State Programme for prevention of AIDS, infections transmitted sexually
and through injecting way in the Kyrgyz Republic, was developed. The Programme envisages improvement
of the national policies and legislation in terms of HIV/AIDS prevention. It sets HIV prevention among IDUs,
SWs, MSM, and youth as national priority. Current interventions are focused on protection of vulnerable
groups of population and include information, communication and education component, provision of
condoms, treatment of genital infections transmitted sexually, as well as exchange of syringes and needles for
IDUs, distribution of disinfectants and substitution therapy.
The National Coordinating Committee on TB control has introduced DOTS therapy in the Kyrgyz Republic.
The Emergency Anti-epidemic Commission coordinates measures taken to fight malaria that are directed at
timely recognition of the sick, beginning of specific management, and destruction of the vector.
1.
Describe the organizational processes:
A representative from the Government (First Vice Prime Minister) and a representative from NGO (Chair
of the National Red Crescent Society) were appointed as the Co-Chairs of the CCM. The CCM meeting is
considered competent if all its members are present. Attempts to reach consensus of all CCM members are
made to make their decisions. If consensus is not achieved the decision is made by a qualified majority of
¾ of all votes (i.e. not less than 21 of 29) keeping in mind also that government representation on the CCM
is limited to only 9 members.
CCM secretaries are heads of national centers on AIDS, TB and malaria control. In its operations the CCM
uses technical experts groups which exist under the corresponding coordinating committees.
The groups include professionals working both in government, nongovernmental and private sectors
(Attachment 3). These technical groups submit to the CCM the expert statements on the issues under
consideration. UNDP, which was recommended as the primary recipient of the grant, also works in CCM.
2.
Describe the mode of operation of the CCM:
According to its Rules, the CCM meets not less than once a quarter, on the last Friday of March, June,
September, and December. The Secretariat develops a draft agenda that is approved by both Co-Chairs and
by a preceding meeting of the CCM. Any CCM member may submit proposals for the agenda. All
submitted proposals are considered at the CCM meeting. Extraordinary meetings of the CCM may be called
on the initiative of any of its members.
Major functions:
Collective management of the organization and implementation of activities to fight HIV/AIDS, TB and
malaria financed by the Global Fund;
Coordination of activities of different sectors in utilization of the Global Fund resources;
Current planning and evaluation of results of the projects;
Appointment of technical expert examination of the projects;
Interaction with the national coordinating committees and UN Theme Groups.
6. Describe plans to enhance the role and functions of the CCM in the next 12 months, including
plans to promote partnerships and broader participation as well as communicating with wider
stakeholders,
if
required):
After the establishment of the national CCM there will follow setting up of regional CCMs to ensure a
greater scope of consensus among government organizations, civil society and private sector;
a.
CCM will serve as a tool for strengthening of partnership among different sectors and within the
nearest 10 months it will call a national conference to consolidate the activities in fighting AIDS,
TB and malaria that are carried out in Kyrgyzstan;
b.
CCM will assume technical guidance for activities in fighting HIV/AIDS, TB and malaria. It is
entitled to approve respective manuals, guidelines and other methodic documents.
Page 8 of 111
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7. Members of the CCM (Guidelines para. II.16 – 22):
“We the undersigned hereby certify that we have participated throughout the CCM process
and have had sufficient opportunities to influence the process and this application. We have
reviewed the final proposal and are happy to support it. We further pledge to continue our
involvement in the CCM if the proposal is approved and as it moves to implementation”
Agency/Organization
(including type*)
Name
of
representative
Title
The Government of the
Kyrgyz Republic
Mr.
Osmonov
First
Vice
Prime Minister
K.E.
Date
Table II.7
Signature
Date
Signature
Main role in CCM
Chair, representative of the Government, general coordination
Agency/Organization
(including type*)
Name
of
representative
Title
National
Society
Ms.
Ibraimova
Chair
Red
Crescent
R.B.
Main role in CCM
Co-Chair, representative of NGOs, general coordination of activities, coordination on issues of aid,
support and care
Agency/Organization
(including type*)
Name
of
representative
Title
National AIDS Center
Mr.
B.
Shapiro
Director
General
M.
Date
Signature
Date
Signature
Main role in CCM
Secretary, representative of HIV/AIDS professionals
Agency/Organization
(including type*)
Name
of
representative
Title
TB Research Institute
Mr.
A.Sh.
Alisherov
Director
Main role in CCM
Secretary, representative of TB professionals
*
E.g. People living with HIV/ TB/ malaria, NGOs/ Community-based organisation, Private Sector,
Religious/ Faith groups, Academic/ Educational Sector, Government Sector.
Page 9 of 111
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Agency/Organization
(including type*)
Name
of
representative
Title
Ministry of Health
Mr. G.K. Aaliev
Deputy
Minister
Date
Signature
Main role in CCM
CCM member, coordinator on issues of HIV, AIDS, TB and malaria, representative of a central
executive body responsible for public health
Agency/Organization
(including type*)
Name
of
representative
Title
Ministry of Justice
Mr.
Mamyrov
Deputy
Minister
E.T.
Date
Signature
Main role in CCM
CCM member, coordinator on issues of fighting HIV/AIDS and TB in penitentiaries and corrections,
representative of the government bodies responsible for observance of law and human rights
Agency/Organization
(including type*)
Name
of
representative
Title
Ministry of Internal Affairs
Mr.
K.A.
Duishebaev
Deputy
Minister
Date
Signature
Main role in CCM
CCM member, coordinator on issues of legality and observance of human rights when implementing
HIV/AIDS and TB prevention programmes among vulnerable populations, representative of the
government law and order bodies
Agency/Organization
(including type*)
Name
of
representative
Title
Ministry of Health
Mrs.
Shteinke
Deputy Minister
L.V.
Date
Signature
Main role in CCM
CCM member, coordinator on issues of HIV/AIDS and malaria, representative of the central
executive body responsible for public health
Agency/Organization
(including type*)
Name
of
representative
Title
Date
Ministry of Health
Mr.
S.T.
Abdikarimov
Deputy
Director
Department
of
State
Sanitary
Epidemiological
Surveillance
Signature
Main role in CCM
CCM member, coordinator on medical issues of fighting malaria, representative of professional
medical anti-malaria service
Agency/Organization
(including type*)
Name
of
representative
Title
Ministry of Education
Mr.
T.B.
Bekbolotov
First
Deputy
Minister
Date
Signature
Main role in CCM
CCM member, coordinator on issues of information-education work among youth, representative of
the public education sector
Page 10 of 111
10
Agency/Organization
(including type*)
Name
of
representative
Title
Islamic religious faith
Mr.
MuratalyAjy Jumanov
Mufti
of
Kyrgyzstan
Date
Signature
Main role in CCM
CCM member, representative of the religious majority of the population of the country
Agency/Organization
(including type*)
Name
of
representative
Title
Orthodox Christian church
Father Valentine
Priest of the
Othodox Church,
press-secretary
of Bishop of
Bishkek
and
Central Asia
Date
Signature
Main role in CCM
CCM member, representative of the Orthodox Christian faith
Agency/Organization
(including type*)
Name
of
representative
Title
NGO Tais Plus
Ms.
G.U.
Kurmanova
Coordinator
Date
Signature
Main role in CCM
CCM member, coordinator on issues of delivering prevention programmes among sex workers and
other groups of population who are vulnerable to HIV infection, representative of the target groups
Agency/Organization
(including type*)
Name
of
representative
Title
NGO “Socium”
Ms.
B.A.
Estebesova
Leader
Date
Signature
Main role in CCM
CCM member, coordinator on issues of prevention programmes among drug users, representative of
the target group interests
Agency/Organization
(including type*)
Name
of
representative
Title
Date
Signature
NGO
“Koz
Karash”, Mr.
N.E. NGO
Board
Organisation
of
the Shonkorov
member
community of people living
with HIV
Main role in CCM
CCM member, coordinator support programmes for the people living with HIV/AIDS, representative
of the target group interests
Agency/Organization
(including type*)
Name
of
representative
Title
Private
“Almaz”
Mr. R.G.
Koshmuratov
Director
radiostation
Date
Signature
Main role in CCM
CCM member, coordinator on mass media issues on HIV/AIDS, TB and malaria, representative of an
independent mass media
Page 11 of 111
11
Agency/Organization
(including type*)
NGO
R&TV
“Pyramid”
Co.
Name
of
representative
Title
Mr.
A.T.
Biynazarov
Director
General
Date
Signature
Main role in CCM
CCM member, coordinator on issues of mass information on HIV/AIDS, TB and malaria,
representative of independent mass media
Agency/Organization
(including type*)
Name
of
representative
Title
Consulting
“AVANCO”
Mr. V.O.Titov
Director
company
Date
Signature
Main role in CCM
CCM member, coordinator on issues of cooperation with private sector and business representatives
Agency/Organization
(including type*)
Name
of
representative
Title
Private
Educational
Scheme “Ilim”
Ms.
G.D.
Ibraghimova
Director
General
Date
Signature
Main role in CCM
CCM member, coordinator on issues of special education and formation of enabling environment,
representative of independent universities
Agency/Organization
(including type*)
Name
of
representative
Title
Soros-Kyrgyzstan
Foundation
Mr.
M.T.
Tulegenov
Executive
Director
Date
Signature
Main role in CCM
CCM member, coordinator on issues of cooperation with NGOs, representative of international
nongovernmental organisations
Agency/Organization
(including type*)
Name
of
representative
Title
KSMA (medical academy)
Mr.
I.K.
Akylbekov
Dean
Date
Signature
Main role in CCM
CCM member, coordinator on issues of graduate and post-graduate education on HIV/AIDS issues,
representative of academic organisations
Agency/Organization
(including type*)
Name
of
representative
Title
UNDP
Mr. D. Akopyan
Deputy Resident
Representative
Date
Signature
Main role in CCM
CCM member, representative of an international intergovernmental organization, main recipient of
the grant
Page 12 of 111
12
“We the undersigned hereby certify that we have participated throughout the CCM
process and have had sufficient opportunities to influence the process and this
application. We have reviewed the final proposal and are happy to support it. We
further pledge to continue our involvement in the CCM if the proposal is approved
and as it moves to implementation”
Agency/Organization
(including type*)
Name
of
representative
Title
UNICEF
Mr. R. Young
Representative in
Kyrgyzstan,
Chair of the
Theme Group
Date
Signature
Main role in CCM
CCM member, representative of an international intergovernmental organization
Agency/Organization
(including type*)
Name
of
representative
Title
World Bank
Mohinder
Mudahar
World
Bank
Resident
Representative
Date
Signature
Main role in CCM
Agency/Organization
(including type*)
Name
of
representative
Title
Date
Signature
World Health Organisation Mr.
O.A. Liaison Office
Liaison
Office
in Moldokulov
Director a.i.
Kyrgyzstan
Main role in CCM
Agency/Organization
(including type*)
Name
of
representative
Title
USAID
Mr.
Atwood
Resident
Representative in
the
Kyrgyz
Republic
Tracy
Date
Signature
Main role in CCM
CCM member, coordinator on resource mobilization, representative of a bilateral development
agency
Agency/Organization
(including type*)
Name
of
representative
Title
KFW
Gild N.
Representative in
Kyrgyzstan
Date
Signature
Main role in CCM
Page 13 of 111
13
Agency/Organization
(including type*)
Name
of
representative
Title
Date
DFID
Isaev N.T.
Representative in
Kyrgyzstan
Signature
Main role in CCM
Agency/Organization
(including type*)
Name
of
representative
Title
Date
HOPE Project
Mr. T. Aptekar
TB Director
Signature
Main role in CCM
CCM member, representative of an international intergovernmental organization, organization of
interventions among TB patients
7.1 Provide as attachment the following documentation for private sector and civil society CCM
members:
Statutes of organization (official registration papers)
• A presentation of the organization, including background and history, scope of work, past
and current activities
• Reference letter(s), if available
• Main sources of funding
8.
Chair of the CCM and alternate Chair or Vice-Chair
Table II.8
Chair of CCM
Mr. K.E. Osmonov
Vice Prime Minister
Alternate Chair/Vice-Chair
Ms. R.B. Ibraimova
National Red Crescent Society
Address
Government House, 205, Chui Ave.,
Bishkek 720003 Kyrgyzstan
10, Erkindik Bulvard, Bishkek 720040
Kyrgyzstan
Telephone
Fax
E-mail
+996 312 22 50 64
+996 312 66 66 59
[email protected],
[email protected]
+996 312 22 24 14, 22 24 11
+996 312 66 21 81
[email protected]
Name
Title
Signature
9.Contact persons for questions regarding this proposal (please provide full contact details for two
persons – this is necessary to ensure expedient and responsive communications):
Table II.9
Primary contact
Second contact
Mr. G.K. Aaliev
Mr. B.M. Shapiro
Name
Deputy Minister of Health
Director General National AIDS Center
Title
Address
148 Moskovskaya St, Bishkek, Kyrgyz
Republic
8, 5th floor, Logvinenko St., Bishkek,
Kyrgyz Republic
Telephone
Fax
E-mail
+996 312 22 46 32
+996 312 66 07 19
[email protected]
+996 312 22 72 90, 22 75 79
+996 312 22 72 90, 66 37 32
[email protected]
Page 14 of 111
14
SECTION III:
General information about the country setting
18 Describe the burden or potential burden of HIV/ AIDS, TB and /or Malaria: (Describe current
epidemiological data on prevalence, incidence or magnitude of the epidemics; its current status or stage of the
epidemics; major trends of the epidemics disaggregated by geographical locations and population groups,
where this data is available and/or relevant; Guidelines para. III.37 – 38), (1 – 2 paragraphs per disease
covered
in
proposal):
HIV/ AIDS
The Kyrgyz Republic has a rapid growth of HIV/AIDS epidemics. As of September 1, 2002, there were 310
HIV cases reported in the country, of which 257 belong to 2001 and 2002. In 2001 the number of officially
registered HIV infection cases exceeded more than 10 times the corresponding indicators of 2000 and 2.8
times the number of cases registered for this epidemic during the entire period since 1987. This growth is
related to HIV outbreak among injecting drug users. The latter make 85% of all HIV cases, and 95% of cases
registered in 2001. The number of HIV cases in the most affected region, Osh oblast, increased 44 times in
2001 in comparison with the entire previous period, and injecting drug users (IDU) make 97% of all
registered cases. Seven patients have already died because of HIV, including four due to AIDS. HIV infection
spreads among the people of reproductive age. HIV infection prevails among men (81%), especially in the
age up to 29 (64%). 56% of people living with HIV are in prisons and correction facilities.
However, as per the UNAIDS experts’ assessment, the actual number of HIV infection is 10 times more and
reaches about 3,000 people. A the same time sentinel surveillance showed through examination of drug users’
blood traces in their syringes conducted in 2000 that the rate of HIV prevalence in the group under
investigation is 11.5 to 18.5 percent in Bishkek and 32.2 to 49.8 percent in Osh. On the basis of that the
estimated number of HIV-infected IDUs was identified to reach 6,550 in Bishkek and 2,050 in Osh. If
resolute measures are not taken in this situation, then, as the experience of epidemic development in Russia
and other CIS countries shows, before the end of 2003 up to 70% of the injecting drug users (about 40,000
people) can be infected.
DYNAMICS OF HIV SPREADING IN THE KYRGYZ REPUBLIC BY YEARS
149
140
120
88
100
108
80
60
40
20
15
0
2
2
2
16
6 1 10 1
0
1
0
9
8
7
6
5
1
4
s)
99 199 199 199 199 199 199 200 200 nth
1
o
m
87 991
9
8
1
1
(
02
0
Over the country
In Osh Oblast
2
Page 15 of 111
15
HIV infection spread in the Kyrgyz Republic was preceded by an epidemic of syphilis. Syphilis incidence
during the period 1990 to 1997 grew over the country 77 times and in Bishkek 140 times. Although there is
steady stabilization and reduction of the rate of incidence at present, the rate on the whole remains still high.
Thus in 2000, 4,278 cases were reported, or 87.5 per 100,000 population, which is 25 times greater than in
1990. Besides, officially reported cases of syphilis do not reflect a true picture of its prevalence. According to
expert opinion, official statistics know not more than 60% of the real number of syphilis cases. This is
confirmed by the increase during the last years of the proportion of latent and late forms of syphilis as well as
congenital syphilis.
SYPHILIS MORBIDITY DYNAMICS IN THE KYRGYZ REPUBLIC DURING 1986 –2000
(per 100 000 population )
Intensity indicator
160
years
155
153
146,4
110,8
120
87,5
72
80
49,4
40
21,6
2
0
1990
2,1
1991
2,5
1992
4,4
1993
1994
1995
1996
1997
1998
1999
2000
2001
Kyrgyzstan is situated along one of the main drug traffic routes. At present, illicit drug traffic is well
established through Osh oblast on the route: Afghanistan and Tajikistan – Khorog – Osh – Bishkek – CIS –
Eastern Europe. Drugs are cheap and easily accessible: a heroin portion in Osh city costs USD 0.5 and USD 2
in Bishkek city.
Until 1986-87, basically only individual cases of hashish and opium addiction had been observed in the
country. According to the Report of the State Commission on Drug Control, during the period of 1991-2000
drug abuse incidence had increased almost six fold. At this, “the age of a statistically average drug addict in
Kyrgyzstan was lowered to 14-15, and there were individual cases of using drugs at an even earlier age of 1012 (!)”1 Almost half of the injecting drug users are of the most reproductive age (from 21 to 30), and 15% of
them are youth of 16 to 20 years old. As of January 1, 2002, the National Center of Narcology of the Ministry
of Health has official record of 5,100 persons with the drug dependency, including 30 under-aged. Increase of
amounts of opium and heroin in transit through Kyrgyzstan has resulted in the growth of the injecting drug
use among the citizens of the country to reach 96.8% that is fraught with the danger of catastrophic spreading
of HIV, hepatitis and other diseases2.
Actual scope of drug abuse is greater than the official statistics shows. The preliminary results of the rapid
assessment in Bishkek done by the UNODCCP Project, certify that “the number of drug users is 15 times
more than the official statistics figure of the narcology service” 3 and is about 80,000-100,000. Based on this
estimate, the minimal number of IDU in the country is 55,040 (68.8%) of the total number of drug users.
Whereby the level of drug addiction in Kyrgyzstan is the highest among all Central Asian countries and
reaches 1,644-2,054 per 100,000.4 (1,110-1,251 in Kazakhstan; 262-367 in Uzbekistan).
The behavior studies, conducted in 2000 among injecting drug users show high HIV vulnerability of the
representatives of this group. 96% of the polled share their doses, and only 14% of them use sterile syringes;
99% take drug by their own syringe from a common container; 35% use one syringe over 20 times; 42% cent
1
Brief review of drug situation for 2001, introduced by the State Commission on Drug Control under the Government of the
Kyrgyz Republic, p.5.
2
Brief review of drug situation for 2001, introduced by the State Commission under the Government of the Kyrgyz Republic
on Drug Control, addressed to the UNDP Resident Representative in Kyrgyzstan, dated February 11, 2002, p.5.
3
4
Ibidem
UNODCCP estimate, 2001
Page 16 of 111
16
of the polled drug addicts took used or common syringes more than twice. 64% of the polled IDU cannot
afford buying syringes.
According to available estimates, the total number of sex workers (SW) in the country is about 3,000 females
and males including 1,600 in Bishkek, 750 in Osh, 200 in Jalal-Abad. The turnover of their clients with an
average rate of 1-2 clients per SW a day is 1-2 million clients a year (300,000–500,000 persons). Rapid
change of group structure – 40% a year – is of special significance. It means that during five years 9,000
young people will be involved in sex industry. There is a high rate of unsafe sexual contacts. The proportion
of unprotected sexual contacts is great. The rate of condom use (identified on the basis of sex workers
reports) in two large cities where target prevention programmes are being developed, is a little more than 60%
of the total number of working sexual contacts. However, in most cities of the country where such
programmes are not present the rate of condom use by sex workers and their clients in expert estimate hardly
exceeds 10%. STI incidence is high here. Among sex workers who visited a venereologist for the first time in
2001, not less than 37% were syphilis diagnosed. The number of IDU among SW is 2-3% but according to
available expert assessment the proportion of drug users among SW has a tendency to increase. HIV
hazardous drug use is spread among this subgroup practices.
There is a high level of population mobility in the country. As of 1 September 2002, 7,122 Tajik refugees
have been registered officially in the country, and there are also other smaller groups (Chechen, Afghan
refugees). Considerable internal migration and high mobility of the population especially from the rural areas
are important in terms of HIV spread. The research carried out within the framework of preparation of the
UNDP Human Development Report 2002 in the mountainous regions of the country noted that half of the
rural population departed from their villages and many of them (35 to 86%) came back. Migrants including
refugees are low-income citizens changing their residence under the pressure of political and economic
circumstances. When left to their own means they replenish the groups with high-risk behavior. Sex workers
are recruited from their number (49% of sex workers in Bishkek are villagers who came to the city in search
of better life; 22% came from small towns), as well as potential and actual drug dealers, and drug users.
In penitentiary facilities 132 HIV cases were registered among the convicts, this comprising 56% of all
number of HIV cases in the country. The prevalence of HIV among prison inmates is 776.4 per 100,000
prisoners, which is 131.6 times higher than among adult population in the whole country. A high rate of STI
is also maintained there. In 2001, syphilis incidence rate in prisons was 3,470 per 100,000 population (70
times higher than among the general population of the country). 70% of the convicts are drug addicts and
80% of them use drugs by injections. The penitentiary system conditions do not permit to carry out necessary
behavioral research, which is explained by the closed nature of the group and lack of trust of the prisoners in
preservation of confidentiality of that information. At the same time, according to anonymous survey among
the prisons inmates and the warders conducted in 2002 it was found that drugs were accessible in all
correction facilities, from 40 to 50% of the inmates use drugs by injections while 70 to 80% use common
syringes and needles. In connection with this there is a real danger of rapid spread of HIV, hepatitis, syphilis
and other infections in correction facilities of the Kyrgyz Republic.
According to research data, at present in Kyrgyzstan there are about 30,000 sexual minority representatives.
Bishkek is best studied in this respect and here targeted AIDS prevention programmes are carried out
covering 5,000 MSM. Currently there is no specific information about other regions of the country. However,
joint expert assessment performed in Osh by international and national experts shows significant
representation of this group in Osh region as well as unsafe with respect to HIV sexual practices among
MSM. At the same time these groups in the regions of the country have a reserved nature, so they are not
reached with educational and informational programmes on AIDS.
EPIDEMIOLOGICAL SITUATION ON TB IN THE KYRGYZ REPUBLIC
Due to the economic situation in the country and the global expansion of tuberculosis incidence the Kyrgyz
Republic got a significant reservoir of TB infection which determines the nature of epidemiological situation
for this infection.
After a certain period of dropping levels of TB morbidity, prevalence and mortality, annual increase of TB
incidence among all age groups started being registered in the country since 1994. Over the last seven years,
the epidemiological situation in the country with respect to TB has remained strained which is evidenced by a
stable annual growth of its incidence. During this period, the incidence rate grew from 72,4 to 127,3 per
100,000, i.e. 1.9 times. The highest growth rate of incidence was registered in 1995 and 1996 (21,7% and
20,0%, respectively).
Page 17 of 111
17
The rate of incidence in the country increased in 2001 against 2000 from 121,8 to 127,3 per 100,000 (or from
150,9 to 167,8 per 100,000 if the penitentiaries and corrections are included).
D y n a m ic s o f T B in d u c e d m o r b id ity a n d m o r ta lity
in th e K y r g y z R e p u b lic
( p e r 1 0 0 , 0 0 0 p o p u la t io n )
140
1 2 1 ,8
120
1 0 8 ,9
9 5 ,3
100
5 6 ,5
40
20
8 6 ,9
m o r b id it y
80
60
1 2 8 ,4
1 1 4 ,4
7 2 ,4
5 7 ,8
5 4 ,8
5 9 ,5
m o r ta lit y
7 ,7
1 2 ,4
8 ,5
7 ,2
1 3 ,5
1 3 ,4
16
1 3 ,6
1 3 ,5
1 2 ,6
1 3 ,6
0
1991
1992
1993
25
1994
21
20
15
10
1995
1996
1997
1999
2000
2001
20
14,3
8,6
9,7
5
5
0
1998
5,9
1,3
1994
1995
1996
1997
Before DOTS introduction
1998
1999
2000
III
years
.2001
After DOTS introduction
Annual rate of TB morbidity growth was 4.5% in 2001 (6,5% in 2000).
In 2001, the rate of TB incidence among children in the country was 76,7 per 100,000 as against 57,5 in 2000,
i.e. the increase of 33,4%.
The rate of mortality in the country was 13.5 per 100,000 in 2001 (12.6 in 2000).
When analyzing the composition of those who died of TB it was found that cases of chronic forms of TB and
TB patients from such groups as homeless people, drug addicts, alcoholics and ex-convicts prevailed here.
When analyzing the composition of those who died of TB it was found that cases of chronic forms of TB and
TB patients from such groups as homeless people, drug addicts, alcoholics and ex-convicts prevailed here.
MALARIA
Malaria as an epidemic was eradicated in Kyrgyzstan in 1959. Before 1980 there were no malaria cases
reported in the republic. However, owing to the deterioration of the malaria situation in neighbouring
countries of Central Asia, especially in transboundary areas of Tajikistan, massive cross-border population
movements, and lack of appropriate malaria control malaria cases once again started to appear in the country
since 1996. The malaria situation has been also aggravated by a steady increase in the number of imported
malaria into the country during the past years. The majority of malaria cases were imported from Tajikistan.
During 1995-2000, 70 cases of malaria were reported in the country, of which 13 were imported. In 2001, the
number of cases of malaria reported continued to rise, and by the end of September 2002 more than 1,600
malaria cases have been reported. Among these, there are 478 children below 14 (31.8%) including 38
infants under 1 year (2.8%), and 215 from 1 to 6 years of age (14.3%). The country is facing an outbreak of
malaria in the southern regions (OSH, Batken and Jalal-Abad oblasts) in areas bordering Tajikistan and
Page 18 of 111
18
Uzbekistan. The malaria situation in these border areas remains very serious, and there is an alarming trend
towards an increase in the incidence of malaria in the country in years to come. When applying treatment to
children difficulties arise due to very bitter taste of the drugs (there are no drugs in the form of syrups for
children).
The country has been sub-divided into zones with high, moderate and low malaria potential, and although
only a tiny part of the country is considered a high-risk zone, this is a densely populated area (with 2.5
million population) The malaria problem may become a major obstacle to development in Kyrgyzstan, where
at present more than 50 per cent of the total population lives in areas where conditions are favourable for the
transmission
of
malaria.
The National Malaria Prevention and Control Programme is at present implemented and supported by WHO,
and activities consist of diagnosis, disease management, epidemic control, training and surveillance.
However, the limited resources invested by the Government and WHO result in lack of sufficient funding to
cope with the malaria problems in the country.
Plasmodium vivax malaria cases have been registered in the country but data on malaria incidence rate in
Tajikistan show that this year the specific weight of tropical malaria cases there reached 20% of the general
malaria incidence.
M a la r ia in c id e n c e r a t e in t h e K y r g y z R e p u b lic d u r in g
1 9 1 9 -1 9 9 5
P e r io d o f
com b at
10000
1000
P e r io d o f
e li m i n a t i o n
100
P e r io d o f
im p o r ts
10
1
S a f e p e r io d
0 ,1
0 ,0 1
0 ,0 0 1
.
1 9 2 31 9 2 61 9 2 91 9 3 21 9 3 51 9 3 81 9 4 11 9 4 41 9 4 71 9 5 01 9 5 31 9 5 61 9 5 91 9 6 21 9 6 51 9 6 81 9 7 11 9 7 41 9 7 71 9 8 01 9 8 31 9 8 61 9 8 91 9 9 21 9 9 5
19. Describe current economic and poverty situation:
The Kyrgyz Republic faced severe economic problems after gaining independence. Every second person
(52,3%) in Kyrgyzstan lives below the poverty line5, and every sixth (17,8%) is under extreme poverty line6
(which is US$7 per month). Kyrgyzstan is one of the poorest countries of the Central Asian region. The AIDS
epidemic crises may destroy medical resources and generate political and social instability.
The state budget deficit (in 2000 more then 9% of GDP) is one of the major economic problems of the
country. Servicing the state debt that exceeds the value of annual GDP (137,2%7 of GDP in 2000) is
becoming the biggest article of state expenditures. It requires further reduction in the limited funds, which
have been allocated for execution of the main state functions.
In 2000 Kyrgyz GDP was USD 1,304,000,000 or USD 265 per capita. Foreign investments constituted 9,2%
of GDP8.
5
General Poverty Line is meant i.e. a minimal level of consumption of primary food and non-food products. See:
Project “Zdorovie 21 (Health 21)” (basis of policy for achieving good health for all people in Kyrgyzstan), Chapter
'
Poverty'
.
6
Extreme Poverty Line - level of consumption when the minimal need in calories is not met even if all available
resources are spent on food (same)
7
8
Comprehensive Development Framework of the Kyrgyz Republic (CDF), 2001, Appendix B
CDF
Page 19 of 111
19
Human development index was 0.706 in 1999 and 0.719 in 2000. Living standards in Kyrgyzstan are the
lowest among NIS countries. Monthly per capita income - USD 16,7 - cannot provide for the minimum
consumer budget (which is USD 25).
Lack of finance is a dominating factor hindering implementation of social programs. In 2000, only 2.1% of
GDP9 or USD 20,6 million had been allocated for the public health service, which covered only 50% of its
requirements. Real drop in public health funding (with account of inflation) is even more substantial. In
connection with this, the volume and quality of health service including the needed treatment of sexually
transmitted diseases and drug addictions is dropping. Besides, due to the same reason the state guarantees for
provision of safety of medical procedures including donors’ blood safety cannot be ensured in full.
The rate of unemployment and partial employment is estimated at about 26 percent. 62% of the unemployed
are women10. Poor able-bodied population has suffered much more from a much higher rate of irregular jobs
during the year especially in the rural areas. According to poverty estimates, provided by the World Bank for
1999, women in Kyrgyzstan have a 1.5 times higher chance to loose the job in comparison to men. Lack of
permanent source of income, impossibility to find a job as well as such social constraints as the requirement
to have permanent residence and official registration of that, force young women to provide sexual services
for money or other material benefits. Due to the same reason a still growing number of people are drawn into
drug traffic. The feeling of despair, lack of prospects generates manifestations of domestic cruelty including
that with respect to under-age children and refusal to care for them. This increases the number of homeless
children who left their parents because of cruel treatment or because of being abandoned by them. More and
more children are involved in heavy work and drawn into criminal structures. There is evidence of teenager
and child prostitution but this phenomenon has not been studied yet and not included in the priorities of the
National Strategic Plan on HIV/AIDS Prevention or in other social programmes we can have access to. The
beleaguered economy and complicated social situation in the country lead to abuse of alcohol, drugs and
other forms of addictive behavior.
Grave economic problems against the backdrop of a high poverty rate and lack of adequate social safety net
infrastructure impose constraints on the capacity to finance HIV/AIDS prevention programs. The country is
unable to ensure even the required level of donor’s blood testing for HIV. In 2000, only 95,2% donors had
been AIDS tested in the country, including 78,4% in Osh oblast.
Limited allocations are unable to ensure the provision for free qualified and specialized medical care and free
medicines supply for people living with HIV stipulated by the “Law on AIDS Prevention” and the respective
National Program.
Poverty leads to such a lifestyle that people are at higher risk of being infected with HIV. The Government is
unable to develop preventive programs for vulnerable groups and supply them with the required protective
means against AIDS (clean syringes, condoms). For poverty reason, representatives of those groups alone
(SW) cannot buy condoms and pay for treatment of STI, as this amount is a significant article of their family
budget. Due to severe economic situation the Government is unable to ensure adequate financing to promote
HIV/AIDS prevention activities and render medical and social support to people living with HIV and AIDS
patients.
Further spreading of HIV creates substantial hindrances for economic and social development of the country,
which will still increase the level of poverty.
20. Describe the current political commitment in responding to the diseases:
HIV/AIDS
The Kyrgyz Government is aware of HIV problem significance and undertakes certain steps to overcome it.
In 1996, the Law on “AIDS prevention in the Kyrgyz Republic” was adopted. In 1997, Kyrgyz National
Program on AIDS/STI prevention for 1997-2000 was approved. Based on situation analyses and activities on
HIV/AIDS epidemic prevention, Strategic Plan of National Activities was developed to counter the
epidemics. These documents were used as a basis for the second State Program for 2001 – 2005 approved by
the Governmental Decree of 13.12.01 No 785 “On Prevention of HIV/AIDS, infections transmitted sexually
and through injecting way in the Kyrgyz Republic”.
9
CDF, Appendix B
CDF, Appendix C
10
Page 20 of 111
20
AIDS prevention activities use multisectoral approach on the basis of partnerships between the Government
of the Kyrgyz Republic, ministries, administrative departments, NGOs and international agencies.
Interventions for HIV/AIDS prevention are made in compliance with the UNAIDS policies.
The Government carries out financing of AIDS prevention programmes through the Ministry of Health,
Ministry of Education and Culture and other ministries. However, the completed program (for 1997-2000)
was financed only by 18%. The newly adopted program (for 2001-2005) also lacks actual funding support.
Along with this, the Government tries to find resources to support the most important programs. Thus, in the
country contributed USD100,000 to the joint Project with involvement of the Government, UNDP and
UNAIDS Programme (1997-2000). The Programme on syringes exchange, implemented at the expense of
International Organizations (UNDP, UNAIDS, Soros-Kyrgyzstan Foundation) has been partially financed
from the local budget in Osh oblast.
A Joint UN Agencies Programme on Expanded Response to HIV/AIDS in the Kyrgyz Republic is
implemented to support the Government programme for AIDS prevention. It is signed by First Vice Prime
Minister of the Kyrgyz Republic and UN Resident Coordinator in Kyrgyzstan. This Programme unites all UN
agencies represented in the country and Central Asian region and is implemented on the basis of the principle
of national execution. Prime Minister’s Office is the executing agency. The amount of the programme is one
million US dollars of which USD 510,000 has already been allocated.
TB
The Government of the Kyrgyz Republic and the Ministry of Health have been implementing measures to
contain the expansion of TB infection. Thus, in 1996 the National Programme «Tuberculosis» for the period
of 1996-2000 was approved, in 1998 the Law of the Kyrgyz Republic «On Protection of Population against
Tuberculosis», and in 2001 the National Programme “Tuberculosis-II” for 2001-2005 were passed. Decrees
of the Government of the Kyrgyz Republic, legal acts of the Ministry of Health, Ministry of Internal Affairs,
Ministry of Agriculture and Water were adopted to regulate implementation of urgent measures against
tuberculosis across the entire country.
MALARIA
The government of Kyrgyzstan confronting the resurgence of malaria in the country has committed itself to
taking all necessary measures aimed at containing the on-going malaria epidemic. The idea of partnerships is
supported, the National Emergency Epidemic Commission was established, multisectoral decisions are made
and notwithstanding the continued budget deficits funds for malaria control are allocated.
The RBM country project proposal was drawn up by the Ministry of Health of the Kyrgyz Republic with
technical assistance from WHO/EURO and submitted/re-submitted to potential donors in 2000 and 2001. The
RBM Project was planned to support the country in partnership building and working together on the
promotion of health sector actions that prevent malaria outbreaks, reduce the incidence of malaria and prevent
the resumption of malaria transmission in other areas of the country. The national strategy and programme
were developed in accordance with the concept and principles of the “ Roll Back Malaria ” global and
regional movement.
Kyrgyzstan’s specialists joined in the WHO RBM programme and recognized the main ideas of partnership.
Page 21 of 111
21
21.Financial context
21.1. Indicate the percentage of the total government budget allocated to health*:
2.7% in 2001.
21.2. Indicate national health spending for 2001, or latest year available, in the Table III.21.2*:
Public
Private
Total
From total, how much is from
external donors?
Total national health spending
Specify year:
(USD) 2001
33 189 188,25
Spending per capita
(USD)
6,6
33 189 188,25
1 765 643
6,6
0,35
21.3. Specify in Table III.21.3, if possible, earmarked expenditures for HIV/AIDS, TB and/or
Malaria (expenditures from the health, education, social services and other relevant sectors)**:
Table III.21.3
Total earmarked expenditures from government, external In US dollars:
donors, etc. Specify Year: 2001
HIV/AIDS
1010341
Tuberculosis
2750000
Malaria
50000
Total
3810341
21.4. Does the country benefit from external budget support, Highly Indebted Poor Countries
(HIPC) initiatives*, Sector-Wide Approaches? If yes, how are these processes contributing to
efforts against HIV/AIDS, TB and/or malaria? (1–2 paragraphs)**:
A grant of the German Development Bank for procurement of medical equipment and drugs to the amount of
5 mln DM in 2001. These funds facilitated introduction of DOTS strategy in Kyrgyzstan.
The malaria control programme in Kyrgyzstan is funded by WHO. However, the Government and WHO
allocate at present limited resources to fight malaria and the country needs additional aid to cope with the
malaria problem.
During the last years WHO assistance was focused on capacity strengthening of the National Programme of
Prevention and Control of Malaria through provision of technical assistance and consultations, overseas and
in-country training, conduct of entomological research, supply of anti-malaria drugs, equipment for
laboratories and spraying, expendable supplies, support of IEC campaigns in the country and strengthening
malaria surveillance especially in the areas adjacent with Tajikistan and Uzbekistan.
At present malaria control activities include mainly disease management, control of the epidemic, personnel
training, surveillance, procurement and distribution of expendable supplies/equipment.
22. National programmatic context
22.1. Describe the current national capacity (state of systems and services) that exist in response
to HIV/AIDS, TB and/or Malaria:
Public health system is a key link in organization of prevention of HIV, tuberculosis, and malaria and bears a
considerable share of responsibility for implementation of the State Programme of Prevention of HIV/AIDS
and National Programme on Tuberculosis in the Kyrgyz Republic. The Ministry of Health represented by the
AIDS National Association carries out the Secretariat functions for the multi-sectoral coordinating committee
on AIDS prevention under the Government of the Kyrgyz Republic as well as the National Emergency AntiEpidemic Commission. The health system structure comprises of specialized facilities at the national and
*
HIPC is a debt-relief initiative for highly indebted poor countries through the World Bank
Optional for NGOs
**
Page 22 of 111
22
oblast levels. These are the AIDS National Association, five oblast AIDS prevention centers and 36 AIDS
diagnostics laboratories with the staff of about 200, the National Narcological Center, the National
Dermatology and Venereal Dispensary, the National Blood Transfusion Center and oblast units represented
either by independent establishments or divisions in the multi-discipline association of hospitals, and other
institutions. The health facilities carry out epidemiological monitoring including sentinel surveillance over
spreading of HIV/AIDS, perform detection, treatment and observation of the patients, undertake measures to
prevent transmission of infections including that within the hospitals, safety of donors’ blood, and coordinates
development of educational programmes.
At present the health system of the Kyrgyz Republic undergoes reform in line with the “Manas” Programme
funded through the World Bank loan. The main goals of the reform are to improve primary medical and
sanitary aid to the population. The reform envisages health improvement of the population; strengthening
preventive orientation of medicine, growth in the volume and improvement in the quality of medical aid,
transfer of the emphasis of medical assistance from permanent establishments to outpatient clinical level.
Strategic areas in the achievement of these goals will be the reform of financing, management and human
resource policies on the basis of decentralization and redistribution of resources.
Health service financing is effected through national and local budgets, compulsory medical insurance funds,
the share of which in 1999 was about 15% of the national budget, and also through revenues from extrabudgetary activities (9% in 1999), grants and loans provided to health service bodies and facilities. On the
whole, public health sector suffers from chronic budget under-funding, which constitutes 2.1% of GDP. State
budget funds are allocated by the Ministry of Finance via the Ministry of Health to specialized national health
facilities (for example, to the AIDS National Association), oblast AIDS centers are funded from oblast
budgets, and AIDS laboratories from local budgets on account of funds allocated for health service. A similar
system exists for other health establishments, organs and institutions of other agencies (education, defense,
social protection) participating in the implementation of the corresponding departmental programmes on
AIDS prevention. Grants from international organizations are provided to governmental or nongovernmental
organizations for implementation of the agreed and approved programmes. Loans, large projects and
programmes of the UN system agencies are implemented on the basis of bilateral agreements with the
Government of the Kyrgyz Republic. Nongovernmental organizations are not financed from the national
budget. They implement AIDS prevention programmes mostly using their own grants and at the expense of
grants from international organizations. Absence of stable funding of NGOs implementing the programmes
for vulnerable groups restrains development of such programmes and cannot warrant their sustainability.
Activities on HIV/AIDS prevention in the Kyrgyz Republic are carried out on the basis of the State
programme approved by Decree #785 of the Government of the Kyrgyz Republic on 13 December 2001. This
work is performed on the basis of multi-sectoral approach at the level of ministries and agencies, government
bodies on the central and oblast levels with participation of nongovernmental and community-based
organizations representing the interests of the vulnerable populations and people living with HIV/AIDS.
Stable partnership relations are established in the country between governmental, nongovernmental and
international organizations. The national multi-sectoral committee on AIDS prevention under the Government
of the Kyrgyz Republic coordinates the AIDS programmes in the country as well as the UN Theme Group on
AIDS that united the UN system agencies, international bilateral and multilateral cooperation organizations.
With support of the UNAIDS co-sponsors (UNDP, UNFPA, WHO, UNODCCP, UNESCO, etc.)
international donor and nongovernmental organizations provided support to the efforts of the country in
formulation of the policy and shaping the capacity of the country on AIDS prevention, strengthening
multisectoral approach, improving legislation, mobilization of the civil society efforts, peer education,
targeted interventions among the representatives of vulnerable populations, training national specialists, and
conduct of information campaigns. A school programme on fostering of healthy lifestyle has been launched
and 10% of the teachers involved in this programme have been already trained. National experts on various
aspects of HIV prevention have been trained and national priorities identified. However, the national harm
reduction programmes developed in the country for injecting drug users cover only an insignificant portion of
representatives of this vulnerable group. This cannot affect further HIV spread. Besides, prevention
programmes are implemented predominantly in the capital of the country and to a smaller degree in
individual oblast centers, while the nongovernmental organizations capacity is not fully used. For successful
solution of the objectives an AIDS programmes monitoring system should be developed, second-generation
HIV/AIDS surveillance implemented, and knowledge and existing behavioral patterns among different
populations studied.
There is a system of epidemiological monitoring of HIV and STI spread in Kyrgyzstan. The main contingent
of the population subject to examination for AIDS has been identified. Conditions for confidential
examination of the population for HIV have been created in all cities and rayons, anonymous checkup rooms
Page 23 of 111
23
opened. Hotline “trust phone” service functions in the capital and oblast centers. Specialists on HIV/AIDS
psychosocial counseling have been trained. However, appropriate structures for this service have not been
established, so such work is limited to only post-testing consulting. Absence of government funding prevents
treatment of people living with HIV and AIDS patients as well as treatment of pregnant women living with
HIV.
The national programme “Tuberculosis” with inter-sectoral approach to solve the problem was adopted in the
country. The Ministry of Health and Kyrgyz Research Institute of TB is charged with the coordinating role.
State-run health service has specialized hospitals with the total of 3,800 beds, and anti-TB rooms in the
Family Medicine Center (FMC) where more than 300 phthisiatritians work.
Medical aid to TB patients is provided free of charge at the expense of the national budget. After the DOTS
strategy recommended by WHO has been introduced NGOs and persons contacting with TB patients started
being involved in the process of TB patients’ treatment.
The National Parasitological Department (NPD), as part of the National Sanitary and Epidemiological
Service, is responsible for technical guidance, planning, monitoring and evaluation of malaria control in the
country. NPS staff is comprised of epidemiologists, parasitologists, entomologists, laboratory technicians and
administrative staff. Divisions of the Service have been also established at the regional (oblast) and district
(rayon) levels. The National Urgent Epidemic Commission is responsible for coordination of malaria control
efforts, and Urgent Epidemic Commissions also function at regional and district levels. At the regional
(oblast) level, the head of the regional center of sanitary and epidemiological services is responsible for
implementing malaria control activities in the respective area. His team includes epidemiologists,
parasitologists, entomologists and laboratory personnel. At the district (rayon) level, the head of the district
center of sanitary and epidemiological services has overall responsibility for all malaria-related activities in
the area. At regional and district levels, disease management activities related to malaria are carried out by
specialized and general health services equipped with microscope facilities, most of which are in need of
replacement with more modern ones. Various services of the Ministry of Agriculture, Water and Processing
Industry as well as utility services are also involved in this work.
22.2. Name the main national and international agencies involved in national responses to
HIV/AIDS, and their main programmes**:
Table III. 22.2
Type of Agency (e.g.,
Main programs (for example,
Name of Agency
Budget
Government, NGO,
comprehensive HIV/AIDS
(Specify time
private, bilateral,
prevention; DOTS expansion over 3 period)
multilateral, etc.)
years, etc.)
The Government of the
Government
Formulation of state policy on
Kyrgyz Republic
HIV/AIDS; Establishing and
including CCM; Ministry
directing the National multisectoral
of Education and
AIDS Committee; Coordination of
Culture; Ministry of
activity, monitoring, evaluation and
Defence; Ministry of
reporting in its area of the National
Labour and Social
Programme.
Protection; Ministry of
Internal Affairs; Oblast,
city, rayon
administrations and State
Committees (on youth,
drug control, etc.)
Ministry of Justice
Government
Work with service personnel and
6000
Department of
inmates of correction facilities
Corrections
Government
Work among youth and
59130
and Culture
schoolchildren
Ministry of Labour and
Government
Work on AIDS prevention among
29300
Social Protection
students of vocational facilities;
social support to PLHA and AIDS
patients
**
For NGOs, specify here your own partner organizations
Page 24 of 111
24
Ministry of Defense
Government
Ministry of Health
Government
“AIDS” National
Association
Government
Oblast centers for AIDS
prevention
National Narcological
Centre, Osh Oblast
Narcological Centre,
Chui-Tokmok
narcological unit
National Blood
Transfusion Centre,
oblast blood transfusion
centres, blood
transfusion units
National Dermatology
Venereal Dispensary,
oblast dermatology
venereal dispensaries and
rooms
Government
Government
Government
HIV/AIDS prevention among army
servicemen
3260
Coordination of governmental,
nongovernmental and international
organisations on the national and
local levels. Monitoring and
evaluation of the AIDS
programmes. Epidemiological
monitoring, HIV/AIDS prevention,
observation and support of PLHA
and AIDS patients. Psychosocial
consulting. HIV testing.
Development of programmes on
harm reduction among IDUs
(syringe exchange, methadone
substitution treatment), support to
NGOs, international cooperation
Ensuring safety of blood;
development of policy in this area,
training, blood testing for HIV,
M&E
219012
176242
17000
National Health Centre
and similar oblast
structures
Kyrgyz State Medical
Academy
Tais Plus
Government
NGO
Diagnostics, treatment and
specialist observation of STI,
training, establishing a system of
friendly venereal service for
vulnerable group representatives,
epidemiological surveillance among
patients of venereal clinics, M&E.
Psychosocial consulting
Development of information and
education programmes on AIDS
prevention. Work with mass media.
Graduate and post-graduate training
of specialists
Interventions among sex workers
NGO “OASIS”
NGO
Interventions among MSM
21760
NGO ‘Socium”
NGO
Interventions among drug addicts
32000
NGO “White Stork”
NGO
NGO Ulgu
NGO
No funds in
2001
2,500
NGO “Podruga” (Friend)
NGO
Support of educational programmes
for youth
Development of prevention
programmes for cities and villages
Interventions among SW, Osh-city
Rainbow Centre
NGO
28650
Parents Against Drugs
NGO
Tendesh
NGO
“Ilim” Educational
Facilitry
“Almaz” Radio station
Private School
Support to educational programmes
for youth and schoolchildren, Oshcity
Interventions among drug addicts,
Osh-city
for population of rural mountain
areas
Support of educational school
programmes
for youth and schoolchildren
Government
Private
Page 25 of 111
103736
5000
4320
3560
22700
24466
No funds in
2001
4500
4347
25
EL-Bata
NGO
Work with refugees
3500
Interdemilghe
NGO
Work with convicts
11300
National Red Crescent
Society
Koz-Karash
NGO
for youth and schoolchildren
Support to people affected by
HIV/AIDS
Support to the state programme on
AIDS prevention
Prevention of sexual transmission
of HIV infection. Supply and
distribution of condoms.
Treatment of STI of sex workers
17500
UNDP
UNFPA
WHO
UNICEF
Soros-Kyrgyzstan
Foundation
USAID
NGO
Multilateral cooperation
agency
agency
agency
agency
Bilateral cooperation
agency, NGO
agency
for youth (communication,
information, skills-based health
education, peer education, youth
participation).
Support to harm reduction
programmes
Support to educational
programmes, condom social
marketing and surveillance
programmes for HIV
0
59638
53968
15000
60,000
77675
20000
Other
Programmes**:
TUBERCULOSIS
Name of Agency
World Bank (loan)
KFW
USAID
Government, NGO,
private, bilateral,
multilateral, etc.)
agency
agency
prevention; DOTS expansion over 3
years, etc.)
DOTS strategy introduction
Tuberculosis-1 70%Equipment,
30%
Medicines.
Lab equipment
“Meerim” Foundation
agency
agency
agency
NGO
Office equipment for training
centers
Sanitary promotion literature,
medical equipment
Foodstuffs, medicines, vitamins
“Rezlov” Ltd.
Private
Medicines
“Unirice” Ltd.
Private
Foodstuffs
“Shoro” Ltd
Private
Foodstuffs
Café “Navigator”
Private
Foodstuffs
Soros-Kyrgyzstan
Foundation
Project HOPE
Budgetary organisations
Page 26 of 111
DOTS strategy introduction
Budget
(Specify time
period)
$1,6 mln
1998-2000
$2.4 mln.
2000-2001
$70,000 year
2001
$59,000
year 2000
$42,000
2001
$35,100
1999-2001
$293
yr 2000
$3,340
yr 2000
$133
2001
$133
2001
$1,305,000 2001
26
MALARIA
Name of Agency
and Culture
WHO
Ministry of Agriculture,
Water and Processing
Industry
22.3.
Government, NGO,
private, bilateral,
multilateral, etc.)
Government
prevention; DOTS expansion over 3
years, etc.)
Programme of malaria control.
Budget
(Specify time
period)
UN specialized agency
National Roll-Back Malaria (RBM)
programme
Government
Hydro technical operations
$20,00045,000/yr
(over last 3
yrs)
$100,000/yr
$30,000/yr
Describe the major programmatic intervention gaps and funding gaps that exist in the
country’s current response to HIV/AIDS, TB and/or Malaria:
AIDS prevention activities are conducted in the country on the basis of the National Strategic Plan and State
Programme approved by the Government of the Kyrgyz Republic on December 13, 2001. The programme
budget is USD50 million but at this stage the Government can provide not more than 25% of the requirement
even if international contributions are accounted. These funds are used to support the existing establishments
included in the programme (premises, salaries), ensure safety of medical procedures and donors’ blood as
well as perform epidemiological monitoring of HIV/AIDS/STI and organize monitoring of the programmes
under implementation. At the expense of above-mentioned donors’ funds (Table 22.2), support will be
provided to the strategies of the programme on formulation of government policies, involving and training of
the civil society representatives and implementation of limited interventions for vulnerable populations in
accordance with the National P priorities.
In connection with that, the intervention in the country fail to reach the end goal, i.e. containing further spread
of HIV infection in the country. Thus, syringe exchange programmes cover not more than 5% of the
estimated number of IDUs, which precludes effective prevention of HIV transmission in the process of drug
use. The Ministry of Education and Culture allocated only 8 hours per year instead of 32 hours that were
stipulated for the programme of fostering healthy lifestyle for schoolchildren. Such programmes are not
funded at all in the system of secondary, vocational and higher education. There are no funds for training of
teachers for this subject either. Sexually transmitted infections among vulnerable groups are not treated. The
vulnerability reduction programmes for sex workers are implemented only in two cities of the country. But
even these are not provided sufficient quantity of condoms. Full examination of donors’ blood, especially in
the remote areas of the country, is not ensured. Antiretroviral therapy is not accessible for the people living
with HIV/AIDS who need it. Preventive treatment of pregnant women living with HIV/AIDS is not carried
put. Citizens of the country including representatives of vulnerable groups have no access to anonymous
voluntary testing and psychosocial counseling. An extremely complicated situation is formed in the
penitentiary institutions where HIV infection spreading, STI and TB incidence rates are tens and hundreds
times higher than among the adult population of the entire country. There is no funding at all to reduce MSM
vulnerability, which is an epidemiologically important area.
According to the National Programme “Tuberculosis” calculation, USD5,000,000 is required to implement
the measures of response to tuberculosis in the country. Only USD1,305,000 has been allocated by the
national budget. Donor agencies provided USD1,324,000 which leaves an investment gap (budget deficit) of
USD2,371,000, or 47.4%.
MALARIA
-
Shortfalls in funding the national health system including the services directly engaged in control
and prevention of malaria do not permit to solve the malaria problem in the country. According to
the National Programme “Malaria” estimates for 2003-2007, for countrywide activities on response
to malaria epidemic $4,989,900 is needed. The national budget will allocate $120,000. Donors will
provide $50,000, which will leave a funding gap (budget deficit) of $4,819,900, i.e. 96.6%.
-
At present the funds invested by the Government and WHO in malaria control are limited, and the
country needs additional external assistance to solve the problem of malaria.
Page 27 of 111
27
SECTIONS IV – VIII: Detailed information on each component of the proposal
SECTION IV – Scope of proposal
23. Identify the component that is detailed in this section (mark with X):
Component
(mark with X):
X
Table IV.23
HIV/AIDS
Tuberculosis
Malaria
HIV/TB
24. Provide a brief summary of the component:
Kyrgyzstan is in the initial stage of development of the HIV epidemic. However, in 2001 the number of
officially registered HIV cases throughout the country grew 10.6 times and in the most impacted by this
infection Osh oblast increased 44 times. Grave concern causes the spread of HIV among injecting drug users
(IDU). The latter make 95.9 % of all HIV cases in the country and 99% of cases in Osh Oblast reported in
2001. In 2002 HIV infection continues to spread at the same rate but serious concern is caused by the increase
of heterosexual transmission of this infection. Thus, if in 2001 only 4.1% of all HIV cases were attributed to
heterosexual transmission, in 2002 it comprised already 23.1%. If experience of this epidemic development in
CIS countries is taken into account, then it can be assumed that the country entered the second stage of
epidemic when it passes from the drug users environment to the general population. This permits forecasting of
birth of children with HIV. If a high birth rate is taken into account this problem may attain a formidable
dimension for Kyrgyzstan in case targeted interventions are not made. A complicated epidemiological situation
is formed in penitentiaries where 56% of HIV detected in the country, are located; HIV prevalence is 776 per
100,000 convicts, and syphilis and tuberculosis morbidity rates exceed tens and hundreds of times these among
the population of the whole country. Despite the AIDS prevention interventions in the country the factors
facilitating HIV infection spread remain. These include the on-going growth of drug addiction and injecting
drug use, a high rate of sexually transmitted infections, maintenance of risk-bearing behavioral practices:
unsafe sex, and shared use of syringes. Unemployment and migration of population are also contributory
factors. Limited access to clean syringes and condoms does not allow achieving a sustainable behavioral
change by the programmes under implementation.
Prevention of HIV/AIDS is coordinated by the National Multisectoral Committee on AIDS prevention under
the Government of the Kyrgyz Republic. Similar structures exist in oblasts. Nongovernmental, communitybased and international organizations are involved in AIDS prevention programmes implementation.
Permanent interventions among vulnerable populations (IDU, SW, MSM, convicts and other) are carried out.
The country has accumulated its own experience in prevention programmes development that is used as a
model for other countries in the Central Asia region (interventions among SW, MSM, development of
methadone substitution treatment). The activities on HIV/AIDS are implemented in line with the UNAIDS
policy. The above-mentioned certifies that the country has capacity for further development and expansion of
HIV/AIDS prevention programmes and that this proposal is viable.
targeted interventions among the vulnerable groups and organization of support for people living with HIV
and AIDS patients.
Objectives:
1.
2.
3.
4.
5.
Strengthening political and legal support to AIDS prevention programmes based on multisectoral
approach
Reducing vulnerability of young people
Containing HIV infection among vulnerable populations
3.1 Reducing vulnerability of injecting drug users
3.2 Reducing vulnerability of sex workers
3.3 Reducing vulnerability of prison inmates
3.4 Reducing vulnerability of MSM
Ensuring safety of donors blood
Provision of medical and social support to people living with and affected by HIV/AIDS
Page 28 of 111
28
Expected outputs:
As a result of the proposed programme activities the HIV/AIDS prevention interventions in the country
will be strengthened and expanded. HIV/AIDS related political and legal environment should be
improved. Efforts of governmental, nongovernmental, private and international organizations in AIDS
prevention will be mobilized and coordinated. Required scope of interventions among vulnerable
populations will be attained to stabilize the situation and suspend further spread of HIV infection.
HIV/AIDS prevention activities will be implemented all over the country based upon partnership of
networks of governmental, nongovernmental, community-based and international organizations.
25. Indicate the estimated duration of the component:
From (month/year):
October 2002
To (month/year):
Table IV.25
December 2007
26. Detailed description of the component for its FULL LIFE-CYCLE:
Please note: Each component should have ONE overall goal, which should translate into a series of specific
objectives. In turn each specific objective should be broken-down into a set of broad activities necessary to
achieve the specific objectives. While the activities should not be too detailed they should be sufficiently
descriptive to understand how you aim to achieve your stated objectives.
Indicators: In addition to a brief narrative, for each level of expected result tied to the goal, objectives and
activities, you will need to identify a set of indicators to measure expected result. Please refer to Guidelines
paragraph VII.77 – 79 and Annex II for illustrative country level indicators.
Baseline data: Baseline data should be given in absolute numbers (if possible) and/or percentage. If baseline
data is not available, please refer to Guidelines paragraph VII.80. Baseline data should be from the latest
year available, and the source must be specified.
Targets: Clear targets should be provided in absolute numbers (if possible) and percentage.
For each level of result, please specify data source, data collection methodologies and frequency of
collection.
An example on how to fill out the tables in questions 26 and 27 is provided as Annex III in the Guidelines for
Proposals
26.1. Goal and expected impact (Describe overall goal of component and what impact, if applicable, is
expected on the targeted populations, the burden of disease, etc.), (1–2 paragraphs):
targeted interventions among the vulnerable groups and organization of support to people living with HIV
and AIDS patients.
Kyrgyzstan is in the initial stage of development of the HIV epidemic now. Therefore, conditions have been
created in the country for effective development of preventive programmes. This concerns both political and
executive levels and is due to adequate political decisions on this issue and partnership of governmental,
nongovernmental, community-based and international organizations. Concurrently, due to the present
difficult economic situation in the country there is no possibility to expand prevention programmes to the
level required for effective containment of further epidemic spread. This factor is of crucial importance since
HIV infection spread in the country is related to injecting drug use.
As an output of the proposed programme implementation further HIV spread is to be prevented at the initial
stage of the epidemic. This will permit to create a model of response to the infection in countries with low
rates of spread. AIDS morbidity rate during this period will not exceed 0,5% and the estimated number of
HIV cases will not be more than 2% of the adult population of the country. Implementation of the programme
will also permit to ensure necessary medicines treatment for people living with HIV and AIDS cases and to
provide social support to them, which should raise social activity of these people and their involvement in
prevention programmes.
Page 29 of 111
29
Goal:
To contain the spread of HIV in the Kyrgyz Republic at the initial stage of the epidemic
through targeted interventions among the vulnerable groups and organization of support to
people living with HIV and AIDS patients
Target (last year of proposal)
Impact indicators
Baseline
(Refer to Annex II)
Year: 2002
Year: 2007
Estimated number of HIV cases
AIDS morbidity rate
Activities of multisectoral committees
Legislation on HIV/AIDS and with
relation to vulnerable groups
Injecting drug users will be involved
in harm reduction programmes
Schoolchildren aged above 11 and all
students will be exposed to HIV/AIDS
prevention training within the
framework of compulsory school
curriculum
Pregnant women living with HIV will
get HIV-related preventive treatment
Page 30 of 111
0.12% of adult
population
0.0001% of adult
population
In the capital and oblasts
On the whole
corresponding to
international laws but
law-enforcement
practices contradict them
Up to 4% of the
estimated IDU number
covered by syringe
exchange programmes
and 2% of reported IDU
receive methadone
substitution treatment
programme
30% of schoolchildren
Pregnant women living
with HIV do not get any
preventive treatment
Not more than 2% of adult
population
Not more than 0.5% of adult
population
Everywhere in the country : the
capital, oblasts and locally
Legislation on HIV/AIDS and
with relation to vulnerable groups
as well as law-enforcement
practices correspond to the norms
of international law
Up to 60% of the estimated IDU
number covered by syringe
exchange programmes and 80% of
IDU involved in the methadone
substitution programmes
90% of schoolchildren and
students
98%
30
27.Objectives and expected outcomes:
Objective 1. Strengthening of political and legal support to Programs on Response to
HIV/AIDS Epidemic, based on multi-sectoral approach
This objective aims to build public environment, enabling implementation of HIV/AIDS epidemic prevention
activities. This will be undertaken through the coordination of activities of existing and mobilization of new
program participants. Currently there is Multi-Sectoral Coordinating committee on HIV/AIDS Prevention
acting at the national and regional levels. However they are represented mainly by the heads of relative
governmental stakeholders and some NGOs. Among 1000 registered in the country NGOs that are dealing
with the developmental issues only 20 NGOs are involved in activities for HIV/AIDS prevention.
Mobilization of private sector, public universities, and independent mass media in response to HIV/AIDS
epidemic is very limited. To expand and improve the coordination the conferences of governmental and
nongovernmental organization, business and mass media representatives, academic institutions are needed at
the national and regional levels and proper provision of all the participants with the necessary information.
The National Multi-Sectoral Coordinating committee, National AIDS Center and Regional Centers on
HIV/AIDS Prevention, Ministry of Justice of the KR, AIDS servicing NGOs, in particular, “Tais Plus”,
“Sotsium”, “Bely Zhuravl”, “Podruga” and “Koz Karash”, the Association of Independent Lawyers, mass
media will focus on the objective. UNDP is also going to assist in this area.
Table IV.27
Objective:
Strengthening of political and legal support to Programs on Response to
HIV/AIDS Epidemic, based on multi-sectoral approach
Outcome/coverage indicators
(Refer to Annex II)
Number of NGOs participating in
coordinated Programs on Responce to
HIV/AIDS
Number of academic institutions
participating in coordinated Programs
on Responce to HIV/AIDS
Number of agencies, whose directive
basis will be analysed for approprietness
to the objective of responce to
HIV/AIDS epidemic
Share of AIDS-servicing governmental,
non-governmental and community
based organizations, to which the legal
assistance was provided, %
Number of authority meetings (Jogorku
Kenesh and Ombudsman) to discuss
issues on Response to HIV/AIDS
Epidemic
Baseline
Year: 1
20
Targets
Year 2:
30
Year 3:
40
Year 4:
50
Year 5:
70
10
30
50
70
90
0
3
2
0
0
0
20
40
60
80
0
2 (1
Jogorku
Kenesh+
1
Ombuds
man)
1
(Ombuds
man)
0
1
(Jogorku
Kenesh)
Page 31 of 111
31
27.1. Key broad activities for specific objectives and outputs (describe specific key activities, conducted
for implementation of declared objectives) (1 brief paragraph per one activity):
Table IV.27.1
Objective:
Strengthening of political and legal support to Programs on Response to HIV/AIDS Epidemic, based
on multi-sectoral approach
Broad activities
Multi-sectoral
coordination and key
public structures
mobilization to confront
HIV/AIDS
Improvement of
legislation related to
HIV/AIDS Epidemic
Prevention
Ensure public support to
the Programs on
Response to HIV/AIDS
Epidemic
Process/Output
indicators (indicate one
per activity) (Refer to
Annex II)
Number of partners,
covered by the horizontal
information sharing
network between the
implementing agancies
Share of AIDS-servicing
governmental and nongovernmental agencies,
to which legal assistance
was provided, %
Share of people,who
declared positive attitude
to prevention programs
for vulnarable groups
during the public opinion
survey
Baseline
(Specify
year)
Targets
Year 1
Year 2
Responsible/Implementing
agency or agencies
14 (8
NGOs + 6
governme
ntal
agencies +
1
internatio
nal
agency)
0
30
50
National Multi-Sectoral
Coordinating committee, NGOs,
UNDP
20
40
46,0
55
70
Coordinating Committee, NGOs,
UNDP
Jogorku Kenesh
Ministry of Justice
Coordinating committee, NGOs,
UN Theme Group on HIV/AIDS
Activity 1. Multi-Sectoral coordination and mobilization of key structures to respond HIV/AIDS
spread
This activity is directly addressed to the acting and expected participants of HIV/AIDS Programs. The agreed
cooperation and transparency of sectoral and individual agencies’ programs for partners will be ensured. The
advanced international and national mobilization experience will be expanded to involve key participants in
programs on response to HIV/AIDS. The strategies will be developed for participation of newly involved
NGOs, economic sector and academic institution in Programs on Response to HIV spread.
There will be 1 national and 3 regional meetings conducted for non-governmental and business sectors, and
also one national meeting of academic institutions. During the second year it is proposed to conduct similar
meetings to assess the impact of steps undertaken and to modify the selected strategies taking into account the
changes in the situation. Further the annual national meetings will be conducted for every sector to monitor
and evaluate the effectiveness of ongoing activities. Politicians, influencing the situation, among members of
the Jogorku Kenesh and Ombudsman, will be trained.
Costs will include: Attachment 6.1
Funds to conduct the national meetings (USD3000 per national and USD1500 per each interregional meeting)
Resources
Year 1
Year 2
Year 3
Year 4
Year 5
Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
Total
18,000,00
18,000,00
18,000,00
18,000,00
18,000,00
90,000,00
Activity 2. Improvement of HIV/AIDS related legislation
This sub-objective is aimed to develop the legal environment, enabling the effective response to HIV/AIDS
epidemic. This objective will be achieved through: analysis of the existing legislation and development of the
revised versions of current legal by-laws; training of lawyers and enforcement bodies representatives;
provision of legal services to AIDS-servicing governmental intuitions and non-governmental organizations,
representatives of vulnerable groups, people living with HIV and AIDS and HIV affected people;
Page 32 of 111
32
establishment of human rights monitoring system in regards to response to HIV/AIDS spread. Issues on
provision of legal support to HIV/AIDS Prevention Programs will be considered at the session of the special
Jogorku Kenesh Commission and also will be submitted for consideration to Ombudsman Cabinet,
established in Kyrgyzstan in 2002.
Key outputs: directive documents of the governmental and other agencies do not include regulations,
constraining response to HIV/AIDS epidemic; national experts have been trained; NGOs and vulnerable
groups, people living with HIV and HIV-affected people receive necessary legal support; authorities (Jogorku
Kenesh and Ombudsman) supervise the enforcement of Constitution, international agreements and national
legislation in regards to response to HIV/AIDS epidemic; human rights monitoring system is effected.
Expenditures (attachment 6.1) evaluation of the governmental and other agencies’ directive basis and
assessment of the human rights situation regarding aspect of response to HIV/AIDS (primary, intermediate
and final, US$15.000 in total); training of national experts in countries with effective legislative system
supporting the response to HIV/AIDS epidemic (2 lawyers and one representative of enforcement bodies – a
member of the Interior Ministry Working Group, US$13.500 in total), conduction of three national
conferences and one conference for Working Group on strategy development for legal support to Programs
on Response to HIV/AIDS; inputs provision for human rights monitoring (procurement of necessary
computer equipment and technical assistance US$12.000), payment t lawyer – US$ 200 per month.
Resources
needed (USD)
Total
Year 1
27700
Year 2
15200
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
17200
6200
14200
Total
80500
Activity 3. Enabling general public support to Programs on Response to HIV/AIDS
This activity addresses to the wide range of non-governmental and community based organizations and also
mass media, and indirectly through their participation, to socially active citizens. Non-governmental
organizations supporting vulnerable groups, people living with HIV/AIDS and HIV affected people, key mass
media and journalists will be involved in development of public environment, enabling the promotion of
Programs on Response to HIV/AIDS. The target of this activity is the formation of public opinion, positive to
Programs on Response to HIV/AIDS and tolerant to vulnerable groups, people living with HIV/AIDS and
HIV affected people.
Major outputs: transparency of Programs on Response to HIV/AIDS for public is ensured; representatives of
non-governmental organizations have received training and are pro-active in terms of development
cooperation and interaction with governmental structures and mass media; human rights protection
organizations, supporting vulnerable groups, people living with HIV/AIDS and HIV affected people, use the
existing and mobilize new resources for dissemination of information and raising the awareness and advocacy
for selected strategies to confront the epidemic.
Major expenditures (Attachment 6.1.): expenses for general public opinion study (initial, including the
development of monitoring methodology and strategy for wide public coverage through mass media,
intermediate and final studies, first at the cost of US$3000, the next ones at the cost of US$1500), training for
non-governmental representatives (including, one national and two interregional workshops annually, two
interregional workshops for key participants training and strategies development during the first year; one
interregional workshop to assess the outputs of activities and modify the selected strategies during the second
year; and one interregional workshop for monitoring and evaluation of ongoing activities during the
subsequent years, US$24.000); costs of training for key journalists (US$3000; including one national training
workshop annually, taking into account that a new group of journalists will be trained every year); expenses
to arrange contests for better highlighting of the problem in mass media, including contests among students,
studying journalism (annual contest for two groups: working journalists and students, studying journalism, on
six categories for the first group: analytical newspaper article, US$1100, analytical telecast, US$2250,
telecast of “journalist investigation” genre, US$3750, advertising audio reel, US$720, advertising video reel,
US$16500; and as follows categories for the second group: analytical newspaper article, advertising audio
reel; grant for long-term annual reporting (highlighting) the problem, US$1500, contest for conduction of
action, US$2.500), costs for production and placement of outdoor advertisements (US$84.000); expenses to
conduct “round tables” and talk shows (2 “round tables” and 2 talk shows per year at TV national channels
and one of each per year at local TV channels in six regions, US$12000), costs for invitation of the “Quilts”
group (2 times) (US$10.000).
Page 33 of 111
33
Resources
needed (USD)
Year 1
Total
Year 2
36330
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
33330
38330
33330
38330
Total
179650
SECTION V – Budget information
30. Indicate the summary of the financial resources requested from the Global Fund by year and
budget category, (Refer to Guidelines paragraph V.56 – 58):
Table V.30
Resources
Year 1
Year 2
Year 3
Year 4
Year 5
Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
4200
4200
4200
4200
4200
21000
3600
600
600
600
600
6000
36500
31500
27500
22500
27500
145500
17000
17000
17000
17000
17000
85000
Monitoring and
Evaluation
Administrative
Costs
12000
1500
4500
1500
4500
24000
1200
1200
1200
1200
1200
6000
Other
(Please specify)
10530
15530
10530
15530
10530
62650
Total
85030
71530
65530
62530
65530
350150
Human
Resources
Infrastructure/
Equipment
Training/
Planning
Commodities/
Products
Drugs
Resource allocation to
implementing partners*
(%)
Government
NGOs / CommunityBased Org.
Year 1
Year 2
Year 3
(Estimate
)
Year 4
(Estimate
)
Year 5
(Estimate
)
Total
5,5%
6,3%
0,0%
0,0%
0,0%
2,6%
94,5%
93,7%
95,6%
100,0%
95,4%
95,7%
0,0%
0,0%
4,4%
0,0%
4,6%
1,7%
Private Sector
People living with HIV/
TB/ malaria
Academic / Educational
Organizations
Faith-based
Organizations
Others (please specify)
Total
Total in USD
100%
85030
100%
71530
Page 34 of 111
100%
65530
100%
62530
100%
65530
100%
350150
34
Objective 2. Reducing vulnerability of young people to HIV/AIDS
A demographic feature of Kyrgyzstan is that the total number of young people aged 15 to 29 comprises 27
percent (1.118 million) of the country’s population, which makes 51.7% of the total strength of able-bodied
population. The numerical strength of this group, its great social importance – it is this youth that will ensure
productive activity and development of the country within the next decades – and the possibility to develop
large-scale prevention programmes for young people makes this group a priority one.
A conditional group “Youth” identified based upon risk for HIV-infection is one of the priorities of the national
strategic plan and includes people in the age 11 to 25. The lower age bracket has been established in accordance
with beginning of puberty and the time of first trials of psychoactive substances (PAS) while the upper bracket by the end of the peak period of sexual activity and involvement in PAS use.
Accessibility of the group in terms of information interventions is conditioned by a high rate of exposure of
teenagers and youth to compulsory school education (99.7%) as well as by readiness of government structures
(Ministry of Education and Culture, Ministry of Defense) to develop informational preventive programmes in
the system of educational establishments. At this time, there are 1,953 secondary schools (27 of them being
private), 92 higher educational establishments as well as 165 vocational schools functioning in the country.
There are 1,100,000 schoolchildren and 122,000 undergraduate students.
Among the youth in general one can identify subgroups that differ in terms of their behavior, risk of HIV
spread, and methods of reaching them with prevention programmes:
Organized school youth – students of secondary and special schools, vocational system, and
higher educational establishments;
Working youth;
Migrants (both internal and refugees);
Youth in informal youth associations (both school and working, and unemployed);
Military personnel and staff of law-enforcement system;
Street children.
HIV vulnerability of a group is determined by the following factors:
Limited capacity to control own behavior determined both by personal and social causes (first of all by
dependence on parents);
Limited access to individual contraceptives as a consequence of the moral prejudices prevailing in the
society;
Insufficient economic and social protection including limited access to adequate venereal and
narcological medical service;
Limited access to adequate information concerning sexual health and PAS use consequences
determined by the taboo maintained in the society on free discussion of the topics of sex and drugs,
and limited quantity of information materials containing required knowledge in the form acceptable for
young people;
Insufficient legal protection;
Limited involvement of young people when programmes and activities targeting them are designed..
Specific goals of interventions include: (1) raising awareness of youth through introduction of
compulsory educational programmes on fostering healthy lifestyle (HLS), forming safe behaviour through
programmes of peer education, increase of condoms accessibility, providing access for youth to good and
friendly medical service.
Page 35 of 111
35
Table IV.27
Objective:
Reducing vulnerability of young people to HIV/AIDS
(Refer to Annex II)
Percent share of educational
establishments where the compulsory
programme on HLS is introduced
Proportion of educational
establishments (general secondary,
vocational and higher), with the
faculty trained to conduct classes on
HIV/AIDS/STI/drug addiction
prevention
Proportion of graduate students of
pedagogical institutions and
departments who were trained (in
their institution) to teach HLS
Proportion of school youth in the age
14-20 who know not less than 2
methods of protection against HIV
and STI
Number of cities where assessment is
made and interventions among
“street” youth conducted
Proportion of the total number of the
Army soldiers (privates) exposed to
programme training on issues of
HIV/AIDS/STI/drug addiction
prevention
Baseline
Year: 2002
Targets
Year 2:
Year 3:
Year 4:
Year 5:
20%
40%
60%
80%
90%
30%
50%
70%
80%
100%
10%
30%
70%
100%
100%
30%
50%
60%
70%
80%
1
3
5
10
12
30%
50%
70%
100%
100%
27.1. Broad activities related to each specific objective and expected output
Objective:
Broad activities
Reducing vulnerability of young people to HIV/AIDS
Process/Output
Baseline
Targets
indicators
Year 2002 Year 1
Introduction of a
compulsory course on
HLS in all educational
establishments and
among military
servicemen
Development of “peer
education” programmes
for youth
Ensuring access of youth
to friendly medical
service and counseling
Supply of condoms to
sexually active youths
Number of educational
establishments
20%
Proportion of polled
children and teenagers
of 11-28 years who
know 2 ways of
protection against
HIV/AIDS
Number of friendly
venereal rooms (doctors)
Not
available
Proportion of the polled
young people of the age
15-24 who use condoms
during sexual
intercourse with varying
partners
10-20%
Page 36 of 111
1 clinic
for SW
40%
Year 2
60%
20%
30%
4
8
30%
50%
agency or agencies
Ministry of Education, Ministry of
Labour and Social Protection,
Ministry of Health, Ministry of
Defense, Ministry of Internal
Affairs, NGO
NGO, Ministry of Education,
Ministry of Labour and Social
Protection, Ministry of Health
Ministry of Health, NGO
Ministry of Health, NGOs
36
Activity 1. Introduction of a compulsory course on HLS in all educational establishments and among
military servicemen
Organized school students can be easily reached with educational (school) programmes on HIV/AIDS
prevention. At present a school course “HLS” has been developed, pilot tested and is in the process of
introduction in senior forms. This course includes lessons on STI/HIV/AIDS and drug addiction prevention as
well as general issues of reproductive health protection and family planning. 15 seminars were held and about
400 teachers were trained. 2 training workshops were conducted for medical personnel and officers
responsible for educational work with army soldiers and privates of MIA.
But at present teaching “Healthy Lifestyle” (including topics on HIV/AIDS, STI and drug addiction) is not a
regular subject in the school curriculum. Such lessons are mostly conducted during out-of-school hours at
schools, vocational schools of large cities, oblast and rayon centers.
There exist a number of problems:
- The number of trained trainers (teachers) on such complicated for them specific topics as
sexual education, HIV/AIDS/STI, drug addiction remains insufficient;
- Lack of textbooks on “Healthy Lifestyle” for various age groups of students;
- Lack and shortage of visual aids (plaster casts, plane-tables, video equipment);
- Insufficient or non-existent state funding of teachers pay for teaching “Healthy Lifestyle”;
- Insufficient knowledge of issues of HIV/AIDS/STI prevention by parents.
Expected outputs:
Sufficient number of teachers trained for universal introduction of the course “Healthy Lifestyle”
(not less than 2 teachers per educational establishment);
Continuous training of students of pedagogical institutions and teachers improvement courses for
conduct of the course “Healthy Lifestyle” prepared and organized;
Each educational establishment supplied a “class-kit” of the course “Healthy Lifestyle” (the “classkit” includes 30 textbooks “Healthy Lifestyle” and a package of visual and methodological aids);
Introduction of the course “Healthy Lifestyle” in all educational establishments of the country
supported;
A national network of ngos providing consultative and methodological assistance to teachers
established.
Main executing agents: local government administrations, nongovernmental organizations providing
consultative and methodological assistance to teachers, Ministry of Education, Ministry of Labour and
Social Protection, Ministry of Health, Ministry of Defense, and Ministry of Internal Affairs.
Costs include (detailed budget in Attachment 6.2):
(1) Education of teachers and professors to teaching the course “HLS” (including military instructors).
This envisages two ways of solving the task:
(a) development and introduction of the course “HLS” teaching methods for all students of
pedagogical institutions. Implementation of this activity will permit to establish a permanent state-run
base for training teachers for the course “HLS”.
(b) on-the-job training of teachers at schools using the principle “teacher-to-teacher” or during the
teachers improvement courses (TOT).
- development of methodology – USD5,000;
- training expenses: 180 training workshops and annual conferences – USD 265,000;
- expenses for material and technical basis (physical plant) – USD50,000;
(2) Printing of “HLS” textbooks in the amount of 30 copies per educational establishment (2,200
educational establishments), total 66,000 copies. Expenses – USD264,000.
(3) Preparation and publication of a methodological package to support the educational programmes,
total 2,200 copies. Expenses – USD22,000;
(4) Support of NGOs providing consultative and technical assistance to teachers and professors to
introduce the course “HLS”. Expenses – USD90,000;
(5) Organization of training for schoolchildren living with AIDS who cannot attend classes in secondary
schools due to their health condition (according to the medical recommendations). Expenses –
USD30,000;
(6) Monitoring and evaluation of the activities, including rapid assessments, surveys, questionnaires and
invitation of foreign auditors. Expenses – USD9,000.
Page 37 of 111
37
Resource
allocations (US$)
Total
Year 1
Year 2
Year 3
(estimate)
Year 4
(estimate)
Year 5
(estimate)
Total
283,000
261,000
129,000
29,000
33,000
735,000
Activity 2. Development of “peer-to-peer” education programmes
This activity is focused directly on all youth groups, especially, young people from the most vulnerable
groups. Despite the availability of training programmes on “HLS”, it is impossible to expose “street” youth
and young people from trouble families to school programmes. According to the Minors Adaptation and
Rehabilitation Center of the MIA, the number of “street” children has reached almost 800. There are reasons
to assume that actual number of “street” children is considerably greater.
The major problems are: absence of political and legal support for poor youth as well as lack of governmental
and nongovernmental organizations that are interested and ready to take part in resolving the problem.
Young people “peer-to-peer” training was started in 1999 but for the time being it happens as one-time
actions and cannot change the situation significantly.
This makes us to actively develop the “peer” training programmes for young people. As a result of this
activity the information on ways of catching HIV/STI and methods of protection will be spreading in addition
to educational establishments also in informal environment at disco parties, in the yards, and families.
Information disseminated by peers among socially unprotected young people, refugees, street children and
teenagers will be extremely important. Development, publication and dissemination of targeted information
materials will be a good addition to the permanent work of the component and different events.
Young people from various social groups will develop the materials together with NGO specialists, and
specialists of AIDS prevention centers.
Expected results:
A national network of NGOs working with young people established;
Information materials and products with special logos developed and issued for all youth groups in
sufficient quantities;
Higher level of awareness among young people on issues of STI/HIV/AIDS and drug addiction
prevention;
Regular sensitization of youth and wide public to the problem by organizing thematic actions.
Major executing agents: local government administrations, NGOs working with young people, Ministry of
Education, Ministry of Labour and Social Protection, Ministry of Health, and Ministry of Internal Affairs.
(1) Support of NGOs working with in-school, out-of-school, and “street” youth. This item includes
expenses for continuous training of volunteers, support of field activities including conduct of onetime actions, and bonuses to active volunteers. Total USD 180,000 (9 subcontracts per year).
(2) Development and publication of information materials and publications with special logos for
youth, 3 types/year for 7 youth groups (“street youth”, militiamen, soldiers, schoolchildren of 2 age
groups, students and refugees). Total USD200,000;
(3) Thematic actions. Total for 5 years USD15,000;
(4) Monitoring and evaluation of the activities. Total USD9,000
Resource
allocations (US$)
Total
Year 1
Year 2
80,000
80,000
Year 3
(estimate)
80,000
Year 4
(estimate)
Year 5
(estimate)
Total
80,000
84,000
404,000
Activity 3. Ensuring access of youth to friendly medical service and counseling
The level of sexual activity of young people has been rising. The STI incidence among young people is high:
in 1998 there were reported 117 cases of syphilis among children and teenagers, and in 1999 – 120 cases.
Among all HIV-infected people in the country young people of the age 15 to 29 constitute 54.4%.
Page 38 of 111
38
When solving this problem we face a number of difficulties:
- Lack of sympathetic, supportive public attitude to the problem. When discussing issues of sexual health,
or condom use children and teenagers face disapprobatory position of adults.
- Low level of social protection of young people, lack of money for professional treatment and cure. Young
people, especially from socially unprotected populations, have practically no possibility to obtain
medical aid to treat STI.
- An extremely limited network of hotline “trust phones” and psychological support service.
- Absence of youth-oriented clinics with good quality and friendly medical service. Both state-run and
private venereal rooms are not designed to provide free services to young people with various STIs. Only
Bishkek has a medical center for sex workers operating under WHO support.
- No epidemiological surveillance in the group.
Expected outputs:
A national network of clinics is established targeted at work with young people on reproductive
health;
Targeted and rational distribution of condoms among young people is organized;
Regular epidemiological surveillance is conducted in the group;
The rate of STI incidence among young people is reduced.
Major executing agents: NGOs working with youth, private clinics, and Ministry of Health.
(1) Training of physicians to work with socially unprotected youth and on the issues of psychosocial
counseling. Total expenses for 5 years USD12,000
(2) Initial expenses to set up a network of youth clinics (rooms) including equipment, medicines,
instruments, and supplies. Total for 5 years USD93,000
(3) Development of hotline “trust phone” service network for young people and creation of a
sympathetic public opinion;
(4) Organization of free targeted (only for young people) distribution of condoms through the youth
clinics network;
(5) Epidemiological surveillance actions in the group. Expenses – 3000 (3 times: 1-st, 2-nd & 3ed years)
Resource
allocations (US$)
Total
Year 1
Year 2
10,000
20,000
Year 3
(estimate)
20,000
Year 4
(estimate)
25,000
Year 5
(estimate)
30,000
Total
105,000
Activity 4. Supply of condoms to sexually active youths
Supply of condoms as humanitarian aid is mostly organized through the family planning agencies, which is
not very effective with relation to young people. Free condoms are distributed among teenagers and young
people as one-time actions in extremely small quantities.
Condoms in the market when even low-priced are inaccessible to most young people, especially to lowincome groups (school students, soldiers), socially unprotected (refugees, street teenagers).
The socially unprotected sexually active youth comprises about 20% of the total numbers of youth. Total
annual need is 9,450,000 condoms. Partially this need is met by UNFPA supply, and with the most rational
distribution of the condoms supplied through the channels of all humanitarian aid organizations not more than
half of the need would be covered. The main problem is in the absence of a system of institutions, clinics or
NGOs dealing in targeted condom distribution among youth. Most of the currently distributed free condoms
do not reach youth.
Expected outcomes:
All low-income youth supplied with a sufficient quantity of condoms;
A system of targeted rational distribution of condoms among young people organized;
STI morbidity rate among young people reduced.
Main executing agents: NGOs working with youth, private clinics, Ministry of Health, and Ministry of
Defense.
Expenses for procurement of condoms (9,450,000 pcs per year over 5 years) - USD2,350,000
Page 39 of 111
39
Resource
allocations (US$)
Total
Year 1
Year 2
470,000
470,000
Year 3
(estimate)
470,000
Year 4
(estimate)
470,000
Year 5
(estimate)
470,000
Total
2,350,000
Resources needed
(USD)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Table V.30
Total
Human Resources
10000
11000
10000
10000
10000
51000
Infrastructure/
Equipment
Training/ Planning
33000
40000
31000
21000
21000
146000
113000
113000
113000
23000
23000
385000
Commodities/
Products
Drugs
Monitoring and
Evaluation
Administrative
Costs
659000
637000
605000
505000
505000
2911000
2000
2000
4000
2000
14000
2000
19000
2000
24000
10000
63000
18000
4000
4000
4000
4000
4000
20000
Other
0
0
0
0
0
0
Total
823000
811000
779000
584000
597000
3594000
33. Indicate in the Table below how the requested resources will be allocated to the implementing
partners, in percentage (Refer to Guidelines para. V.63):
Resource
allocation
to
implementing
partners* (%)
Academic /
Educational
Organizations
NGOs/Communit
y-Based Org.
Private sector
People
living
with HIV/AIDS
/TB/ malaria
Total
Total in USD
Year 3
(Estimate)
Table V.33
Year 4
Year 5
(Estimate)
(Estimate)
Year 1
Year 2
Total
65%
65%
50%
35%
35%
50%
34,5%
34,3%
48,9%
62,9%
63%
48,72%
0,2%
0,3%
0,2%
0,5%
0,1%
1%
0,1%
2%
2%
0,12%
1,16%
100%
823000
100%
811000
100%
779000
100%
584000
100%
597000
100%
3594000
Note: Item “Government” includes educational and academic establishments of the Ministry of Education
and Culture, Ministry of Health, Ministry of Defense and other government structures.
Page 40 of 111
40
Objective 3.1. Reducing vulnerability of injecting drug users to HIV/AIDS
25.Indicate the estimated duration of the component:
From (month/year):
To (month/year):
1 October 2002
Table IV.25
1 October 2007
Reduction of IDU vulnerability to HIV/AIDS is one of the three priority areas of the National Strategic Plan
and State Programme of the Kyrgyz Republic approved by the Government of the Republic on 13 December
2001. Harm reduction programmes gained political and social support. Since 1999, targeted prevention
interventions among IDU have been organized in the Republic. Since 2000, syringe exchange programmes
have been implemented, and since 2002 two pilot projects of methadone substitution treatment (MST) for
IDU in Bishkek and Osh have been launched. On the whole five syringe exchange projects for IDU are being
implemented in the capital and two oblasts, the number of permanent clients is more than 2000 with syringe
return rate of 95%. Interventions based on the principle of peer education and information support of the ongoing programmes are conducted. At the same time the syringe exchange programmes cover only 4% of the
estimated number of IDUs and the MST programmes only 2% of the reported IDU, which cannot actually
impact on HIV infection spread.
The proposed expansion of the syringe exchange and MST programmes will permit to exert real influence on
containing further spread of HIV among IDU and provide opportunity to carry out epidemiological
monitoring of HIV infection spread in this group including the use of sentinel surveillance.
Goal: To contain the spread of HIV/AIDS among IDU through fostering a safer behavior and development
of harm reduction programmes.
Objective:
Reducing vulnerability of injecting drug users to HIV/AIDS
Outcome/coverage
Baseline
Targets
indicators
Year 1:
Year 2:
Year 3: 2004
Year 4: 2005
2002
2003
Number of syringe
exchange programmes for
IDU
Coverage of IDU by syringe
exchange programmes
Proportion of IDU exposed
to voluntary confidential
checkup for HIV, including
those who are involved in
the programmes
Proportion of IDU covered
by the syringe exchange
programme and constantly
using clean instruments
Number of participants of
MMTP programmes
Use of condoms by the
IDU participating in the
programme
Year 5: 2006
5
15
20
25
30
4%
15%
30%
50%
60%
0,02%
/ 10%
0,5%
/ 20%
1%
/ 30%
2%
/ 40%
3%
/ 50%
60%
70%
75%
80%
90%
100
300
600
900
1500
5%
15%
20%
30%
40%
Page 41 of 111
41
27.1.
Broad activities related to each specific objective and expected output
Objective:
Reducing vulnerability of injecting drug users to HIV/AIDS
Broad activities
Process/Output
Baseline
Targets
indicators
(2002)
Year 1 Year 2
(2003)
(2004)
1. Development of
Development and
5/4
8/10
15/15
syringe and needle
expansion of new
exchange programmes
projects to populated
for IDU
areas of the country,
strengthening capacity of
the existing projects
(number of
projects/cities-villages)
2. Development of
Support of existing
2/100
3/300
4/600
methadone substitution
programmes and
treatment (MST)
launching new
programmes
programmes (number of
programmes/persons)
3. Information,
education,
communication
Proportion of IDU
involved in “peer-topeer” education
programmes
4. Development of
medical service and IDU
support system
Number of IDU-friendly
clinics
4%
8%
16%
1
2
4
agency or agencies
Working initiative groups
with participation of local
administrations, Ministry of
Health, representatives of
communities, IDUs themselves,
NGOs
National Narcological
Center, Osh Oblast Narcological
Dispensary, Ministry of Health,
State Commission on Drug
Control, oblast and rayon central
hospitals
NGO, Ministry of Health,
National Narcological Center,
Osh Oblast Narcological
Dispensary, health facilities,
religious faiths
Ministry of Health, health
facilities
Activity 1. Development of syringe and needle exchange programmes
The on-going drug abuse growth, risk-bearing behavioral practices are serious factors of HIV infection spread
in the country. There are five on-going syringe exchange prevention programmes for IDU but they cover only
4% of the estimated number of IDU in the target group, which cannot produce a desired effect on
constraining further epidemic development. Sharing syringes, needles and/or containers for preparation of
drug solutions, insufficient knowledge of safe behavior when using drugs facilitate rapid spread of HIV
among drug addicts. More than 60% of drug addicts do not work and have no funds of their own to buy
sterile syringes and needles.
This activity involves the following actions:
Distribution of sterile instruments for injections (syringes and needles) and disinfectants;
Removal of used syringes from circulation and their safe destruction;
Establishing new syringe exchange programmes in all areas of the republic, expansion of the
existing ones.
Distribution of condoms among the programme participants;
Monitoring and evaluation.
These actions will be implemented in stationary syringe exchange points, mobile stations and through street
work of volunteers (former drug users or co-dependent persons), which will provide access to sterile
instruments for IDU.
Executing agents: nongovernmental organizations, narcological centers and AIDS prevention centers, former
drug users, co-dependent people.
Expected outputs:
Increased access to sterile instruments from 4% to 60% of the estimated number of IPU over 5
years.
Increased number of IDU who constantly use clean instruments from 60 to 90% of the
programme participants.
Increased number of IDU who use condoms from 5 to 40%.
By 2007 the estimated number of people living with HIV limited to not more than 20% of the
estimated number of IDU.
Page 42 of 111
42
Prepared trainers from the number of specialists and volunteers of the programmes on
development of similar projects in other areas of the country.
The costs include (detailed budget in Attachment 6.3):
Procurement of syringes, needles, disinfectants, dressing materials, containers for syringes;
Payment of the programme workers (volunteers, social workers);
Sentinel surveillance;
Evaluation, expert examination of the programmes, monitoring.
Resource
allocation (US$)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Total
413 578
735 604
990 614
2 167 028
2 593 432
6 900 256
Activity 2. Development of methadone substitution treatment programmes
Substitution therapy is an effective means of HIV/AIDS prevention among IDU especially among people
with HIV/AIDS, hepatitis, tuberculosis and other diseases. There are two pilot projects on methadone
substitution treatment programme functioning in the country since 2002. These interventions gained political
support, specialists for their implementation were trained, and permission was granted for imports and
certification of methadone. The outputs prove effectiveness and viability of these programmes. Development
of MST will permit not only to ensure reliable prevention of HIV/AIDS transmission but also improve social
functioning of the MST participants.
This activity envisages the following actions:
Receiving, procurement of methadone, its safe storage to prevent its leakage into illicit traffic;
Provision of methadone treatment to MST participants;
Distribution of condoms among the programme participants;
Establishing new MST in all regions of the republic;
Establishing and training of interdisciplinary teams for methadone programmes (physicians,
psychologists, social workers, lawyers);
Support in social rehabilitation and reintegration;
Monitoring and evaluation of the methadone programmes.
Expected outputs:
- Reduction of the number of IDU by 3000 persons over five years owing to transfer of the MMTP
participants to non-injecting drug use;
- Reduction of the number of illegal drug users by 3000 over five years;
- Reduction of IDU vulnerability to HIV/AIDS;
- Improved social functioning of the MST participants;
- Increased coverage by the MST from 0.2 to 5% of the estimated number of injecting drug users.
Executing agents: Narcological centers, academic institutions, religious confessions, NGOs, drug-dependent
and co-dependent people, State Commission on Drug Control, city rayon administrations, oblast and rayon
central hospitals.
The costs include (detailed budget in Attachment 6.3):
Procurement of methadone hydrochloride and accompanying materials (reagents, batchers, disposable
cups, etc.);
Payment of the MST workers;
Administrative expenses related to provision of safe storage and delivery of methadone;
Training the programme workers;
Monitoring and evaluation of the MST.
Resource
allocation
(US$)
Total
Year 1
64 332
Year 2
99 980
Page 43 of 111
Year 3
176 744
Year 4
293 040
Year 5
592 980
Total
1 227 076
43
Activity 3. Development of information, education and communication programmes
There is an acute shortage of information materials on prevention of HIV/AIDS transmission through
injecting drug use in the Kyrgyz Republic. Lack of information materials and a holistic strategy on
information-education work among IDU makes the information-education interventions sporadic, local and
with low effect.
Increase in the number of harm reduction programmes requires coordination of efforts of the participants of
the prevention process, however, lack of modern means of communication at present hinders successful
achievement of the objective to reduce IDU vulnerability to HIV/AIDS. Preservation of this situation may
aggravate it and reduce the effectiveness of prevention interventions.
It is envisaged within the framework of this activity to carry out the following actions:
Training of trainers for development of peer education programmes for specialists, volunteers
and IDUs;
Including the issues of HIV prevention among IDUs and of harm reduction programmes in
various specialists training and retraining programmes (physicians, social workers, teachers, law
and order officers);
Development of training programmes and modules for different specialists and for peer
education trainers;
Development, publication and distribution of information materials (printed, radio and TV);
Establishing educational and training centers on harm reduction in two regions of the country
where more than 80% IDUs live;
Establishing a National Harm Reduction Network;
Conduct of national and regional conferences;
Participation in international conferences.
Expected outputs:
- Not less than 68% of IDUs will be involved in the “peer-to-peer” training programmes;
- Complete coverage of the programme participants with information materials on HIV/AIDS
prevention will be achieved;
- A national network of harm reduction programmes for IDU will be established and effective
interaction between them ensured;
2 regional training centers will be established to implement information and education
programmes among IDU and harm reduction specialists;
- Annual national and regional working review meetings on programme outputs will be organized
with participation of governmental, nongovernmental organizations and representatives of the
target groups.
Executing agents: Narcological centers, public health service centers, AIDS prevention centers, academic
institutions, religious confessions, NGOs, drug-dependent and co-dependent people.
Costs of this activity include (detailed budget in Attachment 6.3):
Preparation and publication of information materials (printed, radio and TV);
Preparation of training programmes and modules (payment to national experts, members of
working and focus groups, rent of premises, coffee-break, lunch for participants of working
meetings, stationary, multiplication of materials, traveling expenses, sundries);
Expenses for conduct of seminars and conferences;
Procurement of office equipment for training and resource centers (computers, projectors,
whiteboards, copying machines, hard and soft inventory, etc.);
Expenses for telecommunications.
Resource
allocation
(US$)
Total
Year 1
Year 2
Year 3
Year 4
Year 5
Total
91 376
62 685
92 138
63 733
86 813
396 745
Activity 4. Medical service and support of IDU
A very high incidence rate of virus hepatitis, venereal and other diseases is observed among IDU and most of
them have chronically infected green wounds and sores requiring surgical interference. But access to medical
aid is difficult for most IDUs because of their material problems and disapprobative attitude of the society.
Page 44 of 111
44
Difficult access to medical aid causes a need in establishing “friendly clinics” where IDU could get necessary
medical assistance and support. Participation of IDU in training programmes facilitating attitude change leads
to the need of undergoing voluntary confidential testing for HIV and psychosocial counseling, As of today
such service remains practically inaccessible to IDU.
The following actions are envisaged in the framework of this activity:
Making contracts with state-run and private health facilities for medical service of the
participants of syringe exchange and MST programmes, i.e. establishing “friendly clinics” for
IDU;
Establishing new and support to the existing self-help (mutual help) groups for IDU;
Training specialists and creation of conditions for voluntary confidential HIV testing and
psychosocial counseling.
Expected outputs:
- all participants of the harm reduction programmes obtained access to medical service and
psychosocial counseling in friendly clinics;
the number of state-run and nongovernmental health establishments, so-called “friendly clinics”
will reach 20 over five years (from only one at present);
- the number of self-help (mutual help) groups for IDU will reach 20 (from present 5).
Executing agents: Narcological centers, dermato-venereological dispensaries, AIDS prevention centers,
academic institutions, religious confessions, NGOs.
Costs (detailed budget in Attachment 6.3):
- expenses for treatment in “friendly clinics”;
- expenses for support of self-help groups;
- establishing the system and training of specialists on HIV counseling;
- training physicians of friendly clinics.
Resource
allocation (US$)
Total
Year 1
Year 2
Year 3
Year 4
Year 5
Total
11 360
16 080
20 150
21 660
21 760
91 010
budget category:
Table V.30
Resources
Year 1
Year 2
Year 3
Year 4
Year 5
Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
Human Resources
69 630
118 500
198 260
289 350
407 850
1083590
Infrastructure/
Equipment
Training/
Planning
Total cost of
syringes, needles
and condoms
Drugs
33396
32 704
22 800
22 760
12 260
123 920
67 900
63 600
115 200
104 000
170 250
520 950
228 539
389 443
757 572
1 257 797
1 613 204
4 246 555
5 840
14 600
26 280
43 800
87 600
178 120
8 288
15 642
21 402
27 862
37 472
110 666
35 869
49 932
59 446
77 592
107 757
330 596
Other
(Please specify)
19 990
21 540
23 090
24 640
24 640
113 900
Total
469 452
705 961
1 224 050
1 874 801
2 461 033
6 708 297
Monitoring and
Evaluation
Administrative
Costs
Page 45 of 111
45
30.1. For drugs and commodities/products, specify in the table below the unit costs, volumes and
total costs, for the FIRST YEAR ONLY:
Table V.30.1
Volume (specify
Item/unit
Unit cost
Total cost
(USD)
measure)
(USD)
Methadone hydrochloride
800$/ g
7,3
5 840
Syringes
0,08
794 240
63 539
Needles
0,03
1588480
47654
Condoms
0,03
329004
9870
126 903
partners, in percentage
Table V.33
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
Government
23%
23%
23%
23%
23%
23%
NGOs /
CommunityBased Org.
Private Sector
People living
with HIV/ TB/
malaria
Academic /
Educational
Organizations
Faith-based
Organizations
Others (please
specify)
Total
Total in USD
75%
75%
75%
75%
75%
75%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
100%
469 452
100%
705 961
100%
1 224 050
100%
1 874 801
100%
2 461 033
100%
6 708 297
* If there is only one partner, please explain why.
Page 46 of 111
46
Objective 3.2. Reducing vulnerability of sex workers and their clients
24. Provide a brief summary of the component (Specify the rationale, goal, objectives, activities, expected
results, how these activities will be implemented and partners involved) (2–3 paragraphs):
Targeted programmes to prevent HIV/AIDS among SW have been developed in the country since 1997.
Currently there are two such programmes implemented on a sustainable basis in the largest cities of the country
– Bishkek and Osh. They are implemented by nongovernmental organizations and based on the peer education
principle. The programmes distribute condoms and form a positive attitude to their use and also provide free
anonymous medical service to sex workers. In the third largest city of the country – Jalal-Abad – information
programmes for sex workers have been initiated. These programmes are financed sparsely and cannot expand to
other cities to increase the coverage of the group and improve their approaches. Insufficient funding makes
further development of the programmes for sex workers impossible.
Goal of interventions: Containing the spread of HIV infection among sex workers and their clients in the
Kyrgyz Republic through development of prevention programmes.
Specific goals of interventions include: (1) increasing coverage of SW and their clients through initiation of
new country-wide programmes and regional programmes in six regions of the country as well as through
development of the existing groups subject to interventions; (2) raising awareness of sex workers and their
clients on issues of preventing HIV/AIDS contagion and safe behaviour; (3) provision of access for sex
workers to good medical service including anonymous consultations and HIV testing; (4) provision of access
to condoms; (5) establishing a national network of NGOs and government structures providing for
development of prevention programmes among sex workers and their clients.
From (month/year):
Table IV.25
December 2007
To (month/year):
December 2002
27. Objectives and expected outcomes:
Objective 3.2:
(Refer to Annex II)
Year: 2002
Number of cities with 2
prevention
programmes for SW
including access to
good dermatological
venereal service
Proportion of SW
60%
addressed by the
prevention
programmes (directly
or indirectly, of the
total estimated
number)
Proportion of SW
30%
who visited the
friendly venereal
clinics (of the total
estimated number)
Proportion of SW
9,8%
with confirmed
“syphilis” diagnosis
when visiting a
friendly venereal
clinic for the second
time
Baseline
Year 2:
3
Page 47 of 111
Table IV.27
Reducing vulnerability of sex workers and
their clients
Targets
Year 3:
Year 4:
Year 5:
4
5
6
70%
80%
85%
90%
40%
50%
60%
70%
8%
7%
6%
5%
47
Proportion of SW
who obtained
psycho-social
counseling when
visiting a friendly
venereal clinic for the
first time
Proportion of SW
who reported the use
of condom during the
last sexual contact
with a client
Proportion of SW
who know two
methods of protection
against HIV
0%
30%
50%
70%
90%
61.2%
65%
70%
75%
80%
64,1%
70%
75%
80%
90%
27.1. Broad activities related to each specific objective and expected output (Describe the main
activities to be undertaken, such as specific interventions, to achieve the stated objectives) (1 short paragraph
per broad activity):
Objective 3.2:
Broad activities
Reducing vulnerability of sex workers and their clients
Process/Output
Baseline
Targets
indicators
2002
Year 1 Year 2
Evaluation and
monitoring of the
situation, development
of programmes and
establishing in the
regions and training of
initiative groups to
provide for interventions
among SW and their
clients
Training of trainers, sex
workers and their clients
on the basis of “pear-topear” approach
Provision of access to
condoms at the time and
place where they are
especially needed
Establishing new and
support of the existing
friendly dermatological
and venereal clinics
Establishing a national
network of organizations
developing prevention
programmes among SW
and clients
Number of groups
established
2
Proportion of SW who
got at least one
consultation from a peer
during the year
26,7%, 40%, 50%
Proportion of sexual
contacts with the use of
condom in the total
number of sexual
contacts of SW and their
clients
70%
Number of friendly
dermatological and
venereal clinics
Number of groups in the
national network
Page 48 of 111
3
4
26,7%
61,2%
2
NGO “Tais Plus” (Bishkek),
NGO “Podruga” (Osh), JalalAbad OCAPC, NGO
“Gineco” (Cholpon-Ata),
initiative groups in Naryn and
Batken oblasts
NGO “Tais Plus”, NGO
“Podruga”, NGO “Gineco”,
initiative groups in Naryn and
Batken oblasts
65%
3
2
agency or agencies
3
NGO “Tais Plus”, NGO
“Podruga”, NGO “Gineco” ,
Jalal-Abad OCAPC, initiative
groups in Naryn and Batken
oblasts
4
MC “NauchDiaMed”
4
NGOs and government
structures directly engaged in
the prevention programmes
and contiguous NGOs and
government structures
48
Activity 1. Evaluation and monitoring of the situation, development of programmes and establishing in
the regions and training of initiative groups to provide for interventions among SW and their clients
At present ongoing HIV/AIDS/STI prevention programmes exist and continue to develop and expand in a
sustainable way only in two largest cities of the country. The correlation of SW exposed to these prevention
programmes (directly or indirectly, of the total estimated number) does not exceed 60 % of the total estimated
number of the group. These programmes cannot be expanded to other regions due to insufficient funding.
This activity includes mobilization of local executors through setting up groups comprising sex workers
themselves, representatives of government and (depending on the local situation) nongovernmental
organizations. These groups will assume responsibility for development of prevention programmes among
sex workers and their clients in the regions.
Expected outputs:
Baseline assessment of the situation in the area of sex work preformed in four regions of the country
In six regions of the country annual monitoring of the situation is carried out within the framework
of behavioral epidemiological surveillance
Initiative groups in six regions of the country established and manned by trained personnel to
provide for development of prevention programmes among sex workers and their clients including
also venereologist doctors trained in the principles of relations with sex workers
Programmes for sex workers and their clients prepared and developed in six regions.
Expenses for administrative and technical support, conduct of regional training seminars (one new region a
year), training at workplace and retraining of specialist on the basis of interventions existing in the country
(eight persons a year) as well as on the basis of successful foreign interventions (total three persons over the
entire period), expenses for baseline study of the situation in a new region including identification of key
partners (one new region per year), procurement of minimally required office equipment, software and
supplies, payment for technical assistance of an international consultant and translations.
Resource
allocations (US$)
Total
Year 1
21900
Year 2
15080
Year 3
(estimate)
22860
Year 4
(estimate)
12540
Year 5
(estimate)
19820
Total
91200
Activity 2. Training of trainers, sex workers and their clients on the basis of “pear-to-pear” approach
The country has considerable experience in organization of sex workers training on the basis of “peer-topeer” approach. The programmes of such training are limited, however, to two largest cities of the country.
This activity is focused on forming a safer behavior of sex workers through development and expansion of
peer-to-peer education. The training programme will include issues of safe sex and safe behavior including
the use of condom, harm reduction in drug use, as well as legal protection and relations with the surrounding
to create the environment for safe sex. Trained sex workers will be involved in their client training during
their work.
Expected results:
Sex workers and their clients informed on the main issues related to anti-HIV/AIDS protection. Not
less than 90% of sex workers know two ways of anti-HIV protection.
Sex workers and their clients formed skills of safer behavior including the use of condom. Not less
than 80% of the working sexual contacts take place with the use of condom.
Expenses for continuous volunteers and peer-educators training in workshops conducted every week
(including training on issues of HIV/AIDS prevention and development of practical communication skills),
for primary education of the newly recruited sex workers, publication of information materials, payment of
individual and group consultations of invited specialists (gynecologists and other adjacent specialists, and a
lawyer), field-work support expenses, including payment for one-time actions, bonuses to active volunteers,
purchase of a car (in the capital) and transportation expenses (in the regions), provision of mobile
communications for working groups.
Resource
allocations (US$)
Total
Year 1
18000
Year 2
14100
Page 49 of 111
Year 3
(estimate)
16400
Year 4
(estimate)
18700
Year 5
(estimate)
19900
Total
87100
49
Activity 3. Establishing new and support of the existing friendly dermatological and venereal clinics
A friendly clinic is functioning in the capital providing access of sex workers to free good anonymous
dermatological and venereal service. In one larger city a reference system has been established and functions
successfully to refer sex workers to friendly doctors of the existing state-owned clinics. This is an effective
system but it does not cover the needs of a significant number of sex workers of the country. In fact, the work
in this area will be done on the basis of existing dermatological and venereal departments and rooms,
however, at present most of them lack elementary conditions and minimal medical equipment. This activity
will permit to expand an effective model of providing sex workers with access to good anonymous venereal
services into six regions. The doctors of the clinics will also be involved in information activities such as
training the sex workers who visit the doctor in proper use of condom and psycho-sociological consulting
during voluntary HIV testing, which will provide support to activity 2.
Expected outputs:
70% of all sex workers having free access to good anonymous free venereal service including access
to required drugs and materials
Access of sex workers to voluntary anonymous counseling and HIV testing, with 90% of all sex
workers who addressed friendly venereal clinics for the first time getting psycho-social consultations
by the end of the Programme
An institutionalized system of unlinked epidemiological screening for HIV among sex workers in six
oblasts
Additional pay for extra working hours to doctors, consulting psychologists and other medical personnel,
initial expenses for establishing the clinics including preparation of the premises, procurement in case of need
of simple medical equipment, instruments, drugs and supplies.
Resource
allocations (US$)
Total
Year 1
Year 2
22860
26240
Year 3
(estimate)
29620
Year 4
(estimate)
33600
Year 5
(estimate)
37580
Total
149900
Activity 4. Procurement and provision of access to good quality condoms
In large cities condoms are physically accessible to sex-workers and their clients. In other regions physical
accessibility of condoms at the time and place where they are especially needed is limited. This activity will
ensure access to condoms for sex workers and their clients in the regions and also will give access to female
condoms for street sex workers of the capital. It is envisaged to supply only the most vulnerable groups of sex
workers (not more than 60% of the total estimated number of the group), whereby not less than 30% of all the
condoms will be distributed through the condom social marketing programme. This activity will also create
conditions for forming the skills of systematic condom use by sex workers.
Expected outcomes:
Physical access to condoms is ensured in six regions of the country through existing regional
programmes
The rate of condom use during sexual contacts of sex workers and their clients will be increased.
70% of all working sexual contacts happen with condom
Expenses for procurement of male condoms (based on calculation of 2 sexual contacts a day per one sex
worker, for low paid sex workers in 50% of the estimated number of the group, taking into account also 30%
of condoms through the social marketing programme), and female condoms (proceeding from calculation of 1
condom per week for 900 street SW in Bishkek). Setting up the condom distribution system, supply of
respective information materials and consultations on protected sex issues will be ensured on account of
activity 2.
Resource
allocations (US$)
Total
Year 1
149 850
Year 2
155 325
Page 50 of 111
Year 3
(estimate)
160 800
Year 4
(estimate)
163 538
Year 5
(estimate)
166 275
Total
795 788
50
Activity 5. Establishing a national network of organizations developing prevention programmes among
SW and clients
There are two well-developed HIV/AIDS prevention programmes operating among sex workers in two
largest cities of the country. Baseline estimate was made and initial contacts with sex workers and potential
executors of similar programmes in two more cities established. The organizations assuming responsibility
for development of prevention programmes in this area need information sharing. This activity will ensure
coordination of the country programme while individual executors will keep their independence.
Expected outputs:
Association of AIDS servicing NGOs for sex workers and other associated groups (IDU, MSM etc.)
established
Conditions created for information sharing among local executors of interventions including that
through conduct of annual national conferences
Conditions created for the country joining the existing regional networks of Projects.
Expenses for E-mail communications between projects and for conduct of national conferences and
participation in international conferences.
Resource
allocations (US$)
Total
Year 1
Year 2
4410
6450
Year 3
(estimate)
4490
Year 4
(estimate)
6540
Year 5
(estimate)
4580
Total
26470
Table V.30
Resources needed
Year 1
Year 2
Year 3
Year 4
Year 5
Total
(USD)
(Estimate)
(Estimate)
(Estimate)
Human Resources
9000
11460
14520
17580
20640
72200
15700
8200
8200
8100
8100
48300
18000
22500
23300
22500
22700
109000
164250
170725
177600
182338
186075
880988
6800
800
6800
400
9000
23800
1470
1710
1950
2200
2440
9770
2200
217420
2200
217595
2200
234570
2200
235318
2200
251155
11000
1155058
Infrastructure/
Equipment
Training/ Planning
Commodities/
Products
Drugs
Monitoring and
Evaluation
Administrative
Costs
Other
(Please specify)
Total
33.Indicate in the Table below how the requested resources will be allocated to the implementing
Table V.33
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
13,4%
15,7%
17,0%
18,4%
19,1%
16,8%
Government
84,3%
83,0%
81,6%
80,9%
83,2%
NGOs/Communit 86,6%
y-Based Org.
Total
Total in USD
100%
217420
100%
217595
Page 51 of 111
100%
234570
100%
235318
100%
251155
100%
1155058
51
Objective 3.3 Reducing vulnerability of prison inmates
Alongside with HIV, the tuberculosis status in prisons is complicated, too. As of today, more than 2,500 TB
patients are found in penitentiaries, which mean that it exceeds 10,000 cases per 100,000 convicts, 84% of
them with resistant forms of tuberculosis. From among people held in penitentiaries and corrections 10
people living with HIV/AIDS (7.5%) have tuberculosis. All people with HIV in these establishments obtain
no antiretroviral therapy and preventive treatment for opportunistic infections.
Kyrgyzstan has its own experience of AIDS prevention programmes implementation in the Main Directorate
for Execution of Punishments (MDEP) facilities. Political support has been obtained from MDEP leadership;
specialists as well as volunteers from among convicts are trained. Targeted information materials prepared by
a convict have been published. Transfer of MDEP in 2002 to the Ministry of Justice of the Kyrgyz Republic
will facilitate adherence to law and human rights in the penitentiary system establishments of the country and
implementation of AIDS programmes.
Still, limited budget funding (in 2001 only 20% of the MDEP financial requirements had been met) does not
permit to continue the activity started earlier and to provide the required rate of interventions among the
convicts. At present prevention programmes cover not more that 20% of the MDEP convicts.
Goal: Containment of HIV infection in corrections and penitentiaries through strengthening information and
education programmes, peer education, and increased access to clean instruments, condoms and disinfectants.
The proposed project envisages coverage with prevention and rehabilitation programmes of all correction
facilities of the republic and not less than 95% of the people held in confinements at the time of
implementation of the project.
The major output of the project will be formulation of MDEP policy on HIV/AIDS prevention in the
penitentiary system facilities. As a result of this project, a strategy for organization of the programme will be
developed and support groups from the number of convicts established. The existing structure capacity in
MDEP network will be strengthened through personnel training and formation of its own system of
management and reporting in compliance with the State Programme on AIDS Prevention. Targeted
information materials will be developed and published. In the course of the project, cooperation of
governmental, nongovernmental and international organizations will be established. Access to medical
service for treatment of HIV/AIDS/STI, opportunistic infections, and access to voluntary confidential HIV
testing and psychosocial counseling will be provided. After completion of the project, the mechanisms of
prevention work will be utilized by the trained national specialists in accordance with the methodological
guidelines on organization of this work and orders of the Ministry of Justice governing this activity. The
project personnel will be seeking to mobilize additional financial resources to continue with implementation
of the existing project or expansion of kinds of activity.
Objective:
Reducing vulnerability of prison inmates
Baseline
Targets
Year:2002
Year 2:
% of convicts covered with prevention
20%
40%
programmes
Proportion of officers and convicts
20%
40%
trained in HIV/AIDS/STI prevention
skills
Introduction of voluntary consciencious 1 station
4 stations
HIV testing and counseling
Number of support groups among the
2
4
convicts
Introduction of harm reduction
No
1
programmes
Page 52 of 111
Year 3:
60%
Year 4:
80%
Year 5:
95%
60%
80%
100%
6 stations
8 stations
6
8
11
stations
11
2
4
5
52
27.1. Broad activities related to each specific objective and expected output (Describe the main activities
to be undertaken, such as specific interventions, to achieve the stated objectives) (1 short paragraph per broad
activity):
Table IV.27.1
Objective:
Reducing vulnerability of prison inmates
Broad activities
Process/Output
Baseline
Targets
indicators
2001
Year 1 Year 2
agency or agencies
Formulation of policies
in MDEP Ministry of
Justice the Kyrgyz
Republic to implement
State Programme on
AIDS prevention
Development of
information and
education programmes
Development of harm
reduction programmes
for IDU
Provision of access to
medical service
Number of MDEP
establishment
implementing own
programmes of AIDS
preventions
% of convicts coverage
with peer education
programmes
Number of
establishments with
harm reduction
programmes
Number of MDEP
establishments with
psychosocial counseling
rooms
Ministry of Justice, MDEP
facilities, NGO
2
20%
6
40%
0
2
0
5
11
60%
5
7
facilities, NGO, faith-based
organizations
facilities, NGO
Ministry of Justice, Medical
Department, NGO
Activity 1. Formulation of policies in MDEP of Ministry of Justice of the Kyrgyz Republic to
implement State Programme on AIDS prevention
Since 1998, HIV/AIDS prevention programmes have been implemented in MDEP facilities of the Ministry
of Justice of the Kyrgyz Republic. There is experience of implementation of such programmes, support from
prison administrations, and trained specialists. However, limited financial resources could not allow covering
more than 20% of convicts with such programmes. For the time being a single strategy of MDEP on
development of HIV/AIDS prevention programmes has not been evolved; AIDS prevention programmes are
implemented only in two establishments and based on enthusiasm of their executing agents. In this
connection technical assistance is needed to formulate MDEP policy on various aspects of HIV/AIDS
prevention policy and strengthening the penitentiary establishments to implement State Programme on AIDS
prevention.
The proposed project envisages establishment of a working group from representatives of the Ministry of
Justice, MDEP, AIDS prevention centers, and nongovernmental organizations to develop the strategy and
mechanisms for its implementation in the MDEP establishments. The formulated strategy will be discussed at
a conference with participation of all stakeholders and approved in due order by the leadership of the Ministry
of Justice. Leaders and main executing agents from each MDEP establishment will be trained as trainers for
further independent implementation of the activities within the framework of the approved strategy of AIDS
prevention and coordination of work in the correction establishments on HIV/AIDS/STI prevention. As
outputs of their work will be adopted resolutions, orders, instructions. This project stipulates coverage of 11
correction facilities, prevention work, and conduct of seminars among decision-makers, operatives, and
medical personnel, volunteer training, training in psychosocial counseling methods.
Costs (detailed budget in Attachment 6.5) :
- Payment to national experts (2 experts x 2 times x $500), and members of the working group on
strategy development (10 persons x 10 days x $20);
- Round table workshop (twice a year) at $3,000;
- Training of trainers (25 from 11 correction facilities once a year at $2,500);
- Development of departmental instructions $2,000;
- Evaluation (travel expenses, transportation, per diem – 2 persons $200 x 2/year);
- Behavioral surveys in years 1, 3, 5 at $2,000
Resource
allocations (US$)
Total
Year 1
Year 2
14300
5800
Page 53 of 111
Year 3
(estimate)
9300
Year 4
(estimate)
6300
Year 5
(estimate)
8300
Total
44000
53
Activity 2. Development of information and education programmes
Despite the high level of HIV prevalence among convicts risky forms of behavior still persist among them.
Limited budget forbids prevention programmes development among convicts. Convicts are highly susceptible
to HIV/AIDS because of their confinement in closed rooms. Still this group is accessible. As a result of such
activities all convicts will be informed of HIV/AIDS transmission ways and methods of protection. A “peerto-peer” education programme will be introduced; information materials (booklets, brochures, posters) will be
developed and published. A great role in these activities is attached to NGOs and to procurement of office
equipment for development of information materials.
- volunteer training $5,000
- publication of information materials 5 titles per year 3,000 copies each - $1,500
- support to NGO - $5,000
- procurement of office equipment - $1,500
Resource
allocations (US$)
Total
Year 1
Year 2
13000
13000
Year 3
(estimate)
13000
Year 4
(estimate)
13000
Year 5
(estimate)
13000
Total
65000
Activity 3. Development of harm reduction programmes for IDU
Since there are no effective methods for treatment of HIV and drug addiction today the only way is
prevention. The existing attitude to a drug addict as a criminal creates obstacles to implementation of
education programmes and development of safe forms of behavior. The main output will be established and
finalized practices for prevention programmes implementation to reduce harm for IDUs.
- Introduction of methadone programme with annual increment -$25,000
- Syringe exchange - $5,000
- Supply of hypochloride lime - $3,000
- Personnel training - $5,000
- Psychosocial sessions for convicts at $3,000/session in 11 corrections
Resource allocations
(US$)
Total
Year 1
Year 2
71,000
71,000
Year 3
(estimate)
71,000
Year 4
(estimate)
71,000
Year 5
(estimate)
71,000
Total
355,000
Activity 4. Medical aspects
The expected output will be establishment of a system of voluntary anonymous testing and psychosocial
counseling. To have high quality testing each facility needs a specialized room and involvement of
psychologists.
There is a need in support for PLHA among convicts. NGOs can become the main executing agent for this
activity. PLHA are supposed to be involved, too. As a result, a system of social support will be established for
adaptation of the people living with HIV/AIDS.
The activities include provision of dermatological venereal services, psychosocial consulting, anonymous
testing, and setting up support groups.
- Procurement of test-kits - $4,000
- Psychosocial consulting - $3,000
- Equipping the rooms, conduct of training workshops, procurement of learning aids
- Payment to resource persons, consultants, and psychologists - $10,000
- Expenses for procurement of drugs to treat opportunistic infections - $200
- Seminars on psychosocial consulting (twice a year) at $3,000 each
Resource
allocations (US$)
Total
Year 1
Year 2
17200
17200
Page 54 of 111
Year 3
(estimate)
17200
Year 4
(estimate)
17200
Year 5
(estimate)
17200
Total
86000
54
Table V.30
Resources needed
Year 1
Year 2
Year 3
Year 4
Year 5
Total
(USD)
(Estimate)
(Estimate)
(Estimate)
Human Resources
5000
6000
7000
8000
9000
35000
Infrastructure/
Equipment
Training/ Planning
6000
7000
8000
9000
10000
40000
20000
20000
20000
20000
20000
100000
Commodities/
Products
Drugs
15000
30000
40000
50000
60000
195000
8000
10000
16000
35000
48800
117800
Monitoring and
Evaluation
Administrative
Costs
5000
5000
5000
5000
5000
25000
5000
5000
5000
5000
5000
25000
Other
(Unforeseen)
1000
2000
3000
3000
3200
12200
Total
65001
85002
104003
135004
161005
550000
Table V.33
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
59%
53%
47%
41%
35%
47%
Government
NGOs/Communit
y-Based Org.
40%
45%
50%
55%
60%
50%
Religious/Faithbased Org.
Total
Total in USD
1%
2%
3%
4%
5%
3%
100%
65001
100%
85002
100%
104003
100%
135004
100%
161005
100%
550000
Page 55 of 111
55
Objective 3.4. Reducing vulnerability of MSM
There have been interventions among MSM in Kyrgyzstan since 1995. During 1997-1999 Social Fund
“OASIS” made them with support of international organizations WHO, UNDP and AIDS. Since 1999, NGO
“OASIS” has been implementing preventive programmes on its own account without any external financial
assistance. Of course, lack of sustainable funding affected the performance of the programmes under
implementation. Absence of officially reported HIV cases among MSM generates an atmosphere of
complacency and negation. But unsafe sexual practices among MSM persist and the number of IDU is
increasing in this group.
The interventions will include implementation of preventive programmes among MSM to asses the needs,
develop IOC, and increase access to venereal service and condoms.
Goal: To strengthen and expand the existing HIV/AIDS prevention programmes among MSM to form a safer
behavior.
Objective:
Reducing vulnerability of MSM
Outcome/coverage
Baseline
Targets
indicators
Year: 2002
Year 2
Use of condoms by people
covered by the programme
Knowledge of not less than
two methods of protection
against HIV
Percent of provision of
condoms to the people
involved in the programme
depending on their need
Proportion of MSM visiting
a venereologist at least once
a year for prophylactic
examination, of the total
number of MSM involved in
the prevention programmes
Increase in the number of
prevention programmes and
MSM coverage
27.1.
Year 4
Year 5
20%
30
40
50
60
30%
45%
56%
65%
75%
8%
45%
50%
50%
50%
0,7%
1,9%
3,8%
4,5%
5%
1 program
/5,000 MSM
2
programs
/5,500
MSM
3
programs
/8,000
MSM
5
programs
/9,000
MSM
6
program
s
/10,000
MSM
Broad activities related to each specific objective and expected output
Objective:
Reducing vulnerability of MSM
Broad activities
Process/Output
Baseline
indicators
2002
Development
of
information
and
education programmes
Doing research
Year 3
Knowledge of not less
than two methods of
protection
against
HIV/AIDS
Recommendations
on
improvement
of
interventions
among
MSM
Page 56 of 111
Targets
2003
2004
30%
45%
56%
Assessme
nt
performed
in 1997
Resear
ch with
involve
ment of
intern’l
experts,
SES
Assessm
ent with
involve
ment of
local
experts,
SES
agency or agencies
Social Fund “OASIS”
56
Strengthening
the
existing AIDS service
programmes and their
extension to the regions
Establishing a system of
accessible
dermatological
and
venereal service for
MSM
Supply of condoms
Increasing the number of
community-based
programmes and MSM
coverage
User-friendly
venereal
service
becomes
accessible for MSM in
the capital and regional
centers of the country
Proportion of satisfaction
of the need for condoms
1program
/5,000
MSM
1clinic/37
MSM
8%
2progra
ms
/5,000
MSM
2clinics
/100
MSM
3progra
ms
/8,000
MSM
3clinics
/300
MSM
30%
40%
Social Fund “OASIS” and userfriendly clinics
Activity 1. Development of information and education programmes
Effective information and education programmes make significant impact on containing HIV/AIDS infection
among MSM. The country has experience in implementation of such programmes, however, interventions in
this area have not resulted in forming a sustainably safe behaviour because of their limited nature.
Expected output: Knowledge of HIV/AIDS among MSM will be raised from 30% to 90% of the total number
of MSM covered; 180 volunteer trainers will be trained to extend the IOC programme to 6 regions of the
country, increase in the rate of condom use in sexual contacts.
It is envisaged within the framework of the first activity to develop and disseminate IOC materials, train
trainers and conduct educational seminars on HIV/AIDS/STI, safe sexual behaviour, use of means of
protection, to provide counseling assistance to MSM through anonymous telephone service.
Costs of this activity implementation will make USD 68,500, including (Attachment 6.6): USD 27,000 for
development and printing of IOC materials (6 issues a year 3,000 copies each); USD 20,000 for training of
trainers on IOC (2 seminars/year with 20 participants each); USD 9,000 for training of volunteers and leaders
of regional programmes (6 regions – I seminar a year); USD 18,500 for training 6 key leaders on HIV/AIDS
abroad (5 in CIS countries at USD2,000 each, and 1 in the Netherlands at USD2,500).
Resource allocation
(US$)
Total
2003
2004
27410
2005
(Estimate)
22295
2006
(Estimate)
18130
2007
(Estimate)
21735
Total
18195
107765
Activity 2. Doing research
At present there are no assessments of the situation in the country and estimation of the needs of MSM or
HIV/AIDS situation in this group as information on concealed MSM group. Rapid assessment performed in
1997 is largely outdated now since the situation has changed. Lack of behavioral surveys prevents
development of interventions strategy among MSM in the country and hinders planning, forecasting and
implementation of AIDS prevention programmes.
The research on HIV/AIDS/STI will produce quantitative and qualitative estimates required for the
development of interventions strategy among MSM and monitoring prevention programmes among MSM.
Sentry epidemiological surveillance including sero-surveillance and behavioral studies will furnish data on
HIV/AIDS spread and risk-bearing behavioral practices among MSM. Recommendations will be made on the
basis of this information to raise the effectiveness of HIV/AIDS prevention among MSM and structural
characteristics of the MSM group identified.
Costs (Attachment 6.6): USD 5,500 for sentinel epidemiological surveillance (USD1,100 per year);
USD1,400 for sentinel sero-surveillance (USD280 per year); USD2,500 for studies in the concealed MSM
groups (USD500 per year). USD1,850 is to be allocated for procurement of office and service equipment
required for efficient conduct of research. An international expert is to be recruited to evaluate the programme
performance within the framework of this activity with a total allocation of USD6,000 (USD3,000 for the first
and the last year of the programme).
Resource allocation
2003
2004
2005
2006
2007
Total
(US$)
(Estimate)
(Estimate)
(Estimate)
Total
7 320
2770
Page 57 of 111
2820
2770
5 770
21 450
57
Activity 3. Setting up a network of AIDS servicing programmes for MSM and their extension into the
regions
At present interventions among MSM are carried out only in the capital of the republic with coverage of the
adjacent rayons of Chui Oblast. Expansion of MSM coverage will require establishing a network of AIDS
service programmes for MSM and their extension to the regions. A single methodological approach to the
development of interventions should be ensured as well as sharing the experience of existing interventions
and samples of information materials with the regional working groups.
Implementation of this activity will permit to expand the MSM group to be covered. The output will be
working groups established and trained to ensure sustainable interventions.
Extension of AIDS service programmes to the regions should be made on account of involvement of leaders
and volunteers from among MSM in the areas with high rates of HIV/AIDS. Other methods of this activity
implementation will include establishing HIV-infected MSM support groups. Central coordinating role in
such groups will be played by SF “OASIS” representatives who were exposed to respective training.
Besides, it is planned to use the existing service and establishment and expansion of new telephone
consultation services in the framework of which general consultants (including legal, psychological, medical
etc.) who were exposed to training will provide emergency and general consultative support to MSM. The
major costs (Attachment 6.6) incurred in this activity will be linked to support of the existing HIV/AIDS
prevention programme and establishing (expansion) of the regional AIDS service programmes for MSM.
Resource allocation
(US$)
Total
2003
28350
2004
22160
2005
(Estimate)
27340
2006
(Estimate)
26100
2007
(Estimate)
Total
27440
131390
Activity 4. Provision of medical service
At present MSM have no access to good dermatological and venereal service. The existing paid services are
too expensive for low-income MSM especially those who come from the rural areas and small towns and
have no permanent jobs or other sources of income. State dermatological and venereal service is of low
quality and does not ensure sufficient confidentiality, which is the main hindrance for MSM requiring
medical aid.
In the course of this activity MSM (first of all MSM-SW) will get access to voluntary anonymous treatment
of STI in friendly clinics as well as psycho-social counseling and first medical aid in emergency situations.
The costs (Attachment 6.6) will be distributed as follows: USD11,400 allocated for direct treatment of STI,
and USD10,000 for development of the crisis center.
Resource
(US$)
allocation
Total
2003
2200
2004
3600
2005(Estim
ate)
4400
2006
(Estimate)
5200
2007
(Estimate)
Total
6000
21 400
Activity 5. Supply of condoms
The need in distributing condoms within this programme arises out of a high degree of risk during sexual
intercourse between MSM. The reasons for high HIV/AIDS incidence risks among MSM are identified by the
SF “OASIS” research as follows:
1) A high level of unprotected sexual contacts among MSM
2) Lack of practice of systematic use of condoms
3) Impossibility to buy special condoms because of their absence on the market
Implementation of this activity will reduce the number of unprotected sexual contacts among MSM, increase
the rate of condom use and facilitate MSM’s independent purchase of condoms. Besides, distribution of
condoms will prove the advantages of their use during sexual intercourse between MSM.
Page 58 of 111
58
This activity envisages distribution of condoms and other means of protection against HIV/AIDS among the
MSM group to be covered. Total financial need for this activity will be USD328,100
Resource allocation
(US$)
Supply of condoms
2003
2004
52 500
80 000
2005
(Estimate)
2006
(Estimate)
2007
(Estimate)
101 250
125 000
137 500
Total
496 250
Table V.30
Resources needed
Year 1
Year 2
Year 3
Year 4
Year 5
Total
(USD)
(Estimate)
(Estimate)
(Estimate)
Human Resources
Infrastructure/
Equipment
Training/ Planning
Commodities/
Products
Drugs
8780
10000
12440
13660
14860
59740
19250
10050
13800
11770
12370
67240
17400
12600
7400
10600
6600
54600
61930
90755
112880
137355
150655
553575
5720
2720
2720
2720
5720
19600
2700
2700
2700
2700
2700
13500
2000
2000
2000
2000
2000
10000
0
117780
0
130825
0
153940
0
180805
0
194905
0
778255
Monitoring and
Evaluation
Administrative
Costs
Other
(Unforeseen)
Total
Resource
allocation to
implementing
partners* (%)
Year 1
Government
Year 2
2%
Year 3
(Estimate)
3%
Year 4
(Estimate)
3%
Year 5
(Estimate)
3%
Table V.33
Total
10%
4%
NGOs
98%
Total
100%
97%
97%
100%
100%
97%
100%
90%
100%
96%
100%
Total in USD
117780
130825
Page 59 of 111
153940
180805
194905
778255
59
Objective 4. Ensuring safety of donors’ blood
Blood safety is a prerogative of the state. Despite the complicated economic situation, allocations are made in
the national and local budgets for donor blood examination for HIV and other infections. This is very
important because Kyrgyzstan belongs to the endemic zone for viral hepatitis that is similar in transmission to
HIV. Over the last years it is noted that there is a substantive increase in syphilis morbidity rate, drug
addiction, and reported number of cases of HIV, malaria, and tuberculosis. All this increases the proportion of
people with interdiction to blood donorship. However, many people with high-risk behaviour donate their
blood to obtain some money. This causes grave concern among specialists because it is impossible to ensure
blood safety only on the basis of HIV screening examinations. Besides, at regional levels there happen cases
of blood transfusion that was not examined for HIV by clinical indications. 95.7% of total blood was
examined for HIV in the country in 2001 although this figure may be lower because of retrospective (after
transfusion) examination of donor blood. In this connection there is an acute need of a strategy for free blood
donation and development of new approaches to blood testing all over the country and especially at the
regional level. There is no doubt that establishing an integrated electronic system of monitoring blood safety
should raise the effectiveness of this work.
Table IV.27
Objective:
Ensuring safety of donors’ blood
Baseline
(Refer to Annex II)
Year:
Development of state strategy for free
No
blood donorship
Testing donor blood for HIV
95,2%
Development of information materials
No
for population on free blood donorship
number of titles/ number of copies
Establishing groups of volunteers for No
promotion of free blood donorship
Proportion of free blood donors in the 30%
total number of donors (%)
Decrease of rejected blood in the whole 24%
blood storage (%)
Targets
Year 2:
1
Year 3:
Year 4:
Year 5:
100%
3/30000
100%
3/30000
100%
100%
14
24
24
24
45%
50%
55%
60%
22%
20%
18%
16%
Table IV.27.1
Objective: Ensuring safety of donors’ blood
Broad activities
Process/Output
Annex II)
Development of state
Free donors proportion
strategy for free blood
in the total number of
donorship in the
donors
Kyrgyz Republic
Development of new
Examination of donors
approaches to
blood for AIDS
examination of donor
blood for HIV in
remote rural areas
Establishing an
integrated computer
network for continuous
monitoring of donors
blood safety
Number of facilities
connected to the network
Page 60 of 111
Baseline
(Specify
year)
Targets
Year 1
Year 2
agency or agencies
30%
40%
45%
National Blood Ttransfusion
Centre, NGO «Interhelp»
92,5%
100%
100%
NBTC, Blood transfusion
facilities at local level
5
15
33
NBTC, Blood transfusion
facilities and auxilliaries
60
Activity 1. Development of state strategy for free blood donorship in the Kyrgyz Republic
According to statistics, in average 20-25 thousand donors donate their blood annually for production of blood
components and preparations. On average 10% of them are paid donors donating their plasma for blood
preparations, and 90% are free blood donors. Free blood donors are relatives who donate their blood for their
next-of-kin, friends and acquaintances who are inpatients of hospitals. However, polling showed that 60% of
donors donate their blood being paid by the inpatients’ relatives. Purely free donorship comprises only 3040%. Earlier, specially trained activists of the Red Cross and Red Crescent Society numbering more than 400
were engaged in promotion of free donorship. At present there is no funding for this activity either on the part
of government or other organizations. To solve this problem it is necessary:
- To develop a State Strategy for Involvement of Population in Free Blood Donorship;
- To develop information and education materials on safe donorship, on issues of AIDS in blood
donorship, prevention measures, indications and contra-indications for blood donations, etc.;
- To establish volunteer groups to engage in mobilization of free blood donors.
It is planned to establish in each oblast and Bishkek-city a group of volunteers each of 3 members who will
promote free blood donorship using propaganda and methodological materials. 24 volunteers are planned to
be involved in the country on the whole.
Expected outcome: Increase in the number of free blood donors; higher responsibility of the donors for their
blood safety; improved quality of donors; changed behavior of the potential donors in terms of conscientious
choice of safer behaviour with regard to HIV/AIDS; reduced number of cases of blood transfusion.
Costs will include (Attachment 6.7): Development of State strategy, preparation and dissemination of
information materials, recruitment of volunteers, their training and actions for free blood donorship.
Resource
allocation (US$)
Total
Year 1
33,750
Year 2
33,065
Year 3
(Estimate)
2,000
Year 4
(Estimate)
2,000
Year 5
(Estimate)
2,000
Total
78,750
Activity 2. Development of new approaches to examination of donor blood for HIV in remote rural
areas
Donor blood safety control system has been established in the Kyrgyz Republic. There are specialized
facilities (National and regional blood transfusion centers) and respective units at district (rayon) level
(transfusiology units) as well as HIV/AIDS testing laboratories. However, unsatisfactory funding leads to
failures of blood examination for AIDS. On the whole 95.2% of blood donors were examined for HIV in
2001. That means that at least 1,341 persons had blood transfusion without checking it for HIV, i.e. these
people were exposed to danger of getting HIV infection in medical facilities. Furthermore, there were cases of
retrospective (after blood transfusion to patients on life indications) examination for HIV. In conditions of
HIV infection spread this may result in in-hospital contamination of patients with HIV11.
The main reason, on the one hand, is in insufficient funding and, on the other hand, in absence of HIV blood
testing strategy at local levels. Remote sparsely populated areas perform few investigations for HIV. Existing
investigation techniques permit performing such tests with not less than 12 samples submitted for test so lowcapacity labs carry out such investigations once in 7-10 days. If immediate blood transfusion is required for
life indications, in individual cases transfusion is made without HIV examination of blood. There are
practically no blood banks and reserve donors in such areas, and delivery of blood from the oblast center or
capital cannot be done. That is why direct transfusion of blood is made in many regions and donor blood is
examined retrospectively (after transfusion).
To solve these problems it is necessary:
- To assess the situation on blood examination at local levels.
- To develop a strategy for examination of donor blood.
- To develop methodological guidelines on donor blood examination.
- To train the specialists responsible for donor blood examination.
11
State Programme on Prevention of AIDS, infections transmitted sexually or by injections in the Kyrgyz
Republic, Strategy 2
Page 61 of 111
61
-
To procure required test-kits of different kinds and different manufacturers for investigations and
development of methodology guidelines.
To perform monitoring including reference-investigation with the use of high-quality test-kits to
improve local situation.
Expected output: Development of strategy for ensuring donor blood safety. Examination of each blood
donation before transfusion. Improved quality of blood testing due to better testing kits, introduction of up-todate techniques, training of specialists and quality control.
The Global Fund resources will cover only part of the amount needed for HIV testing of blood (not more than
50% of the requirement, the other half of investigations will be provided for by government). Costs include:
Situation assessment, procurement of various types of diagnostic kits for HIV investigation to carry out
examinations and finalize the strategy locally; quality control of investigations with the use of both routine
and high-quality test-kits; quality control of work of physician’s lab assistants with the use of positive and
negative sera control panels (Attachment 6.7).
To conduct donor blood examination for AIDS total 108 kits are needed a year with 192 examinations each
100 stripped (12 to 96 examinations each). The requirement of the country is USD 130675 only for the cost
of diagnostic kit (108 kits with 192 examinations each at USD107 and 100 sets with 92 examinations each at
USD70; 10,000 express tests USD1 per each) if the cost of test systems made in Russia is taken into account.
The sera control panels and test systems for the reference researches of high class will be procured.
Resource
allocation (US$)
Total
Year 1
26,605
Year 2
24,540
Item/unit
Test-kits for 192 examinations
Stripped test-kits for 92 examinations
Rapid test-kits
Reference test-kits
Total
Year 3
(Estimate)
25,850
Unit
(USD
108
70
1
200
cost
Year 4
(Estimate)
26,010
Year 5
(Estimate)
27,670
Volume (specify
measure)
60 kits
100 kits
10,000 pcs
8 kits
Total
(USD)
6,480
7000
10000
1600
25,080
Total
130,675
cost
Activity 3. Establishing an integrated computer network for continuous monitoring of donors blood
safety
Kyrgyzstan is the endemic zone for virus hepatitis B and C. Therefore blood rejects for that reason are very
high and reach 15% of the total volume of blood taken. This increases substantially the expenses for setting
up a blood bank because of additional costs of blood taking, reagents, investigations and destruction of blood
rejects. The blood transfusion facilities in Bishkek including the National Blood Transfusion Center, blood
transfusion units of large multi-discipline hospitals are united in a single computer network of monitoring
blood safety. A programme for establishing a data bank and safety monitoring has been developed in the
country. Estimated costs include procurement of computers for all blood transfusion facilities and units,
auxiliary services as well as development of the software connection programme for the facilities and their
access to Internet.
Costs:
There are 2 oblast blood transfusion centers and 60 transfusion units in the country. To build an integrated
network 48 computers, 8 laser printers, and 2 servers are needed. Total cost of computers USD 40560. Cost
of one printer USD 285. Cost of one server is USD 2,000.
Expected output: Donor blood testing monitoring. Higher safety of donor blood. Exclusion of a possibility to
have reject blood in the stored donor blood.
Resources
needed (USD)
Total
Year 1
Year 2
Year 3
Year 4
Year 5
30224
18044
5496
5496
5496
Page 62 of 111
Total
64756
62
Total costs for objective 4
Resources needed
(USD)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Human Resources
4880
2880
5760
5760
5760
25040
Infrastructure/
Equipment
Training/ Planning
20920
14640
-
-
-
35560
3256
5756
-
-
-
9012
Commodities/
Products
Drugs
40680
39540
25850
26010
27670
159750
6500
2000
3000
3000
3000
17500
Monitoring and
Evaluation
Administrative
Costs
4648
3248
4496
4496
4496
21384
80884
68064
39106
39266
40926
268246
Other
(Please specify)
Total
Resource
allocation
to
implementing
partners* (%)
Government
Year 1
Year 2
Year
3
(Estimate)
Year
4
(Estimate)
Table V.33
Year
5 Total
(Estimate)
90
90
90
90
90
90
NGOs
CommunityBased Org.
Total
10
10
10
10
10
10
100
80884
100
68064
100
39106
100
39266
100
40926
100
268246
Total in USD
/
Page 63 of 111
63
Objective 5. Provision of medical and social support to the people living with
HIV/AIDS (PLHA) and people affected by HIV/AIDS (PAHA)
Out of 310 people living with HIV/AIDS who were registered in the country, 4 died because of AIDS.
Neither of them obtained antiviral treatment. This objective is aimed at protection and mobilization of the
people who bear the immediate burden of the disease and know from their own experience the real needs of
the HIV-infected people. To extend the expectancy of these patients and to improve the quality of their life
antiretroviral therapy is needed. At the same time the complicated economic situation in the country does not
allow provision of the treatment required for PLHA. A component part of the activities to support to PLHA
will be provision of an access to tri-therapy. Participation of PLHA and PAHA in response to HIV/AIDS will
be encouraged by these activities. Their participation will include promotion of prevention among vulnerable
groups, actions to raise awareness of government, governmental organizations and various societal structures
on social priorities of the people living with HIV including those of support, care and safeguarding their
inalienable civil rights, opposition to stigmatization, segregation and discrimination.
Organizations of the people living with HIV will be directly engaged in the implementation of this objective
together with nongovernmental organizations working with vulnerable groups and independent researchers,
independent lawyers and human rights watch organizations that are involved in AIDS prevention
programmes. National and regional AIDS prevention and control centers will provide medical support to
PLHA.
Objective 5
Provision of medical and social support to the people living with HIV/AIDS (PLHA)
and people affected by HIV/AIDS (PAHA)
Target
Output
Baseline
indicators/coverage
Year 1
Year 2
Year 3
Year 4
Year 5
Year
2002
A study of the needs of
PLHA/PAHA
Coverage of PLHA with
antiretroviral therapy and
treatment of opportunistic
infections (%)
Preventive treatment of
pregnant women and
newborn infants with
antiretroviral medicine (%)
Proportion of PLHA and
PAHA involved in
participation in HIV/AIDS
prevention programmes (%)
Proportion of newly
detected PLHA who
received pre-test counseling
(%)
Proportion of PLHA/PAHA
who got support from their
community organization (%
of the estimated number of
officially reported/ people)
Training national trainers on
psychosocial counseling on
HIV/AIDS, persons
0
1
0
0
0
0
0
100
100
100
100
100
100
100
0.5
10
100
25
0
50
100
0,5 / 2
10 / 54
25 / 177
8
15
Page 64 of 111
20
100
100
50
70
80
100
100
100
25 / 219
25 / 261
25 / 303
25
30
35
64
Objective 5
Provision of medical and social support to the people living with HIV/AIDS (PLHA) and people
affected by HIV/AIDS (PAHA)
Broad activities
Process/Output
Baseline
Targets
indicators
2002
Year 1 Year 2
agency or agencies
Sociological surveys of
priority needs of the
people living with
HIV/AIDS
Strengthening capacity
of PLHA/PAHA
community
organisations
Provision of PLHA with
antiretroviral (ARV)
therapy. Prevention of
perinatal HIV
transmission
Provision for voluntary
anonymous HIV/AIDS
testing and psychosocial
consulting
Number of surveys
Proportion of
PLHA/PAHA who got
support from their
community
organization (%)
Coverage of PLHA
with ARV therapy (%)
Proportion of PLHA
who received pre-test
consultations
No
1
0
0,5
10
25
0
50
100
5
10
15
NGO of people with HIV
(Bishkek), NGOs working in
vulnerable groups, independent
researchers.
(Bishkek), NGOs working in
vulnerable groups, independent
lawyers
Ministry of Health, National
AIDS Association,
(Bishkek), NGO working with
vulnerable groups
National AIDS Association,
regional AIDS centers
Activity 1. Sociological surveys of priority needs of the people living with HIV/AIDS
Most of the people living with HIV/AIDS in Kyrgyzstan belong to socially and legally vulnerable groups of
the population and need corresponding support and protection. It is necessary to identify priority needs of
these people for planning and proper provision of support they require. An expatriate international expert
recruited from among the people living with HIV should be invited for this work as well as representatives of
an NGO of these people, NGOs working with vulnerable groups and professional sociologists who will be
subcontracted for the work.
Expected outputs: A baseline sociological survey will be performed in populated areas with the highest
concentration of the people with HIV, i.e. Bishkek and Osh. This survey will yield the information required
for planning of programmes of medical and social support to PLHA and PAHA. Surveys to monitor changes
in the situation will be conducted each year.
The cost incurred will include the expenses for the international expert (USD4,500 for year 1) and planning
and conduct of the survey (USD3,000 annually). See Attachment 6.8
Resource
allocation (US$)
Total
Year 1
4.500,00
Year 2
3.000,00
Year 3
(Estimate)
3.000,00
Year 4
(Estimate)
3.000,00
Year 5
(Estimate)
3.000,00
Total
16.500,00
Activity 2. Strengthening capacity of PLHA/PAHA community organizations
At present a community-based organization of the people living with and affected by HIV functions in
Bishkek and a similar organization is being established in Osh. This activity is designed to ensure greater
independence of the organizations of the people living with HIV and people affected by HIV, which could
raise issues on their own initiative and conduct a dialogue with government and civil society and protect
human rights of the people living with HIV/AIDS.
The activity shall also facilitate greater involvement in consultations of the people living with HIV. It is
proposed to conduct annually 3 training seminars for a NGO of the people living with HIV and affected by
HIV. These seminars will cover basic management of programmes, accounting and reporting, relations with
governmental institutions and mass media; pre- and post-test consulting and human rights in terms of HIV
infection. NGOs working with vulnerable groups will also participate in these seminars. Representatives of
these NGOs will be trained in the area of relations with PLHA and PAHA, provision for their needs and
Page 65 of 111
65
involvement in participatory actions. PLHA will get access to adequate information and to services of
licensed psychologists and psychotherapists. Effective functioning of NGOs requires their equipping with
office equipment, furniture, hotline telephone, and a possibility for operational telecommunication with
access to Internet. Provision of these organizations with office space and utility payments will be done at the
expense of the national budget.
Expected outputs: Growing human capacity of the communities of people living with HIV; their greater
involvement in HIV/AIDS response partnerships; NGOs working with PLHA/PAHA provided necessary
equipment
Costs (Attachment 6.8): funding for the seminars mentioned above (USD3,000 per each seminar, 2 seminars
during year 1 at USD1,500 each), development, printing and dissemination of information materials, training
of PLHA and NGO representatives working with vulnerable groups, as well as physicians on the basis of
other countries’ experience, administrative support to PLHA NGO (USD 24,000), delivery to 2 NGOs each a
personal computer with network equipment (USD700 each), modem (USD100), phone-fax (USD300), office
furniture(USD500), expenses for office supplies and telecommunications services (USD500) –total two sets.
In addition, allocation should be made for bonuses for volunteers from these organizations (USD1,800).
Resource
allocation (US$)
Total
Year 1
Year 2
29250
39370
Year 3
(Estimate)
30580
Year 4
(Estimate)
32930
Year 5
(Estimate)
36290
Total
168420
Activity 3. Provision of PLHA with antiretroviral (ARV) therapy. Prevention of perinatal HIV
transmission
It is estimated that about 10% of all registered PLHA need ARV therapy, i.e. 30 persons to date, 45 persons
expected for year 2, 60 for year 3, 75 for year 4, and 90 for year 5. Also treatment of opportunistic infections
in PLHA is envisaged. Management of one of the opportunistic infections – tuberculosis – will be stipulated
by the DOTS programme.
10% of the reported PLHA in the Kyrgyz Republic are women. Two pregnant women living with HIV were
reported in 1997 and 2002. In both cases preventive treatment was provided on account of humanitarian aid
due to lack of government funding. All women living with HIV/AIDS are of reproductive age, therefore, the
number of HIV-positive pregnant women and the risk of pre-natal infection of the fetus may grow.
Taking into account the 10-fold growth of the number of people infected with HIV each year it may be
assumed that in 2003 there will be 10 women with HIV and at least 8 of them will address the doctor during
their pregnancy and receive ARV therapy. Apparently the need for preventive ARV treatment will arise for 8
pregnant women living with HIV/AIDS and their newborn children during year 1, 20 during year 2, 35 during
year 3, 50 during year 4, and 100 during year 5.
ARV therapy should be done under viral load control for each patient and for this a polymerase chain reaction
(PCR) laboratory is required. At least two PCR laboratories are needed – one in the south and one in the north
of the country. Also respective training of medical specialists will be required but at the national seminars and
with the use of experience of other countries.
Expected outcome:
100% coverage with antiretroviral therapy of all people living with HIV/AIDS who need treatment
(total 300 over 5 years).
100% treatment conducted under laboratory control of each patient’s viral load.
Each diagnosed pregnant woman living with HIV/AIDS and also after childbirth her newborn infant
will obtain preventive ARV treatment to prevent infant infection.
The risk of child birth with HIV infection will be reduced by 50% (it is estimated that over 5 years
28 infants will be prevented HIV transmission from mother to child.
The costs (Attachment 6.8) will include procurement of antiretroviral medicines. Currently the cost of drugs
required for tri-therapy of one patient for a year is USD 9,460.5. For preventive treatment of one pregnant
woman with Zidovudine and her newborn infant with Retrovirum, USD 890 is needed. At present the country
intends to join the existing system of accelerated access to medicines as a result of which the cost of such
Page 66 of 111
66
treatment may drop to USD 2,000 a year. A national protocol for treatment of HIV cases, AIDS patients and
pregnant women will be developed. Conduct of workshops and specializations abroad are also envisaged.
The costs will be also incurred in procurement of equipment and reagents to launch PCR. The cost of
equipment is USD 25,000, and reagents for 1000 investigations – USD 8,000. Personnel will be trained on the
basis of AIDS diagnostics laboratory in Moscow, Russia. Trainer experts will also be invited from Moscow .
Resource
allocation (US$)
TOTAL
Year 1
Year 2
Year 3
(Estimate)
355225
509772,5
650530
Year 4
(Estimate)
Year 5
(Estimate)
Total
1008695
3333510
809287,5
Calculation of treatment of HIV patients with three antiretroviral drugs and preventive treatment of
pregnant women and newborns.
Item/unit
Unit cost
(USD)
0.8
16
2.7
1.1
Zydovudine capsules 0.1
Retrovirum syrup 100ml
Salcitabine tablets 0.75
Indinavirum capsules 0.2
Volume (specify
measure)
71160capsules
500 ml
32 850 tablets
129600 capsules
Total cost
(USD)
56928
80
88 695
142560
Activity 4. Provision for voluntary anonymous HIV/AIDS testing and psychosocial counseling
The system of psychosocial consulting on HIV/AIDS is new to Kyrgyzstan. At present anonymous checkup
rooms function in the country, trained specialists are available, including 200 general practitioners. But these
consulting rooms are only a few, not equipped properly, and their personnel has to combine consulting with
other responsibilities. As a result, all detected PLHA could not obtain pre-testing but only post-testing
consultations. This requires training and retraining of specialists, setting up special rooms of psychosocial
consulting in the capital, oblast and rayon centers of the republic In the course of this programme
psychologists are to be involved in each anonymous checkup room at the “AIDS” National Association and 7
oblast centers of AIDS prevention and control. In addition, a base for training and conditions for psychosocial
consulting by general practitioners, practicing psychotherapists, and resource centers staff, “trust phone”
hotline service in state-owned and nongovernmental clinics and rooms will be established.
Expected outcomes: There will be established 8 resource centers and 30 rooms of psychosocial consulting on
HIV in the capital, oblast and rayon centers of the republic. General practitioners, psychologists, staff of
crisis centers, anonymous rooms and “trust phones” will be trained in psychosocial consulting skills.
Costs (Attachment 6.8): Equipping the rooms, development of special programmes for graduate and postgraduate education, training of training on HIV/AIDS psychosocial counseling, development and publication
of methodological guidebooks for trainers, payment for services of international and local consultants,
training specialist and information support.
.
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation (US$)
(Estimate)
(Estimate)
(Estimate)
Total
40900
27480
Page 67 of 111
26880
27480
27130
149870
67
Table V.30
Resources needed
Year 1
Year 2
Year 3
Year 4
Year 5
Total
(USD)
(Estimate)
(Estimate)
(Estimate)
Human Resources
11120
21960
25320
30680
34040
123120
Infrastructure/
Equipment
Training/ Planning
46540
29860
4860
1600
1600
84460
32300
32900
22750
21000
23000
131950
Commodities/
Products
Drugs
35380
38780
41780
46780
55030
217750
296935
452522,5
610780
769037,5
958445
3087720
7600
3600
5500
3600
3000
23300
0
0
0
0
0
0
0
429875
0
579622,5
0
710990
0
872697,5
0
1075115
0
3668300
Monitoring and
Evaluation
Administrative
Costs
Other
Total
Resource
allocation to
implementing
partners* (%)
Year 1
Government
Year 2
92,7
92,3
7,3
7,7
100%
579902,5
Year 3
(Estimate)
Year 4
(Estimate)
95,0
95,5
5,0
4,5
100%
871537,5
Year 5
(Estimate)
96,0
Total
94,7
NGOs
Total
Total in USD
100%
428655
Page 68 of 111
100%
709330
4,0
100%
1073951
5,3
100%
3663376
68
28. Describe how the component adds to or complements activities already undertaken by the
government, external donors, the private sector or other relevant partner:
The HIV/AIDS component is aimed at implementation of the effective National Programme on AIDS
Prevention approved by the Government of the Kyrgyz Republic on 13 December 2001. The work will be
done on the basis of multisectoral approach with technical support of the UN Theme Group on HIV/AIDS.
The main implementing agents – representatives of the Ministry of Health, Ministry of Internal Affairs,
Ministry of Justice, Ministry of Labour and Social Protection, Ministry of Education and Culture, NGOs,
mass media – have experience in developing programmes on AIDS and trained specialists at the central and
partly at the regional levels. There is in the country a supportive political environment at the level of central
government and governmental organizations as well as readiness of the civil society to practical
implementation of the programmes at community level. Kyrgyzstan has own experience in development of
prevention programmes. Beneficiaries of the project will be organized youth, street children, sex workers,
injecting drug users, people living with and affected by HIV/AIDS, prison inmates and others. The main
problems of these groups are dangerous in terms of HIV/AIDS/STI behavior, underdevelopment of
prevention programmes, limited access to condoms distribution programmes, venereal and narcological
services. As an outcome of this project solution of these issues is envisaged, which will create positive
attitudes to HIV/AIDS/STI prevention among representatives of the target groups thus containing the
infection among the population of the country reducing the impact of the epidemics on social and economic
development of the country.
Support of the Global Fund for this proposal will enable increase of the amount and expand existing
interventions for HIV prevention among vulnerable populations; strengthen the multisectoral approach in the
country and decide the issues of improving national legislation and law-enforcement practices. Besides, new
programmes and interventions will be evolved in line with the declaration of commitment to HIV/AIDS
control adopted at the UN General Assembly session of 27 June 2001. These actions together with the efforts
undertaken by UN Agencies and other donors will help the country to implement the Strategic Plan of
National Response to HIV/AIDS epidemic and suspend its development at the early stage of the epidemic.
b) How these activities are related to the national Strategic Plan or how do they facilitate the work on
development, planning and monitoring in the framework of the Integrated Working Plan of the UN
System.
The objectives of this proposal comply with the major priorities of the National Strategic Plan and State
Programme on Prevention of HIV/AIDS, infections transmitted sexually and by injections in the Kyrgyz
Republic. The proposal also corresponds to the main priorities of the Integrated Plan of UN Agencies present
in the Kyrgyz Republic. Implementation of this proposal will provide support to execution of the National
Response to HIV/AIDS epidemic in the Kyrgyz Republic and permit making a serious contribution in
prevention of further spread of HIV infection in the country at this early stage of the epidemic.
29. Briefly describe how the component addresses the following issues (1 paragraph per item):
29.1. Involvement of beneficiaries such as people living with HIV/AIDS:
Implementation of this component will be focused immediately on improving the quality of life and forming
HIV/AIDS safe behavior of the vulnerable groups representatives, provision of care, access to treatment and
support for the people living with HIV/AIDS. This will be achieved through involvement of members of the
target groups in planning the interventions, participation in decision-making on HIV/AIDS prevention by way
of membership in the existing multisectoral committees on the central and regional levels. In addition,
vulnerable groups representatives will be directly executing the interventions as volunteers or being involved
in the peer education programmes on AIDS prevention.
29.2. Community participation:
The proposed programme activities are focused on the wider community comprising all representatives of
vulnerable groups (sex workers, IDU, PLHA, MSM, convicts) and local communities such as village
communities, youth groups, refugee and migrants’ communities. The main objective of the programme is to
build communal capacity in development of target programmes through training including peer-to-peer
training, increasing access to knowledge and skills of safe behavior, as well as commodities and services
(condoms, clean syringes, medical service, and counseling).
29.3. Gender equality issues (Guidelines paragraph IV.53):
Page 69 of 111
69
Gender issue is an important aspect of this proposal. Women are more vulnerable to HIV/AIDS and women
are also more subject to discrimination. Women become more often victims to violence including sexual but
they are not always in a position to ensure safe behavior because man makes the decision. This proposal
envisages solution of these issues. This is achieved by school education of boys and girls on issues of AIDS
prevention, opposition to violence, including sexual violence, development of safe sex skills and ability to
defend their right for safe behavior.
The issue of gender equality has special significance when planning and organizing interventions among sex
workers. In this case in addition to the described approaches respective political decisions should be made
and legal dimensions of the problem identified. The Programme envisages legal education, supply of
condoms, increasing access to venereal service, legal and social support to sex workers.
29.4. Social equality issues (Guidelines paragraph IV.53):
This proposal is aimed at comprehensive development of the problem of AIDS prevention among different
groups of population at the level of cities and rural areas of the country. Remote populated areas will be
reached through school education to address children, teachers and parents. Unorganized youth will be
exposed to peer education programmes. Of the utmost importance will be target programmes for vulnerable
groups that are least protected, such as sex workers, injecting drug users, convicts, people living with and
affected by HIV/AIDS. At this, priority will be set on the socially unprotected groups of population for whom
access to information, education, medical service and means of protection against AIDS will be increased.
29.5. Human Resources development:
One of the main directions of activities in the framework of all objectives of this component is education. As
a result of this proposal implementation the country will build its own capacity for development of
educational programmes, effective systems of graduate and post-graduate training of different specialists will
be created, such as medical specialists of different professions, teachers, social workers, army servicemen,
law enforcement officers, journalists and others. Trainers for work with vulnerable populations and for peer
education programmes development will be trained. This will be achieved through training of national experts
and teachers. This training will be conducted in the country on the basis of available national capacity. In
addition, invitation of international experts is envisaged, training national specialists on examples of foreign
experience as well as through participation in international and regional conferences or meetings on AIDS
issues.
29.6. For components dealing with essential drugs and medicine, describe which products and
treatment protocols will be used and how rational use will be ensured (i.e. to maximize adherence and
monitor resistance), (Guidelines para. IV.55), (1–2 paragraphs):
For the time being the Kyrgyz Republic has no experience in treatment of AIDS patients. The country has
well-trained specialists but they have no practical experience in conduct of antiretroviral therapy, control and
observation during HIV/AIDS treatment. To provide for this area of activity training of national experts on
work experience of the leading clinics of the Ukraine and Russia will be conducted. After that a national
protocol for AIDS cases management will be developed with account of WHO recommendations. National
specialists who administer treatment will be trained in the country and provided with the national protocol of
treatment. The issues of HIV/AIDS treatment will be included in the programmes of graduate and postgraduate training of respective specialists. Monitoring and evaluation of the quality of training will be
performed. To control the treatment, PCR instruments will be procured and installed in two leading centers
of the country.
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70
Table V.30
Resources
Year 1
Year 2
Year 3
Year 4
Year 5
Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
Human
Resources
Infrastructure/
Equipment
Training/
Planning
Commodities/
Products
Drugs
Monitoring and
Evaluation
Administrative
Costs
Other
(Please specify)
Total
122610
186000
277500
379230
506350
1471690
178406
143054
89260
74830
65930
551480
308356
301856
329150
223600
293050
1456012
1221779
1413243
1777682
2222280
2614634
9249618
324995
485842,5
672780
872557,5
1127565
3483740
49036
34490
52398
47558
76168
259650
49539
63842
73596
91992
122397
401366
33720
41270
38820
45370
40570
199750
2288441
2669597,
3311186
3957417,
4846664
17073306
The budget categories may include the following items:
Human Resources: Consultants, recruitment, salaries of front-line workers, etc.
Infrastructure/Equipment: Building infrastructure, cars, microscopes, etc.
Training/Planning: Training, workshops, meetings, etc.
Commodities/Products: Bednets, condoms, syringes, educational material, etc.
Drugs: ARVs, drugs for opportunistic infections, TB drugs, anti-malaria drugs, etc.
Monitoring & Evaluation: Data collection, analysis, reporting, etc.
Administrative: Overhead, programme management, audit costs, etc
Other (please specify):
Table V.30.1
Volume (specify
Item/unit
Unit cost
Total cost
(USD
measure)
(USD)
Zydovudine capsules 0.1
0.8
71160capsules
56928
Retrovirum syrup 100ml
16
500 ml
80
Salcitabine tablets 0.75
2.7
32 850 tablets
88 695
Indinavirum capsules 0.2
1.1
129600 capsules
142560
Methadone hydrochloride
800$/ g
7,3
5 840
Syringes
0,08
794 240
63 539
Needles
0,03
1588480
47654
Condoms
0,03
329004
9870
30.2. In cases where Human Resources (HR) is an important share of the budget, explain to what
extent HR spending will strengthen health systems capacity at the patient/target population level,
and how these salaries will be sustained after the proposal period is over (1 paragraph):
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71
31. If you are receiving funding from other sources than the Global Fund for activities related to this
component, indicate in the Table below overall funding received over the past three years as well
as expected funding until 2005 in US dollars (Guidelines para. V.62):
Table V.31.1
1999
2000
2001
2002
2003
2004
2005
Domestic
484000
555900
667347
633000
675000
699000
732700
(public and
private)
External
421761
409237
340993
585398
514860
244000
0
Total
907760
967137
1010341 1220400 1191863 945004
732700
Please note: The sum of yearly totals of Table V.31.1 from each component should correspond to the
yearly total in Table 1.b of the Executive Summary. For example, if Year 1 in the proposal is 2003, the
column in Table 1.b labeled Year 1 should have in the last row the total of funding from other sources for
2003 for all components of the proposal.
32. Provide a full and detailed budget as attachment, which should reflect the broad budget categories
mentioned above as well as the component’s activities. It should include unit costs and volumes, where
appropriate.
Table V.33
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
41,9%
41,46%
39,9%
36,5%
36,57%
Government
39,27%
NGOs /
CommunityBased Org.
Private Sector
47,45%
47,75%
54,3%
58,4%
57,9
54,60%
0,3%
0,32%
0,4%
0,4%
0,51%
0,43%
People living with
HIV/ TB/ malaria
Academic /
Educational
Organizations
Faith-based
Organizations
Others (please
specify)
0,11%
0,15%
0,3%
0,2%
0,25%
0,25%
10,21%
10,25%
5,4%
4,4%
4,57%
6,97%
0,03%
0,06%
0,1%
0,1%
0,2%
0,1%
0
0
0
0
0
0
Total
100%
2288441
100%
2669597
100%
3311186
100%
3957417
100%
4846664
100%
Total in USD
17073306
Page 72 of 111
72
Component
(mark with X):
Table IV.23
HIV/AIDS
X
Tuberculosis
Malaria
HIV/TB
24. Provide a brief summary of the component:
The overall goal of this component is to reduce the TB morbidity and mortality rate of the population in
the Kyrgyz Republic. To achieve this goal three main objectives should be implemented:
1) improving detection and diagnostics of TB cases;
2) ensuring out-patient clinical management of the patients (continuation phase);
3) treatment of the patients with drug resistance developed due to various causes.
The first objective is focused on promoting early consultations of the population in the medical
establishments and to make microscopic examination more accessible for people suspected of TB.
The second objective is aimed at improving adherence of the TB patients themselves to treatment and
controlled case management especially at the out-patient stage.
The
third
objective
is
aimed
at
treatment
of
drug-resistant
TB
patients.
From (month/year):
September 2002
To (month/year):
Table IV.25
December 2007
The goal of this component is to achieve effective implementation of the National Programme “Tuberculosis”
in the Kyrgyz Republic based on DOTS strategy recommended by WHO, which will facilitate reduction of
TB morbidity and mortality rates.
This goal involves three major objectives:
1) improving detection and diagnosing of TB cases;
2) ensuring out-patient clinical management of the patients (continuation phase);
3) treating the patients who developed TB drug-resistant forms of disease due to various causes.
The first objective is focused on promoting early consultations of the population in the medical
establishments, and making microscopic investigations more accessible for the TB suspects.
ACTIVITIES:
Improving health education activities among the population;
Procurement of binocular microscopes;
Procurement of reagent supplies for microscopic examination;
Retraining of laboratory assistants;
Introduction of journals for records of microscopic examinations of TB suspects;
Training of physicians for family doctor groups (FDG);
Training of TB specialists.
Training of medical staff on TB diagnosing and management;
The second objective is focused on improving adherence of the TB patients to treatment and bringing this
treatment to complete cure.
ACTIVITIES:
Improving awareness of the patient of the consequences of incomplete treatment;
Training of physicians of FDGs in improved clinical management;
Involving NGOs and volunteers in the process of treatment;
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Recording and reporting of the cases;
Short-course chemotherapy of the newly detected TB cases using DOTS strategy;
Monitoring of the treatment;
Personal account of TB cases in electronic form.
The third task is focused on treatment of patients who had an unsuccessful repeated course of treatment.
ACTIVITIES:
Organization of sputum culture-taking from the failures after re-treatment to identify drug
resistance;
Provision of treatment for patients with multi-drug resistant (MDR) forms of TB using second
line drugs.
Expected outputs:
1. Improved detection and microscopic confirmation of the diagnosis for TB cases.
2. Uninterrupted supply of anti-TB drugs, monitoring of treatment will make the DOTS treatment more
effective.
3. Reduced rates of TB morbidity, including drug-resistant forms, and mortality.
The coordinating role in the implementation of this component will be played by the Ministry of Health
of the Kyrgyz Republic (government organisation) with participation of NGOs: Red Cross, “HOPE”
Project, CDC, Soros-Kyrgyzstan Foundation, “Meerim” Foundation, orphanage, and members of the TB
patients’ families, religious groups and volunteers.
26.1. Goal and expected impact
Table IV.26.1
To reduce TB morbidity and mortality by 2007
Goal:
Impact indicators
Baseline
(Refer to Annex II)
Year: 2001
Morbidity
Microscopic confirmation of TB
diagnosis
Cure rate (per cent)
Mortality
Year: 2007
127,3
36.3%
125/100 000 population
70%
71,3 %
13,5 per 100000
population
87%
10.0
27. Objectives and expected outcomes:
Improving diagnosing of smeer positive cases
Objective:
Baseline
Targets
(Refer to Annex II)
Year:
Year 2:
Case-detection rate
4
2.8
Table IV.27
Year 3:
6
Year 4:
7
Year 5:
10
Permanent and uninterruptible supply of TB drugs
Objective:
Baseline
Targets
(Refer to Annex II)
Year:200 Year 2:
Year 3:
1
Sufficiency of supply
100%
100%
100%
Year 4:
Year 5:
Microscopic confirmation of the diagnosis
Objective:
Baseline
Targets
(Refer to Annex II)
Year:200 Year 2:
1
45
36.3
Year 3:
Year 4:
55
60
70
Year 4:
90,3
Year 5:
95
Sputum conversion rate of new cases (smear+)
Objective:
Baseline
Targets
(Refer to Annex II)
Year:2001
Year 2:
89,5
87.2
Page 74 of 111
Year 3:
90,2
100%
100%
Year 5:
74
Cure rate
Objective:
(Refer to Annex II)
Baseline
Year:2001
71.3
Targets
Year
Year 3:
2:
74.2
80.0
Year 4:
Year 5:
82.1
85.0
Objective 1. Improving of diagnosis of new smear positive cases
Sub-objective 1. . Increasing the rate of TB diagnosis among the suspected cases. This intervention is
directed at improving the integration of the National TB Programme (NTP) with the primary health care
(PHC). Involvement of family doctors through their additional training will facilitate early diagnosing of
TB cases, and strengthening health education will lead to earlier consultations of the patients at medical
establishments, which in its turn will have a positive impact on management results.
Sub-objective 1.B. Improving laboratory diagnostics. Supply of microscopy centres with reagents and
proper microscopes will improve diagnosing TB. The existing microscopes with a magnification power
of 630 times do not allow making a reliable detection of TB mycobacteria. Microscopes with the
magnification power of 1000 times are needed. Repeated training of the laboratory assistants (taking into
account a high rate of personnel turnover) will also permit to improve professional skills and reliable
detection of TB mycobacteria.
27.1. Broad activities related to each specific objective and expected output:
Objective 1. Improving of diagnosis of new smear positive cases
Sub-objective 1. . Increasing the rate of detection of TB among suspected cases.
Activity 1. Improving health education among the population. Detecting TB cases at the DOTS stage
assumes passive detection, however, many TB patients fail to consult doctors timely because they are not
aware of TB symptoms and of the consequences of late consultations with the doctors. Sanitary
promotion among the population will improve their TB literacy and awareness. With this aim in view it
is necessary to produce and disseminate booklets, fliers, posters in places where homeless people are
largely concentrated (markets, bazaars), neglected children residence homes “Ak-Jol”, “Meerim”
Foundation, especially among those groups that are more susceptible to TB infection. On the other hand,
it is important to ensure that medical personnel are friendly to any person who turns to their aid.
Expected output:
1. Increased awareness of the population on TB symptoms;
2. The patients will come earlier to the primary medical establishments for consultation;
3. The percentage of neglected forms of TB will drop.
4. Spreading the infection among other people will be contained.
Status by end of 2002:
10% of the population will be informed of initial symptoms of TB.
Situation by end of 2003
30% of the population will be informed of initial symptoms of TB.
Cost:
Year 1: USD6,000 (1 leaflet = $0.02) – 300,000 leaflet $0.02= USD6,000
Year 2: USD6,000 (1 leaflet = $0.02) – 300,000 leaflet $0.02= USD6,000
Resource
allocation (US$)
Total
Year 1
Year 2
6000
6000
Year 3
(Estimate)
5000
Year 4
(Estimate)
3000
Year 5
(Estimate)
2000
Total
22000
Activity 2. Supply of reagents for microscopic examination.
Insufficient supply of reagents for microscopic examination prevents doing such examination for all TB
suspects as stipulated by the DOTS strategy.
To identify one smear positive TB case 33 examinations are required, and to identify 2,000 such cases
33x2000 = 66,000 examinations should be performed.
Expected output:
1. Increase in the number of new smear positive cases
2. Depletion of the reservoir of the source of infection among the population.
Cost:
Page 75 of 111
75
One examination costs $0.11, therefore total amount should be $0.11 $0.10
Resource allocation
(US$)
Total
66000 = USD7,200
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
7200
7400
7400
7200
6400
35600
Activity 3. Supplying binocular microscopes.
The proposal envisages replacing half of the available binocular microscopes with magnification x630
with microscopes of magnifying power x1000, which will improve the quality of laboratory diagnosis.
The country with a population of 5 million needs 50 microscopes if one microscope is used per 100,000
population. Of these, 50% is to be replaced, i.e. 25 microscopes.
Expected output:
1. Increased rate of microscopic confirmation of the diagnosis from 37% (2001)
70% by the end of
2007.
2. Improved management quality with proper identification of correct category of treatment.
Cost:
One binocular microscope costs USD2,000.
25pcs. 2000 = USD50,000.
Year 1 –10 pcs x $2,000= USD20,000,
Year 2– 15 pcs x $2,000=USD30,000.
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
20600
30600
0
0
0
51,200
Activity 4. Refresher training of laboratory technicians.
Taking into account a high turnover of the medium level medical personnel (for low salaries), including lab
technicians, there is a necessity to propose refresher training of the lab technicians. The training will be
conducted on the basis of the guidelines for microscopic examination issued for CAR in 2002 with funding
from WHO.
Expected outputs:
30. Decrease of number of lab technicians who are not trained in TB diagnostics.
31. Improved professional skills of the working lab technicians.
32. Improved quality of TB diagnostics.
Cost:
Year 1 : 2 courses with 10 participants each. Cost of every course is USD1,000. (2 x $1,000 = $2,000)
Year 2 : 3 training courses of 10 lab assistants in each (3 x $1,000 = $3,000).
Resource allocation
(US$)
Total
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
2000
3000
1000
1000
1000
8000
Activity 5. Introduction of the journal of microscopic examination records of TB suspected cases. Use
of such a TB suspect journal in the family doctors groups (FDG) (765 of these in the country) will permit to
standardize reporting on TB detection at primary level, monitor both the quantity and the quality of TB
detection at primary level.
Expected outputs:
1. Improved registration of TB suspects including persons with lungs diseases.
2. Improved reporting on detected new cases.
Cost:
Year 1 : 400 journals $1.0 = $400
Year 2 : 400 journals $1.0 = $400
Page 76 of 111
76
Resource allocation
(US$)
Total
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
400
400
0
0
400
1200
Activity 6. Training physicians of FDG. An important component of the National TB Programme is
involvement of FDG physicians in the early detection and diagnosis of TB with the use of DOTS strategy.
Expected outputs :
1. Higher rate of detection of the patients with contagious forms of TB.
2. Increased rate of early detection of TB cases
3. Reduced reservoir of TB infection
4. Improved results of case management at the out-patient treatment stage
Cost:
Year 1: 12 interregional training events with 40 FDG physicians in each (each training event will cost
USD2,000)
Year 2 : 12 interregional training events with 40 FDG physicians in each (each training event will cost
USD2,000)
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
24,000
24,000
12,000
12,000
12,000
84,000
Activity 7. Provision of office equipment to the Training Center for Coordination of the TB Control
Programme of the Kyrgyz Republic to develop the specialists using DOTS strategy. It is proposed to
equip a training room with modern training facilities and publish a manual on DOTS.
Expected outcome:
Improved professional knowledge of the medical personnel and better quality of their work.
Cost:
Year 1: procurement of a white board 1 pc = $300, computer projector 1 pc = USD4,000; notebook
computer 1pc = USD2,000; copying machine 1 pc=$2,000. Total $8,300
Year 2: Publication of 100 copies of DOTS manual =USD1,000
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
8,300
1,000
0
0
0
9,300
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77
Objective 2. Ensuring outpatient controlled management of the patients (continuation phase)
After an intensive therapy phase and sputum conversion outpatient treatment is used. To consolidate the
treatment results further management of the patient should be better controlled. For this purpose
nongovernmental organizations (NGOs) and volunteers can be involved to ensure continuous observation of
the patient taking prescribed medicines.
Expected outputs:
1. Increased percentage of cured TB cases.
2. Reduced proportion of defaults
3. Reduced number of treatment failures
4. Reduced rate of relapses
5. Reduced rates of disability and mortality due to TB
Activity 1. Improving patient’s awareness of the consequences of incomplete treatment. Publication of a
brochure for TB patients to explain consequences of failure to complete the TB treatment, and the need to
complete a full course of management.
Expected outputs:
1 Reduced number of treatment failures.
2 Reduced interruptions on the phase of continued treatment
3. Reduced risks of spreading the infection.
Cost:
Year 1: 9,000 newly diagnosed patients 1 brochure (at $2.0 each) = USD1,800.
Year 2: 9,000 newly diagnosed patients 1 brochure (at $2.0 each) = USD1,800.
Resource allocation
(US$)
Total
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
1800
1800
1800
1700
1600
8,700
Activity 2. Training FDG physicians to improve controlled management of the patients (see data for
training in Activity 6, Objective 1).
This activity will be conducted in Activity 6, Objective 1
Activity 3 . Involving NGOs and volunteers to supervise drug-taking..
Involving patient family members, volunteers and NGO members (Red Cross, religious groups) in the
process of drug-taking supervision.
Expected outputs:
1. Improved control of treatment in the supporting phase
2. Reduced number of treatment failures
3. Reduced number of defaulters
4. Increased effectiveness of the treatment
Cost:
Year 1 : training volunteers 740 persons
Year 2 : training volunteers 740 persons
Resource allocation
(US$)
Total
USD5 /day = USD3,700
USD5 /day = USD3,700
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
3700
3700
3000
2500
2000
14,900
Activity 4. Treatment of newly diagnosed patients. In 2001 there were reported 6,569 patients, 1,500 of
these were smear positive cases. In addition, about 2,000 patients were registered in the penitentiary
establishments. It is expected that, KfW will provide first line drugs till the end of 2002.
Expected outputs:
1. Uninterruptible drug supply will permit to ensure continued introduction of the DOTS
strategy recommended by WHO.
2. Reduced number of interruptions in management of patients
3. Increased number of successful cure of TB patients.
4. Prevention of development of drug resistant forms of TB;
5. Reduced mortality.
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78
Cost:
Year 1 : number of patients requiring therapy 7524 USD27 = USD203,148
Year 2 : number of patients requiring therapy 8276 USD 27 = USD 224,452
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
203148
224452
246781
271000
257500
1202880
Activity 5. Accounting and registration of patients. Full registration of newly diagnosed patients and
patients with relapse should be established in the country to have complete account of TB patients. On
recommendations of WHO, for this purpose accounting and reporting forms and documentation should be
published.
Expected outcomes:
1. Improved quality of registration for each case.
2. Improved observation of the epidemiological situation dynamics.
3. Improved control of the effects of interventions.
4. Improved prognosis and planning of TB control activities.
Cost:
Year 1: printing of 11 forms of the monitoring system accounting and reporting documentation: TB01 – 8,000
copies x USD 0.02 =USD160; TB02 – 8,000 copies x USD 0.02 =USD160; TB03 – 100 copies x USD 0.5
=USD50; TB04 – 100 cc x USD 0.6 = USD60; TB05 – 150,000 copies x USD 0.02 =USD3,000; TB06 – 500
copies x USD 0.02 =USD10; TB07 – 700 copies x USD 0.06 =USD42; TB08 – 700 copies x USD 0.06
=USD42; TB09 – 1000 copies x USD 0.06 =USD60; TB10 – 50 copies x USD 0.02 =USD1.00; TB11 –
1,500 copies x USD 0.06 =USD900. Total USD 5,000
Year 2 – USD 5,000
Resource allocation
Year 1
Year 2
Year 3
Year 4
Year 5
Total
(US$)
(Estimate)
(Estimate)
(Estimate)
5000
Total
5000
5100
4900
4700
24700
Activity 6. Monitoring of TB control activities.
Regular monitoring of the TB control programme implementation by TB service specialists should be
performed to evaluate its progress, outcomes and get feedback. Central coordinators (2) will visit each oblast
once a quarter (7 oblasts), oblast coordinators (2) will visit each rayon (district) once every two months (55
rayons).
Expected outcome:
1. Improved professional skills of the TB specialists in monitoring.
2. Increased number of cured patients.
3. Reduced number of patients with relapse.
4. Reduced number of patients with failures.
Cost:
Year 1: 1 visit of Central Coordinators (2) – $195 travel expenses + $70 per diem (for 7 days)= $265 x 7
oblasts = $1,855 x 4 visits a year = USD7,420
During one visit (two months duration, 1 to each rayon) all oblast coordinators’ mileage reaches 13,940 km
for which they spend 2,788 liters petrol x $0.4(per liter) = $1,115 x 6 trips a year $6,700 + per diem expenses
$240 = USD 7,000. Total USD14,420
Year 2: USD14,420
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
14420
14420
14420
14420
14420
72100
Activity 7. Maintenance of E-Mail and Internet service. All TB institutions of the country are equipped
with computers and modems along the CDC line. From September 1, 2002, an electronic programme of
monitoring each TB patient will be commissioned to follow each case from the moment of detection until the
final outcome of the treatment.
Expected outcome:
1. Availability of operational data on each TB patient.
2. Timely correction of the patient management process in the regions.
Page 79 of 111
79
3.
4.
5.
Full information on epidemiological situation in different population groups.
Provision of feedback and taking operational response measures.
Ensuring continuity of case management when the patient changes his/her place of residence.
Cost:
Year 1: Servicing one post a month (E-mail) – USD50 x 9 centers = USD 450 x 12mth =USD5,400 +
USD600 for maintenance service and expendables = $6,000
Year 2: USD 6,000
Resource allocation
(US$)
Total
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
6000
6000
6000
6000
6000
30000
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80
Objective 3. Treating the patients who developed drug-resistant TB forms of
disease due to various causes
Among the patients taking repeated treatment 20% of the cases remain unsuccessful as a result of forming
drug-resistant TB.
Sub-objective 1. Identification of drug resistance.
To identify drug-resistance, materials for culture (two kinds of medium) as well as chemical reagents and TB
drug substances should be supplied to the national reference-laboratories.
Sub-objective 2. Treatment of TB patients with drug resistance.
Sub-objective 1. Identification of drug resistance.
Activity 1. Organisation of sputum culture from the failures after re-treatment to identify drug
resistance.
Expected outputs:
1. Establishment of the number of drug-resistant TB patients.
2. Reduced reservoir of infection of drug-resistant forms of TB.
3. Reduced number of patients with drug-resistant TB.
4. A decrease of TB mortality rate.
Cost:
Year 1: Sputum culture is made three times from one patient, cost of one culture $0.5 3 = $1.5. To identify
drug-resistance, two examinations are made. Cost of one examination – $0.8 2 = $1.6. Cost of drug
sensitivity test for one patient is $3.1 300 patients (to select 90 patients with MDR) = $930 + chemical
reagents ($1,070) = USD2,000.
Year 2 : to select 75 patients 824 + 1,070 = USD1,894.
Resource allocation
(US$)
Total
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
2000
1894
1721
1618
1515
8748
Sub-objective 2. Treatment of drug-resistant TB patients with second line drugs.
Due to the increase in the number of patients with multi-drug-resistant (MDR) forms of TB there arises a
need in procurement of second line drugs for 90 patients in the specialized departments of TB institutions.
Activity 1. Provision of second line medicines for patients with MDR-TB.
Second line medicines have not been used until now, which may facilitate expansion of drug-resistant forms
of TB. Treatment of patients with MDR may solve one of the problems of chronic forms of TB.
Expected outputs:
1. Reduced reservoir of infection of drug-resistant forms of TB
2. A decrease in TB mortality rate.
Cost:
Year 1 : 90 patients USD3,502 (cost of second line medicines for 21-months long therapy) = USD315,198
(WHO recommended price,1998).
Year 2 : 70 patients USD3,502 = USD245,200.
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
315198
245200
210120
210120
175100
1155738
Page 81 of 111
81
Objective:
Training medical staff on issues of diagnosing and clinical management within DOTS (Increased awareness
of population to 90%, proportion of neglected forms of TB drops to 2.0%, incresed proportion of cure to87%,
reduction of mortality rate to 10.0%)
Broad activities
Process/Output
Baseline
Targets
(Specify
Year 1
Year 2
agency or agencies
year)
Annex II)
Training of FDG
Number of workshops
29
29
KRIoT and project “HOPE”
10
physicians and
voluntteers in disease
Number of participants
1,240
895
FDG
1,240
detection
Diagnosing among
Microscopic
4
6
PMSP(PHC)
2.8
suspected TB cases
confirmation of diagnosis
NTP
(sputum microscopy)
Treatment
Cure of pulmonary TB
74.2
80.0
Medical personnel,NGOs and
71.3
patients with smear (+)
other communities
government, external donors, the private sector or other relevant partner:
This component reduces the gap of government financing that covers only 53% of the required budget for
further introduction of DOTS strategy recommended by WHO.
During 1996 to 2002 donor assistance to introduce DOTS strategy has been provided by other external NGOs
such as: “Meerim” Fund =USD35,100; USAID = USD72,000; Project “HOPE” = USD42,000; GDF =
USD2.4mln. We expect additional assistance from GDF at $2.4 mln.
29.1. The involvement of beneficiaries such as people living with HIV/AIDS:
To implement this component, people contacting with TP patients, medical personnel, religious groups
and NGOs will be involved.
On issues of raising awareness and support to the poor the Board of Elders existing in each settlement
will be involved. .
29.3. Gender equality issues (Guidelines paragraph IV.53):
No problems
29.4. Social equality issues (Guidelines paragraph IV.53):
No problems.
29.5. Human Resources development:
The Government provides TB service personnel development through refresher courses planned
regularly (once in 3-5 years)
Recruitment of international consultants and domestic consultants for training and implementation of
this component.
Activity. Development of human resources forecasting tactics and rational use of the available
resources. International consultants and domestic consultants should be recruited to train in the
implementation of DOTS strategy recommended by WHO, develop human resources forecasting tactics
and rational use of the available resources.
Expected outputs:
1. Improved qualifications of the medical personnel in response to TB.
2. Efficient use of available financial resources.
Cost:
1 international consultant services at $7,000 per week.
Page 82 of 111
82
1 domestic consultant services at $1,000 per year.
Year 1: $8,000
Year 2: $8,000
Resource allocation
(US$)
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
Total
8,000
8,000
1,000
1,000
1,000
19,000
29.6. For components dealing with essential drugs and medicine, describe which products and
treatment protocols will be used and how rational use will be ensured (i.e. to maximize adherence
and monitor resistance), (Guidelines para. IV.55), (1–2 paragraphs):
According to DOTS strategy, TB treatment is divided into 3 categories.
Category one is prescribed 4 drugs: Isoniazid (H), Rifampizin (R), Pyrasinamide (Z), Ethambutol (E) –
in brackets shown international designation.
The following treatment protocol is used for category one:
2 E3H3R3Z3/4H3R3
2 EHRZ/4H3R3
2 EHRZ/4HR
2 EHRZ/6HE,
Where figures in front designate the number of months and, and the lower figures the number of times
a week.
For category two five drugs are used according to the following treatment protocol:
2 SEHRZ/ 1HRZE/5H3R3E3
2 SEHRZ/ 1HRZE/5HRE
For category three 3 drugs are used:
2 H3R3Z3/4H3R3
2 HRZ/4H3R3
2 HRZ/4HR
2 HRZ/6HRE
At central and regional levels there are monitoring centers and individual specialists designated to coordinate
drug and medicine supply. Every quarter, the data are entered in the databank in the NMC and at the regional
level as a result of which there is a possibility to trace the use of drugs down to rayon level.
During inspection visits of the central and oblast coordinators they perform regular audit of rational use of
drugs and medicine. The Department of Drug Supply and Medical Facilities of the Ministry of Health
exercises planned supervision.
The following therapy scheme is used to treat MDR-TB patients:
3 CetZ cy/ 18E cy (C – canamycini, Et – ethnonamide , – ophlaxacini, cy – cycloserini).
For sputum microscopy the following reagents are used: fuchsine basic, methylene blue phenol, and
concentrated hydrochloric acid.
The following reagents are used to determine drug sensitivity:
L-asparagine monohydrate 2.4g/ l
Glycerol 12 ml/l
Molachitogreen 2%
Dihydrostreptomycini 4 mkg/ml
Ethambutol 2 mkg/ml
Isonicotinical hydrazide (isoniazid) 0.2 mkg/ml
Rifampizin 40 mkg/ml
Page 83 of 111
83
budget category:
Table V.30
Resources
Year 1
Year 2
Year 3
Year 4
Year 5
Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
Human
Resources
Infrastructure/
Equipment
Training/
Planning
Commodities/
Products
Drugs
8000
1000
8000
1000
1000
19000
28300
30000
0
0
0
58300
29700
30700
16000
15500
15000
106900
0
0
0
0
0
0
527546
478946
466022
489938
440515
2402967
14420
14420
14420
14420
14420
72100
6000
6000
5400
5400
5400
28200
Other publishing
(Please specify)
19400
18400
17500
14800
13500
83600
Total
633367
579468
527345
541062
489840
2771067
Monitoring and
Evaluation
Administrative
Costs
Table V.30.1
Volume (specify
Item/unit
Unit cost
Total cost
(USD
measure)
(USD)
In the process of clarification (disparity
between the total price when related to
calculations on individual drugs)
Drugs for newly detected TB patients
H75 R 150Z400 E 275
30.50
14.81
45170.5
H75 450
8,80
635
5588
H150 E 150
8,92
175
1561
H150 R 150
9,30
1767
16433,1
Z400
9,81
635
6229,35
H330
3.76
268
1007.68
E 400
8.67
224
1942.08
S0.75
2.70
903
2438.1
Water for injections
1,75
452
791
Drugs for MDR-TB treatment
Canamycini
10,0
package
2943
Ethambutol
14,8
package
27972
Z
2,9
package
783
Ophlaxacini
1,87
package
164430
Cycloserini
63
package
119070
Water for injections
Chemical reagents to determine sensitivity
L-asparagine monohydrate 2.4/g l
1.19
1 p – 250 g
149,100
Glycerol 12 ml/l
48.35
1p–3l
290.10
Molachitogreen 2%
0.15
1 p – 250 g
168.00
Dihydrostuptomy 4 mkg/ml
1.7
1p–5g
25.5
Ethambutol 2 mkg/ml
1.23
1 p – 250 g
61.5
Page 84 of 111
84
Isonicotinical hydrazide (isoniazid)
0.2 mkg/ml
Rifampizin 40 mkg/ml
1.27
1p–5g
356.7
27.8
1 p – 250 g
Chemical agents for microscopy
Fuchsine basic 10 g
Methylene blue 30 g
Phenol 50 g
Concentrated hydrochloric acid 30 ml
kit
356.7
kit
7,200
1200000
31. If you are receiving funding from other sources than the Global Fund for activities related to
this component, indicate in the Table below overall funding received over the past three years as
well as expected funding until 2005 in US dollars (Guidelines para. V.62):
Table V.31.1
1999
2000
2001
2002
2003
2004
2005
Domestic
(public and
1305000
1305000 1300000 1300000 1300000 1300000 1300000
private)
1415500
1405500 1450000 1200000 1200000 800000
800000
External
2720500
2710500 2750000 2500000 2500000 2100000 2100000
appropriate.
Table V.33
Resource
Year 1
Year 2
Year 3
Year 4
Year 5
Total
allocation to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
88,7
89,1
88,6
91,6
94,0
Government
89,6
NGOs /
CommunityBased Org.
Private Sector
People living
with HIV/ TB/
malaria
Academic /
Educational
Organizations
Faith-based
Organizations
Others (please
specify)
Total
Total in USD
3,8
4,0
4,7
4,0
4,4
4,1
7,5
6,9
6,7
4,4
5,2
6,3
100%
633367
100%
579468
100%
527345
100%
541062
100%
489840
100%
2771067
Page 85 of 111
85
PLEASE COMPLETE THE FOLLOWING SECTIONS FOR EACH COMPONENT
Please copy sections IV – VIII as many times as there are components
Component
HIV/AIDS
(mark with X):
Tuberculosis
X
Table IV.23
Malaria
HIV/TB
24. Provide a brief summary of the component (Specify the rationale, goal, objectives, activities, expected
results, how these activities will be implemented and partners involved) (2–3 paragraphs):
The project will support the country in building country capacities and capabilities to promote healthrelated actions that contain ongoing outbreak of malaria, reduce the incidence of malaria and prevent its
further spread across the country. The project will focus on addressing malaria related issues through
capacity building, improving capacities for and access to early diagnosis/adequate treatment and timely
response to and prevention of malaria outbreaks, reinforcing surveillance mechanisms, and increasing
community awareness and involvement in malaria prevention. Implementation of the Project will be a
collaborative effort of Ministry of Health in cooperation with other potential partners and the donors in
2003-2007.The project will have a strong but flexible management structure in implementing costeffective but technically sound and sustainable malaria control adapted to the country’s conditions and
responding to local needs.
From (month/year):
January 2003
To (month/year):
December 2007
26.1. Goal and expected impact (Describe overall goal of component and what impact, if applicable, is
expected on the targeted populations, the burden of disease, etc.), (1–2 paragraphs):
- In face of the recent explosive resurgence of malaria transmission in border areas with Tajikistan and
Uzbekistan and the possible resumption of malaria transmission in other areas of the country, the
project attempts to change this unfavourable trend, particularly in epidemic — prone border areas
with Tajikistan and Uzbekistan, where autochthonous cases of Plasmodium vivax malaria have been
reported, and its number has continued to increase in 2002.
- The practical, technical and operational modalities on dealing with malaria by specialized services and
the public health sector as well as the community itself are the expected outcomes of the planned Project,
implemented by the Government of Kyrgyzstan. The project will have strong but flexible management
structure, capable in implementing cost-effective but technically sound and sustainable malaria control
measures adapted to the country’s conditions and responding to local needs.
-
base — line survey conducted in project areas will provide an assessment of the malaria-related
problems and needs at the beginning of the project, whereas terminal evaluation conducted at the
end of the project will bring to light improvements in the malaria situation which have occurred as c
result of project interventions.
- The project goal is to contain/prevent malaria outbreaks, reduce the incidence of malaria,
prevent its further spread across the country, and minimize socio-economic losses provoked by
the disease through the progressive strengthening of the capacities and capabilities of health services
and mobilizing community actions in Kyrgyzstan. Sustaining project activities beyond 2007 could
Page 86 of 111
86
reduce the impact of malaria to
problem.
sufficiently low level so that it n longer represent
public health
Table IV.26.1
To contain/prevent malaria outbreaks, reduce the incidence of malaria, prevent its
further spread across the country, and minimize socio-economic losses provoked by the
disease
Impact indicators
Baseline
2002
2007
A decrease in the incidence of malaria
40
per
100
000 5 per 100 000 population
population
Containment of malaria outbreaks
Ongoing
malaria Malaria outbreaks contained
outbreaks
Prevention of malaria outbreaks
Ongoing
malaria Malaria outbreaks prevented
outbreaks
Prevention of re-establishment of Progressive return of Expansion of areas with epidemic
malaria transmission
epidemic malaria
malaria prevented
Goal:
27.1. Broad activities related to each specific objective and expected output (Describe the main
activities to be undertaken, such as specific interventions, to achieve the stated objectives) (1 short
paragraph per broad activity):
Table IV.27.1
To strengthen institutional capacities of the national malarial control programme, general health services
and enhanced capacity for decision- making related to malaria and its control and prevention
Broad activities
Process/Output
BaseTargets
Responsible/
line
Implementing
indicators (indicate one 2002
2003
2004
2005
2006
2007
agency or
agencies
Annex II)
To render technical 4 missions of technical 2
3
1
Ministry
of
and
managerial consultants completed
Health
expertise and back-up
for the RBM Project
Expected outputs : WHO expert missions in April, August and October 2003 for evaluation and correction of malaria control
activities. In the course of the mission, expert advice on support of the project obtained.
Cost : $45,000 in 2003, $15,000 in 2002
To train senior health
staff in programme 250 senior health staff 20
100
50
50
50
Ministry
of
management
to trained
Health
improve
capacities
for planning and of
project activities
Expected outputs : This activity will be aimed at managerial medical staff to build up the capacity for planning and
implementation of project-related malaria control measures. 250 officers trained.
Cost : $50,000
To
train
Regional/District
400 medical officers 50
200
100
50
50
Medical Officers in trained
existing approaches
to
disease
Ministry
of
management,
Health
epidemic control and
community
mobilization
Expected outputs : This activity is designed to train Regional/District Medical Officers in existing approaches to disease
management, epidemic control and community mobilization. 400 officers trained.
Cost : $60,000
Objective: 1
Page 87 of 111
87
Objective: 2
Broad activities
To improve capacities and access to early diagnosis and radical treatment of malaria
Process/Output
Baseline
Indicators (indicate
one per activity)
(Refer to Annex II)
250
laboratory
technicians trained
Targets
Responsible/
Implementing
agency or
agencies
2002
2003
2004
2005
2006
2007
To select and
50
100
50
50
50
Ministry
of
train/retrain
Health
laboratory staff in
malaria
microscope
Expected outputs : Clinical and parasitological laboratories personnel is to be trained in improving malaria microscope
examinations. Annually 4 on-site seminars conducted and 250 lab technicians trained.
Cost : $50,000
To
upgrade 75
laboratory 15
30
30
15
Ministry
of
laboratory
facilities upgraded
Health
facilities to select
health centers
Expected outputs : To upgrade 75 clinical laboratories of primary health care (PHC) and State Sanitary and Epidemiological
Service Centres microscopes (entomological, diagnostical) will be procured.
Cost : $37,500
To
set
up 3 reference centers 3
Ministry
of
supervision and set
up
and
Health
quality
control functioning
systems
of
laboratory
services
and
ensure
their
functionality
Expected outputs : 3 reference centers (in Osh, Bishkek, Jalal-Abad) are established to set up supervision and quality control
systems of laboratory services. They are equipped with computer facilities to monitor the work of State Sanitary and
Epidemiological Service Centres.
Cost : $3,000
To set up a system 3 reference centers 3
Ministry
of
for the assessment set
up
and
Health
of quality of care functioning
and ensure its
functionality
Expected outputs : A system for the assessment of quality of care established with 3 reference laboratories (in Osh, Bishkek,
Jalal-Abad). They are equipped with computer facilities to monitor the work of State Sanitary and Epidemiological Service
Centres.
Cost : $3,000
To
develop/ Various
malaria- Some
Materials The
The
Ministry
of
modify/produce
related
materials materials
develope same
same
Health, KRSU
training/learning
developed
and developed and d
and
materials
on produced
(all distributed
distribute
disease
materials produce
d
management and in 2003 and 2004)
prevention
Expected outputs : Training and information materials on malaria management and prevention for all health service
specialists engaged in malaria prevention and control developed and produced.
Cost : $50,000
To train basic 900 BHS trained
50
300
300
200
100
Ministry
of
health staff in
Health
case management
epidemic control
and community
mobilization
Page 88 of 111
88
Expected outputs : To improve epidemiological surveillance basic health staff (900 staff) trained in case management,
epidemic control and community mobilization. Annually 5 on-site seminars in epidemic-prone southern areas bordering with
Tajikistan and Uzbekistan conducted.
Cost : $60,000
To procure and All
required Some
Necessar The
The
Ministry
of
distribute
equipment
and equipment and y
same
same
Health
laboratory
supplies procured supplies
equipme
equipment/supplie end
distributed procured and nt
and
s and drugs/other every year
distributed
supplies
items required for
procured
disease
and
management
distribute
d
Expected outputs : Laboratory equipment/supplies and drugs/other items (delagilum, primaquine, quinine, Gimze dye,
microscopic slides, scarifier etc.) required for disease management procured and distributed
Cost : $125,000
To improve capacities for timely response to and prevention of malaria outbreaks.
Objective: 3
Broad activities
Process/Output
Baseline
Targets
2003
2004
agency or agencies
Annex II)
To develop monitoring Consultant
recruited, Consult Mechani Ministry of Health, KRSU
mechanism
for monitoring mechanism
ant
sm
developed by 2003
recruite develope
detection/forecasting
epidemic risk factors
d
d
Expected outputs : An expert recruited (possibly from WHO) to have developed monitoring mechanism for
detection/forecasting epidemic risk factors in the southern regions of the republic.
Cost : $15,000
To
update
NPS Operational
guidelines Guidelin Ministry of Health, KRSU
operational
guidelines and procedures update by
es
and procedures related to 2004
updated
detection and control of
epidemics
Expected outputs : NPS operational guidelines and procedures related to detection and control of epidemics regularly
updated.
Cost : $20,000
To improve emergency Emergency preparedness Emerge The
Ministry of Health, KRSU
preparedness for and for and response to
ncy
same
response
to
malaria malaria
outbreaks
prepare
epidemics in project improved by 2004
dness
areas where outbreaks
improv
are a recurring problem
ed
Expected outputs : Emergency preparedness for and response to malaria epidemics in project areas where outbreaks are a
recurring problem ensured with the aid of this component. A mobile brigade for operational response to malaria outbreaks in
Osh, Jalal-Abad and Batken oblasts and Bishkek maintained.
Cost : $50,000
To procure and deliver Insecticides
and Insecticide Insectic The
Ministry of Health
and ides
same
insecticides
and equipment for spraying s
equipment for spraying
procured and distributed equipment and
every year, except 2007.
procured
equipm
ent
procure
d
Expected outputs : Irreducible amount of insecticides (500 kg) and 70 automaxes for spraying procured and delivered
annually to ensure effective control of the vector.
Cost : $200,000
Page 89 of 111
89
To strengthen malaria surveillance mechanisms
Objective: 4
Broad activities
Process/Output
Baseline
Targets
2003
2004
agency or agencies
Annex II)
To design and carry out Base-line survey in 2003 Survey Ministry of Health
a base-line survey to and impact surveys in
conduct
assess
needs
and 2007 carried out.
ed
problems
related
to
malaria
and
impact
assessment survey
Expected outputs : To improve and strengthen malaria surveillance, expert assessments and surveys carried out to identify the
needs and problems related to malaria and response measures impact including entomological, epidemiological,
parasitological, clinical and laboratory expert surveys and investigations. Epidemiological malaria zoning of the country
performed.
Cost : $30,000
To improve the existing Reporting
and Reporti The
Ministry of Health
reporting
and information
systems
ng and same
information systems
improved
informa
tion
systems
improv
ed
Expected outputs : Improved system of recording and reporting forms, foms of urgent notification, emergency reports, and
national reporting implemented.
Cost : $25,000
To
procure
project Transportation,
Some
Some
The
Ministry of Health
transportation, equipment equipment and supplies equipment equipm same
and supplies to improve procured
and
ent and
supervision
and
supplies
supplie
monitoring of project
procured
s
activities at all levels
procure
d
Expected outputs : 5 vehicles, 10 computers and asupplies procured and delivered to improve epidemiological surveillance.
Cost : $55,000
To undertake monitoring Monitoring undertaken
Monito The
of project activities
ring
same
Ministry of Health
underta
ken
Expected outputs : Regular project monitoring performed with expert missions, analisys and monitoring conducted.
Cost : $30,000
To increase community awareness and participation in malaria control and prevention
Objective: 5
Broad activities
Process/Output
Baseline
Targets
2003
2004
agency or agencies
Annex II)
Malaria The
Ministry of Health
To
strengthen Malaria
care
and community and family prevention
practices
care
same
care and prevention strengthened
and
prevent
practices
through
provision
of
IEC
ion
materials,
awareness
practice
raising
sessions,
s
strengt
community
support,
skills building and mass
hened
media
Expected outputs : To strengthen community work and malaria prevention practices, production and distribution among the
population of mosquito nets, development and dissemination of education materials for the population and promotional
materials for mass media performed.
Cost : $100,000
Page 90 of 111
90
To
conduct
rapid KAP
designed
and KAP
Ministry of Health
assessments on practices conducted in 2003
designe
of
recognition
and
d and
treatment of malaria and
conduct
personal protection in
ed
order
to
develop
effective IEC strategy
Expected outputs : Mobile brigades comprised of various level specialists established and functioning to assess the situation
and provide methodological assistance in the development an effective IEC strategy.
Cost : $25,000
To built IEC service Targeted IEC materials Targete IEC
Ministry of Health
capacity
including developed;
IEC
d IEC campaig
development of targeted campaign implemented
materia n
IEC materials and IEC and monitored
ls
impleme
management
and
develop nted and
monitoring
ed
monitore
d
Expected outputs : Inter-sectoral integrated IEC activity on the national, regional and district levels conducted, targeted
materials developed and disseminated. International conferences at the level of leaders of ministries of health of the
neighboring republics as well as coordination meetings to synchronize activities in the borderline areas at the regional levels
held. National cadre trained at international short-term courses and conferences.
Cost : $100,000
government, external donors, the private sector or other relevant partner: (e.g., does the component
build on or scale-up existing programs; does the component aim to fill existing gaps in national
programs; does the proposal fit within the National Plan; is there a clear link between the component and
broader development policies and programmes such as Poverty Reduction Strategies or Sector-Wide
Approaches, etc.), (Guidelines para. III.41 – 42),(2–3 paragraphs):
- The project will support the country in building national capacities and working together (in
cooperation with WHO and other existing and potential donors in the promotion of health – related
actions that reduce the incidence of malaria and its burden and prevent the further spread of malaria
across the country. The project aims to fill existing gaps in the national malaria control programme.
29.1. The involvement of beneficiaries such as people living with HIV/AIDS:
-
Generally speaking, the target beneficiaries could be represented by more than 2 million
indigenous people and migrants entering these areas for various reasons.
-
The involvement of communities and their partnership with the health sector to empower them in
their own health development is crucial. Particular attention will be paid to activities related to
community awareness and participation in malaria prevention.
Page 91 of 111
91
budget category
Objective 1.
Resources needed (USD)
To render technical and
managerial expertise and
back-up for the RBM
Project
To train senior health staff
in programme management
to improve capacities for
planning and of project
activities
To train Regional/District
Medical Officers in existing
approaches
to
disease
management,
epidemic
control and community
mobilization
45 000
-
Year
3
(Estimate)
-
20 000
10 000
10 000
10 000
-
50 000
30 000
15 000
7 500
7 500
-
60 000
Total: 650 persons
Objective 2
95 000
25 000
17 500
17 500
15 000
170 000
To select and train/retrain
laboratory staff in malaria
microscope 250 lab
technicians.
To upgrade laboratory
facilities to select health
centers
(75 labs)
To set up supervision and
quality control systems of
laboratory services and
ensure their functionality
To set up a system for the
assessment of quality of
care and ensure its
functionality
To develop/ modify/produce
training/learning materials
on disease management and
prevention
To train basic health staff in
case management epidemic
control and community
mobilization
To procure and distribute
laboratory
equipment/supplies
and
drugs/other items required for
disease management
Total:
Year 1
Year 1
Year 2
Year
4
(Estimate)
-
Year
5
(Estimate)
15 000
Total
60 000
Year 2
Year
3
(Estimate)
Year
4
(Estimate)
Year
5
(Estimate)
20 000
10 000
10 000
10 000
-
50 000
15 000
15 000
7 500
-
-
37 500
3 000
-
-
-
-
3 000
3 000
-
-
-
-
3 000
15 000
15 000
10 000
5 000
5 000
50 000
20 000
20 000
13 000
7 000
-
60 000
25 000
25 000
25 000
25 000
25 000
125 000
101 000
85 000
65 500
47 000
30 000
328 500
Page 92 of 111
Total
92
Objective 3
To develop monitoring
mechanism for
detection/forecasting epidemic
risk factors
To update NPS operational
guidelines and procedures
related to detection and control
of epidemics
To improve emergency
preparedness for and response
to malaria epidemics in project
areas where outbreaks are a
recurring problem
To procure and
deliver
insecticides and equipment for
spraying
Total:
Objective 4.
To design and carry out a baseline survey to assess needs and
problems related to malaria
and impact assessment survey
To improve the existing
reporting and information
systems
To
procure
project
transportation, equipment and
supplies
to
improve
supervision and monitoring of
project activities at all levels
To undertake monitoring of
project activities
Total
Objective 5
To strengthen community and
family care and prevention
practices through provision of
IEC materials, awareness
raising sessions, community
support, skills building and
mass media
To conduct rapid assessments
on practices of recognition and
treatment of malaria and
personal protection in order to
develop effective IEC strategy
To built IEC service capacity
including development of
targeted IEC materials and IEC
management and monitoring
Total
Year 1
Year 2
Year
3
(Estimate)
Year
4
(Estimate)
Year
5
(Estimate)
15 000
-
-
-
-
15 000
-
20 000
-
-
-
20 000
30 000
20 000
-
-
-
50 000
50 000
50 000
50 000
50 000
-
200 000
95 000
90 000
50 000
50 000
-
285 000
Year 2
Year
3
(Estimate)
Year
4
(Estimate)
Year
5
(Estimate)
30 000
-
-
-
-
30 000
15 000
10 000
-
-
-
25 000
35 000
20 000
-
-
-
55 000
15 000
95 000
15 000
45 000
-
-
-
30 000
140 000
Year 2
Year
3
(Estimate)
Year
4
(Estimate)
Year
5
(Estimate)
50 000
30 000
20 000
-
-
100 000
25 000
-
-
-
-
25 000
50 000
50 000
-
-
-
100 000
125 000
80 000
20 000
-
-
225 000
Year 1
Year 1
Page 93 of 111
Total
Total
Total
93
30.1. For drugs and commodities/products, specify in the table below the unit costs, volumes and total
costs, for the FIRST YEAR ONLY:
Table V.30.1
Item/unit
Chloroquine 150 mg
Primaquine
Chloroquine syrup
Quinine Di-HCI 300mg/ml 2 ml/amp.
Quinine sulphate
Unit
cost
(USD
8 per 1000 tablets
10 per 1000
tablets
No information
No information
No information
Volume (specify
measure)
Total
(USD)
1. 500
2. 000
cost
500
500
500
31. If you are receiving funding from other sources than the Global Fund for activities related to this
component, indicate in the Table below overall funding received over the past three years as well
as expected funding until 2005 in US dollars (Guidelines para. V.62):
Table V.31.1
1999
2000
2001
2002
2003
2004
2005
Domestic
(public
and 20.000
20.000
25.000
25.000
25.000
25.000
25.000
private)
20.000
25.000
25.000
50.000
50.000
30.000
25.000
External
Total
40. 000
45. 000
50. 000
75. 000
75. 000
55. 000
50. 000
Please note: The sum of yearly totals of Table V.31.1 from each component should correspond to the
yearly total in Table 1.b of the Executive Summary. For example, if Year 1 in the proposal is 2003, the
column in Table 1.b labeled Year 1 should have in the last row the total of funding from other sources for
2003 for all components of the proposal.
appropriate.
Page 94 of 111
94
Table V.33
Resource
Year 1
Year 2
Year
3 Year
4 Year
5 Total
allocation
to
(Estimate)
(Estimate)
(Estimate)
implementing
partners* (%)
55%
60%
60%
60%
60%
60%
Government
NGOs
CommunityBased Org.
Private Sector
/
People
living
with HIV/ TB/
malaria
Academic
/
Educational
Organizations
Faith-based
Organizations
Others
(please
specify)
Consultancy
Total
Total in USD
30%
40%
40%
40%
30%
35%
15%
-
-
-
10%
5%
100%
515 000
100%
330 000
100%
158 000
100%
124 500
100%
53 000
100%
1 180 500
Page 95 of 111
95
SECTION VI – Programmatic and Financial management information
Please note: The following three sections (VI, VII and VII) are all related to proposal/component
implementation arrangements.
If these arrangements are the same for all components, you do not need to answer these questions for each
component. If this is the case, please indicate clearly in which component the required information can be
found.
34. Describe the proposed management arrangements:
The Global Fund proposal implementation will be performed on the basis of the national execution
mechanism for Kyrgyzstan. The administrative agency will be the principal recipient of the grant - UNDP
Representative Office in Kyrgyzstan. The executing agency will be the Prime Minister’s Office of the Kyrgyz
Republic. National Director of the Programme is First Vice Prime Minister of Kyrgyzstan. He appoints the
programme manager who will be in charge of day-to-day running of programme implementation and fully
responsible for its realization. The programme manager reports to the National Director of the Programme
and Country Coordinating Committee (CCM), provides for coordination, monitoring and evaluation of the
proposal implementation progress and liaison between implementing agents.
The financial management system envisages grant funding of the programme sections. Governmental or
nongovernmental organisations will submit justified requests with indication of the plan of action and
financial estimate. Such request will correspond to the present proposal objectives and should be resultoriented in accordance with the indicators of this proposal. Funding is allocated on a quarterly basis in
accordance with the financial estimate and based on the reporting for the previously implemented programme
sections.
Main programme implementation counterparts will be:
Ministry of Health;
Ministry of Education and Culture;
Ministry of Internal Affairs;
Ministry of Labour and Social Protection;
Ministry of Defence;
Nongovernmental organisations;
National programme director will approve the Programme plan and budget as well as technical and financial
statements and reports for the Global Fund. He will appoint national coordinators for each of the main
counterparts. There may be several coordinators (2-3) depending on specific objectives of the counterpart. For
instance, Ministry of Health; may appoint in case of need three coordinators for AIDS, tuberculosis and
malaria. National coordinators report to their respective ministry (department), CCM, and National
Programme Director. They submit quarterly technical and financial reports before 15th day of the month
following the quarter to the National Programme Director and a financial plan and estimate before 20th day of
the month preceding the new quarter. For each main counterpart finance and administrative assistant (one or
two physical persons) will be recruited in a competitive basis. He/she will assist the national counterpart in
managing financial and administrative procedures of the proposal implementation in accordance with the
requirements of this request, and provide for control of expenses in accordance with the financial plan and
estimate approved by the national programme director. Finance assistant will be subordinated to the
programme manager.
Contracts with nongovernmental organisations will be made on the basis of bidding for grant projects. The
bidding commission will include CCM representatives, the manager and assistants of the Programme,
representatives of the main counterparts of the Programme. Representatives of the cooperating NGOs will
report with the same periodicity as the government counterparts of the CCM to the national director and
manager of the Programme. An assistant will be recruited on the competitive basis to provide financial and
administrative support to NGOs in the course of Global Fund Proposal implementation.
MALARIA
At the central level: The National Parasitological Service will be responsible for implementation of project
activities. The Director of the National Epidemiological Supervision Department/Project Manager will work
in close consultation with the Ministry of Health. NPS staff will undertake field visits to supervise the
Page 96 of 111
96
performance of work done in the field. International consultants will be recruited to assist in the planning
and evaluation of project activities.
At the regional / district levels: Focal points for the project (Chiefs of Regional/District Sanitary and
Epidemiological Service/Parasitological Service) will be designated for better communication and
coordination between the central and district levels. Staff of regional/district parasitological and general
health services will be responsible for all project-related activities in their respective areas. Technical advice
will be provided by regional/district specialized health personnel dealing with malaria issues.
The project will be implemented in full consultation with all agencies and organizations involved in order to
enhance coordination and maximize the impact of assistance.
34.1 Explain the rationale behind the proposed arrangements
The management arrangements described in Para. 34 are aimed at ensuring collegiate nature of decisionmaking on implementation of the GF Proposal, at development of partnerships between governmental,
nongovernmental organisations and other participants of the Programme, at ensuring transparency and
openness of the implemented programmes as well as to control targeted spending of the Global Fund financial
resources and goods and services procurement procedures stipulated by this request. Such Programme
management arrangements will promote development of management capacity of the national counterparts
from among government bodies and NGOs. It will facilitate raising responsibility of all Programme
participants for implementation of their section of the GF Programme. Collegiate discussion of the
Programme implementation issues will lead to its improvement and better decision-making.
35. Identify your first and second suggestions for the Principal Recipient(s):
First suggestion
UNDP
Mr. D. Akopyan, UNDP Resident
Representative a.i. in Kyrgyzstan
Second suggestion
World Bank
Mr. Mohinder S. Mudachar
Resident Representative
Address
160, Chui Ave., Bishkek, 720040,
Kyrgyzstan
214 Moskovskaya Strret, Bishkek
720000, Kyrgyzstan
Telephone
(996 312) 61 12 13;
(996 312) 61 12 11
00 873 762 39 91 65 (satellite line)
(996 312) 61 12 17; 61 12 18
(996 312) 61 06 50;
(996 312) 61 03 56
Name of PR
Name of
contact
Fax
E-mail
[email protected]
Homepage: http://www.undp.kg
Table VI.35
(996 312) 61 03 56
mmudahar@ worldbank.org
35.1. Briefly describe why you think this/these organization(s) is/are best suited to undertake the role
of a Principal Recipient for your proposal/component:
UNDP is one of the largest agencies of the UN system and included in the Country Coordinating Mechanism.
Being a legal entity UNDP furnishes technical assistance to many UN agencies and other international
organisations and donor countries in Kyrgyzstan who have no representative offices of their own in the
Kyrgyz Republic. UNDP has its cooperation office in Osh and national and international UN volunteers in all
oblasts and 780 settlements of the country.
The UNDP global strategy on HIV/AIDS envisages provision of support in development of policies based on
leadership and multisectoral approach, in shaping the country’s capacity, improving legislation, mobilisation
of the civil society sector, assessment of the HIV/AIDS epidemic impact on sustainable human development
as well as development of modern information technologies in terms of HIV/AIDS prevention. UNDP has
been working in the Kyrgyz Republic since 1995 on AIDS prevention programmes including systematic
interventions in that area since 1997. UNDP has made a significant contribution in strengthening capacity of
the Kyrgyz Republic on HIV/AIDS issues. UNDP country office has experience in development of
HIV/AIDS prevention programmes, trained staff including HIV/AIDS professionals, experience of
Page 97 of 111
97
partnerships with all national and international counterparts named above. At present, UNDP administers
implementation of the Joint Expanded Programme of UN Agencies on AIDS in the Kyrgyz Republic.
UNDP maintains strict but transparent system of financial and administrative monitoring stipulated by
specially developed and approved rules of implementation of nationally executed programmes and projects.
35.2. Briefly describe how your suggested Principal Recipient(s) will relate to the CCM and to other
implementing partners:
The Principal Recipient suggested by the country will work on conditions of close cooperation and division
of responsibilities with the Country Coordinating Mechanism. Complete transparency of the financial
procedures conducted by the Principal Recipient will be ensured as well as that of goods and services
procurement procedures (See Chapter 8 of this proposal). UNDP staff representative in charge of the Global
Fund Proposal will be reporting to the Chair of the Country Coordinating Mechanism and submit regular
information on GF Proposal implementation progress concerning both its technical and financial aspects.
Distribution of resources between sub-recipients will be effected in accordance with the GF Programme
principles of competitiveness, transparency and obtaining the best result at the lowest financial costs.
36.Briefly indicate links between the overall implementation arrangements described above and other
existing arrangements (including, for example, details on annual auditing and other related deadlines). If
required, indicate areas where you require additional resources from the Global Fund to strengthen
managerial and implementation capacity:
The work on GF Proposal implementation will be carried out on the basis of annual and quarterly plans and
financial estimates prepared by the UNDP manager on submission of the main implementing agents from the
governmental and nongovernmental organisations. The plans will be discussed by the CCM and approved by
the CCM Chair. Annual compulsory audit is stipulated to be performed by an independent auditing company
selected on competitive basis. Independent experts should also make evaluations in the first third and fifth
year of the Programme.
To strengthen administrative aspects of the GF Proposal implementation additional staff will be needed
including programme manager, finance and administrative assistance and a driver. These personnel will be
selected on competitive basis and will be responsible for day-to-day implementation of the Proposal, ensuring
transparency of financial and administrative procedures, and technical support of the GF Proposal
implementation.
Page 98 of 111
98
SECTION VII – Monitoring and evaluation information
37. Outline the plan for conducting monitoring and evaluation including the following information, (1
paragraph per sub-question).
37.1. Outline of existing health information management systems and current or existing surveys
providing relevant information (e.g., Demographic Health Surveys, Living Standard Measurement
Surveys, etc.), (Guidelines para. VII.76):
The National Association «AIDS» collects data on HIV/AIDS issues in the health service sector. Specialized
research in particular areas is conducted by nongovernmental, independent academic and scientific research
institutions. The most complete review of the situation and outcomes of the interventions was done in 2000 in
the process of development of the National Strategic Plan. The latest research has been carried out for the
National Human Development Report. This Proposal uses the results of both of these studies as its basic
premises. Data collection on TB in the health service sector is performed by the Kyrgyz Research Institute of
TB together with National Statistical Center of the Ministry of Health that are equipped with CDC facilities
and connected to the integrated programme information network with support through the World Bank loan.
37.2. Suggested process, including data collection methodologies and frequency of data collection
(e.g., routine health management information, population surveys, etc.):
The Country Coordinating Mechanism will monitor development of all components of the programme
(HIV/AIDS, TB and malaria) by the indicators reflecting compliance of the activities with the plan. This will
be done with the help of the Programme staff on the basis of the technical and financial reports submitted by
the counterparts every half-year. Performance of the Programme will be assessed on the basis of external
indicators that reflect actual changes of the situation in the country. This assessment will be made by the
executing agents of the main sections of the Programme on the basis of the second generation sentinel
surveillance data and special context studies (public opinion surveys, legal situation assessment and other).
Activities to support such assessments are described in the respective sections of this Proposal. A Final
Report will be prepared and issued following a special evaluation review. The Final Report will include both
technical and financial aspects of the Programme progress and substantive changes in the situation. The
National Director and coordinators of the three components will be responsible for the preparation and
submission of evaluation reports. Specific methods of monitoring and evaluation, their timetables and
indicators for Programme objectives achievement will be developed before the beginning of the Programme.
The list of indicators used in accounting and reporting is to be reviewed every two years on the basis of
evaluation of their effectiveness. All stakeholders of the Programme (professional governmental,
nongovernmental, international and other organizations) will take part in that review.
Personnel for the second generation sentinel surveillance of HIV infection will be trained. Countrywide
sentinel surveillance will be introduced. The personnel will be trained on the principles of monitoring and
evaluation of the HIV, TB and malaria control programme performance. The specialists will be familiarized
with effective monitoring systems in the process of their work.
In addition to routine monitoring using the indicators of the process, outputs and outcomes as stand-alone
items, it is proposed to evaluate the effects of interventions through establishing causal relations between
them and the epidemic spread. The evaluation of effectiveness of the interventions will become a basis for
strengthening, planning, forecasting and adjustment of interventions to respond to HIV, malaria and
tuberculosis. Besides, the most effective indicators will be identified in the process.
37.3. Timeline:
Epidemiological data collection on tuberculosis, AIDS and malaria is carried out on a monthly basis. The
DOTS strategy implementation report is regularly submitted to WHO.
37.4. Roles and responsibilities for collecting and analysing data and information:
The Country Coordinating Mechanism and programme coordinators of each of the three components
(HIV/AIDS, TB, malaria) will play a coordination role in collection and analysis of the data and information
on HIV/AIDS. Heads of health service facilities will be responsible for data and information collection and
analysis on medical issues including unlinked sero-surveillance.
Page 99 of 111
99
37.5. Plan for involving target population in the process:
In the HIV/AIDS component, nongovernmental organizations representing the interests of vulnerable groups
will be responsible for collection and analysis of all data on these groups with the exception of serosurveillance. With regard to the tuberculosis component, target population will be involved in the process in
accordance with the National Programme “Tuberculosis” and Law “On protection of population against
tuberculosis”, i.e. multisectoral approach to problem solving is envisaged.
37.6. Strategy for quality control and validation of data:
The strategy fore quality control and validation of data in the HIV/AIDS component includes: (1)
independent surveys including these with participation of international experts; (2) transparency of the results
obtained including their periodic publicizing and comparison of the results of serological, behavioural and
context research; (3) obligatory interaction of independent research teams with nongovernmental
organisations, which will act as direct customers, providers of the primary information and access to the
group/community, and evaluators of the chosen research methodology and results from the point of view of
control of HIV infection. The Government (Ministry of Health, KRIoT, State Department for Sanitary and
Epidemiological Surveillance, the National Association “AIDS”) is implementing the strategy for quality
control of detection and treatment as well as collection of information on TB, malaria and AIDS patients.
37.7. Proposed use of M&E data:
The output of this activity will be the maintenance of the most effective indicators the change of which is
directly linked to the impact on the infection spread. It will be instrumental in more effective operational
planning of response to the epidemic, better information of professionals, review of the existing monitoring
system and subordination of the epidemiological surveillance to coordinated programmes of prevention and
alleviation of the epidemic consequences.
38. Recognizing that there may be cases in which applicants may not currently have sufficient
capacity to establish and maintain a system(s) to produce baseline data and M&E indicators,
please specify, if required, activities, partners and resource requirements for strengthening M&E
capacities.
Please note: As M&E activities may go beyond specific proposals funded by the Global Fund,
please also include resources coming from other sources at the bottom of Table VII.38.
Examples of activities include collecting data, improving computer systems, analysing data,
preparing reports, etc.
The main costs will be incurred by orders for expert opinions (USD300) and conduct of the National
Round Tables (USD3,000) once every two years; conduct of a national seminar on second generation of
sentinel surveillance with participation of international experts (USD15,000), development of the national
protocol of sentinel surveillance (USD500), finalizing methods of sentinel surveillance on work places in
three regions with involvement of national and regional experts (USD6,000), procurement of testing systems
of the required level of effectiveness (USD25,000/year), a final review seminar on the experience of sentry
surveillance introduction (USD3,000); conduct of a national seminar on principles of monitoring and
evaluation (USD3,000) before which a specialists familiarization tour of the country with an effective
monitoring and evaluation system should be conducted to gain experience (USD8,000). Baseline study will
be performed with assistance of external experts who would train national experts on-the-job (USD15,000).
National conferences will be conducted on the results of interventions evaluation (USD3,000 each).
Equipping AIDS prevention and control centers (USD14,800) with provision of access to Internet.
Administrative expenses of the Programme including monitoring of its current operations and finance are also
included. (Attachment 6.9).
Page 100 of 111
100
Table VII.38
Activities (aimed
at strengthening
Monitoring and
Evaluation
Systems)
Partner(s)
(which may
help in
strengthening
M&E capacities)
Development of the
National Strategy
on Programme
Monitoring and
Evaluation
Establishing the
second generation
sentinel
surveillance system
Reporting and
printing
Technical support
to monitoring
Independent
evaluation
Total requested
from Global Fund
Total other
resources available
NCC
Resources Required (USD)
Year 2
Year 3
Year 4
Year 5
32215
6325
10950
6325
10950
Ministry of
Health
17261
17498
9096
5208
17821
66884
NCC
21150
8200
21150
8200
21150
79850
Principal
Recipient
NCC
14190
Government
Year 1
15540
5040
5040
5040
Total
66765
44850
1000
4000
4000
1000
4000
14000
68626
41563
32236
15773
34911
193109
20000
10000
20000
10000
10000
80000
Page 101 of 111
101
SECTION VIII – Procurement and supply-chain management information
39. Describe the existing arrangements for procurement and supply chain management of public
health products and equipment integral to this component’s proposed disease interventions,
including pharmaceutical products as well as equipment such as injections supplies, rapid
diagnostics tests, and commodities such as micronutrient supplements, condoms and bed nets
(Refer to Guidelines paragraph VIII.86).
Table VIII.39
Component of procurement and supply Existing arrangements and capacity (physical and
chain management system
human resources)
How are suppliers of products selected The first step in selecting suppliers is often market
and pre-qualified?
research, particularly if the product or service has
not been procured before. There are a number of
tools available for this initial phase. Check the
United Nations Common Supply Database
(UNCSD) maintained by UNDP/IAPSO. For details
refer to the IAPSO website (www.iapso.org)
Check references such as the Thomas Register
KOMPASS
and
(www.thomasregister.com),
www.prosavvy.com (for professional services).
Pre-qualification is recommended to ensure that
offers are sought only from suppliers who have the
requisite resources and experience to perform the
intended work satisfactorily. The aim of the prequalification is to establish a list of capable suppliers
whilst ensuring that a proper level of competition is
safeguarded. The above is a time consuming
exercise and should be used for contracts of high
value i.e. USD100,000.00 or more for civil works
and contracting of professional services.
Economic prudence and efficiency:
Purchases and contracts will be made at the best
price for equipment, supplies, goods, works, or
services being procured or contracted from suppliers
and contractors who can make delivery and work in
a timely manner.
Transparency:
Procurement
and
contracting
decisions will be made according to a regular and
transparent process that clearly establishes
accountability for such decisions. Any and all
exceptions to or deviations from such processes will
require full justification and prior approval from
relevant agencies.
Competition: Procurement and contracting decisions
will be made on the basis of a competitive bidding
process that allows fair and equal treatment to all
prospective suppliers and contractors through an
equitable geographical distribution.
What procurement procedures are used to
ensure open and competitive tenders,
expedited product availability, and
consistency
with
national
and
international intellectual property laws
and obligations?
The methods used for Procurement of goods, works
and/or services as follows:
1. Request for quotation (RFQ)
2. Invitation to bid (ITB)
3. Request for proposal (RFP)
4. Direct contracting
5. Purchasing
1.
Preparation, Selection and Purchase
less than $1,000
Page 102 of 111
102
For the purchase of equipment and supplies costing
less than $1000, UNDP does not issue a
procurement order. Items costing less than $50 may
be purchased through the Petty Cash Fund (see
Chapter III). For items costing $50 - $999, three
competitive quotations are required from suppliers.
These quotations may be received without the
preparation of written documents, i.e., quotations
may be solicited and received over the telephone. A
simple quotation evaluation is prepared by the
Project Manager containing names of company,
name of the person who gave the quotation,
telephone number, date when the quotation was
received and price. The Project Manager should
also recommend which vendor to buy from.
Attachment 5.2.1 provides a format for this
evaluation.
(ii) $1,000 - $29,999
For the purchase of equipment and supplies
costing from $1,000 to $29,999, the following
preparation for an assessment of competitive
quotations must be taken. The country office may
authorize waiver of the competitive bidding
requirement. Factors involved in the decision to
waive the competitive bidding requirement are
described in Attachment 5.2.2. The following
describe the preparation procedures in
chronological order, which should be adhered to:
Step 1 Work plan All planned purchase of
equipment should be included in the quarterly
operational work plan which has obtained a
UNDP signature for no-objection. A format for
listing the planned procurements of equipment
are provided in Attachment 5.2.3. This list should
contain the broad specifications as given in the
project document, together with the allocation of
funds in the project budget. No preparation for
procurement should be undertaken, without such
a no-objection signature from UNDP.
Step 2 Preparation of Specifications. The Project
Manager must prepare a document with
specifications for project equipment and supplies.
If necessary, the country office or external,
independent technical expertise may be consulted
for assistance in preparing necessary instructions
and evaluation criteria (standard evaluation
criteria are listed in Attachment 5.2.4).
Step 3 Identification and selection of potential
suppliers. The Project Manager can identify
possible suppliers in rosters of suppliers or from
other available databases of suppliers and
contractors, by referrals from the country office,
or by advertisement. In addition, “on-line”
searches for specific suppliers may be conducted
via the Internet and the WWW. Although, it is
not obligatory to invite international companies it
might be cost-efficient in some cases. The UNDP
country office might assist with addresses from
the roster in the country office. After having
Page 103 of 111
103
identified potential suppliers the Project Manager
sends out letters for quotation (see Attachment
5.2.5) The Project Manager must receive at least
three positive responses. Prices quoted in
catalogues or other advertising materials may be
considered as viable written quotations.
Step 4 Selection of vendor The Project Manager,
together with the technical experts involved in
writing the specifications reviews the quotations
received from suppliers and selects the most
desirable offer on the basis of the following
primary selection criteria: conformity with the
specifications or TOR, delivery schedule,
availability of service, warranty and price (see
Attachment 5.2.4 for a list of factors influencing
evaluation of quotations or proposals.) The
project Manager writes an evaluation report,
which justifies the recommendation to the
UNDP.
The following documentation are attached to a
direct payment request and submitted to the
UNDP. Those documents are:
1) List of
Specification 2) Letter of Invitation to Bid, 3)
Minimum of three received quotations, 4) Project
Managers’ evaluation report and recommendation
to the Resident Representative.
(iii) $30,000 to $99,999*
For the purchase of equipment and supplies
costing from $30,000 to $99,999 all proposed
purchases are subject to review by the Local
Contracts Committee (LCC) in the UNDP office.
*Note: If, in accordance with the project
document or through other sources, it is known in
advance that multiple contracts or procurement
orders may be made with any one particular
company over several months, years or for the
duration of the project totaling $100,000 or more,
procurement
and
contracting
procedures
designated for use at the $100,000 level or above
must be followed as described in section (iv)
below.
Step 1 Work plan All planned purchase of
equipment should be included in the quarterly
operational work plan which has obtained a
UNDP signature for no-objection. A format for
listing the planned procurements of equipment is
provided in Attachment 5.2..3. This list should
contain the broad specifications as given in the
project document, together with the allocation of
funds in the project budget. No preparation for
procurement should be undertaken, without such
a no-objection signature from UNDP.
Step 2 Preparation of Specifications The Project
Manager, together with the UNDP Program
Officer identify and hire an external,
independent consultant to conduct a need
assessment, draft the specification document,
including evaluation criteria for the bidding
process, and to advice the evaluation of the
Page 104 of 111
104
quotations.
Step 3 Selection of Supplier. For purchases of
$30,000 to $99,999, international competitive
bidding is required unless a waiver is obtained
and negotiated procurement approved according
to the procedures described in Steps 6-8 below.
The competitive bidding process should be
implemented in accordance with the following
chronological step 1-5:
3.1 Short List
A short list of prospective suppliers (which may
include local suppliers and contractors in addition
to international candidates) may be identified by
the Project Manager from a long list of firms and
institutions known to the executing agency, by
advertisement in business publications, by use of
rosters or recommendations received from the
country office, through “on-line” Internet
searches, and by direct contact from
organizations.
The Project Manager will assess the suitability of
identified firms and institutions and prepare a
short list of not less than 6 qualified
organizations, whereof a minimum of 3 are
international suppliers (see Attachment 5.2.6. for
criteria used to select firms for short-listing). To
ensure the most successful procurement it is
recommended that 6-12 suppliers are short-listed
for procurement of goods. It is recommended that
1-4 short-listed firms come from major underutilized UNDP donors; 1-3 from developing
countries; and 1-2 from countries that may not
have been included in earlier procurement shortlists for a particular project.
3.2 Request for Quotation
Short-listed firms are sent a Request for
Quotation (Attachment 5.2.5), which includes the
result of the above mentioned needs assessment
and the list of specifications (see step 2). In
general, specifications should be used without
requirements for specific makes in order to allow
for the greatest response from contacted
suppliers. A quotation should contain a sealed
technical offer and a sealed financial offer. All
specific conditions required for equipment, e.g.,
terrain, weather, climate conditions specific to the
republic, as well as project deadlines should be
clearly indicated in the proposal.
3.3 Bid Opening
The bids/proposals remain sealed until expiration
of the submission deadline at which time all
bids/proposals are opened. Bids/proposals must
be publicly opened by the Project Manager and
the Chairman of the UNDP Local Contracts
Committee (see Attachment 5.2.7 for opening of
bids report).
3.4 Evaluation of bids
A group of involved parties are involved to
participate in the evaluation of the bidding. The
expert who drafted the specifications will
Page 105 of 111
105
prepare, guide and participate in the evaluation.
The evaluation criteria to be applied are the
ones specified in the documentation regarding
the specifications (see step 2) A short
description of how to evaluate according to a
point system is provided in annex 6.6.
Proposals should be evaluated separately, first
from a technical position and later from a
financial position. The technical evaluation
criteria are the ones identified together with the
specifications (see step 2).
After the evaluation, the expert and the Project
Manager prepare the evaluation report together
with the recommendations of the evaluation.
The recommendation should favor the qualified
and responsible supplier submitting the lowest
bid and in accordance with the list of
evaluation factors listed in the list of
specifications. One of the bids may be selected
for recommendation to UNDP or all bids may
be rejected. Procedures to be followed once a
bid/proposal has been accepted are described
after Step 8 below.
3.5 Procurement Award
The project presents the procurement to the
Local Contracts Committee through the
presenting officer. The presenting officer can
be the Project Manager, an independent expert,
the Program Officer or Finance Officer from
the country office. The presenting officer may
present all relevant documentation related to
the selection process to the Local Contract
Committee. The role of the Local Contract
Committee is to review that the process of
selecting the vendor has been done in
accordance with UNDP rules and regulations.
Based on the review the LCC recommends
suitable
vendors
to
the
Resident
Representative.
For procurements for less than US$20,000 both
the Program Manager and the Procurement
Officer at the UNDP Office can submit
proposals to the Local Contract Committee for
review. This will typically happen if the above
procedures for some reasons have not been
followed. In that case, the UNDP officer
becomes the presenting officer.
3.6 Rejection of Bids
If any or all bids/proposals are rejected, the
Project Manager records the reasons for
rejection and makes a determination whether to
invite new proposals or seek approval for
procurement or contracting on a negotiated
basis.
3.7 Negotiated Procurement
For purchases or proposed contracts of more
than $20,000, competitive bidding may be
waived and procurement may be negotiated
with one particular firm when one or more of
the criteria for waiver has been met and the
Page 106 of 111
106
waiver is approved by the UNDP (see
Attachment 5.2.2 for circumstances under
which competitive bidding may be waived.)
3.8 Justification of Waivers
The Project Manager must prepare and
submit any perceived justification for waiver
along with the Requisition Form or proposed
negotiated contract to the UNDP Resident
Representative.
(iv) over $99,999
Procedures required for procurement in
amounts of $100,000 or more, are the same as
for procedures described for amounts from
$30,000 to $99,999 as described above, with
the following exceptions: 1) recommendations
for awards must be submitted for consideration
by the UNDP HQs Contracts Committee in
New York; and 2) final approval must be
provided by the Chief Procurement Officer in
NY.
Procurement of Vehicles and Computers,
Radio/Security Equipment. Because of the
specific manufacturing characteristics of such
items as vehicles, computers, and various radio
and security equipment, their procurement
must comply with the requirements of IAPSO
or the Division of Administrative Information
Services, details of which are available through
the country office.
What quality assurance mechanisms are
in place to assure that all products
procured and used are safe and effective?
Page 107 of 111
Claims and Disputes. The Project Manager must
promptly notify the NPD and Local Contracts
Committee of any event, which may lead to a dispute
or claim by the executing agency or the contractor.
The LCC will review all claims and advise the
Project Manager of action to be taken in regard to
the disposition of the claim.
Once a list of potential suppliers has been developed,
Supplier capability evaluation takes place. The key
guidelines for Supplier appraisal are as follows:
- technical capacity to deliver the goods and/or
services as per schedule;
- for high valued contract (exceeding USD1
million) and technically complex product, it is
advisable to contact credit rating and reporting
agencies specializing in providing such
investigative services for a fee (company
production facilities reports are furnished);
- evidence of meeting national or international
quality standards for the product offered, or
evidence of national and international
acceptance of its services;
- capacity to provide after-sales-service for the
goods or services provided;
- compliance with UNDP General Terms and
Conditions.
107
What distribution systems exist and how
do they minimize product diversion and
maximize broad and non-interrupted
supply?
To achieve the best distribution system among
suppliers, the process of selecting a supplier should
ensure the following:
- maximize competition;
- minimize the complexity of the solicitation,
evaluation, and the selection decision;
- ensure impartial and comprehensive evaluation
of offerer’s proposal;
- ensure selection of the source whose offer has
the highest degree of realism and whose
performance is expected to best meet UNDP
requirements stated in the solicitation
documents.
40. Describe the existing arrangements for procurement of services (e.g., hiring personnel, contracts,
training programs, etc.), (1–2 paragraphs):
Competitiveness: The recruitment must be made on the basis of a wide search for the most qualified
candidates, and selection of the best-suited individual according to the job description and the program
support document.
Transparency: The recruitment process must be transparent and open, giving full and equal information to all
candidates, with clear criteria for selection, and with the participation of several individuals in the decisionmaking process, for example, through a committee.
Fair Compensation: Compensation will be based on the salary history or market wage rates, whichever is the
best indicator or the values of the skills and experience of the individual being recruited. (In the case of
NPPP, the salary range for national employees of UN country office will be the basis for establishing
compensation).
There are certain contracts that comply with the above:
1) Special Service Agreement (SSA)
The purpose of SSA contracts is to provide expeditious recruitment of skilled individual who can supply
services on a short-term basis, not exceeding 11 months.
2) Service Contract (SC)
The SC is used to hire individuals for activities, which are not part of the central function of the UNDP
work programme. The SC is intended primarily for hiring: a) local personnel on projects (professional
and support functions); b) personnel for activities that are not integral to the work of the office and
normally would be outsourced, but for which outsourcing is not feasible or desirable.
3) Loan Agreement (RLA: reimbursable and non-reimbursable)
RLA does not constitute a contractual arrangement between UNDP and the individual. It is an agreement
between UNDP and another institution, by which that institution makes available the services of an
individual.
4) Model Contract for Professional Consulting Services (Sub-Contract)
This model contract is intended for services (studies, consultancies by firms, etc.) to be obtained from
companies as well as from NGOs, universities, etc. It is not to be used for procuring goods or works.
41. Provide an overview of the additional resources (e.g., infrastructure, human resources) required to
support the procurement and distribution of products and services to be used in this component, (2–3
paragraphs):
The UNDP Country Office in Kyrgyzstan and the Country Coordinating Mechanism will perform Monitoring
and control of the present proposal implementation. To strengthen administrative aspects of the GF Proposal
implementation additional staff will be needed including programme manager, finance and administrative
assistants. This personnel will be selected on a competitive basis and their appointment will be agreed with
the Chair of the Country Coordinating Mechanism. The above-mentioned personnel will be responsible for
day-to-day administration of financial matters and other material resources as well as monitoring of planned
activities execution. It will work in accordance with UNDP procedures and will report to the Global Fund,
UNDP Resident Representative and the CCM Chair. This personnel will closely cooperate with the respective
ministries including the Ministry of Health, Ministry of Education and Culture, Ministry of Internal Affairs as
Page 108 of 111
108
well as nongovernmental organizations and volunteers from the target groups stipulated by this programme.
Main counterparts will be the departments and establishments of the Ministry of Health system: “AIDS”
National Association, Kyrgyz Institute of TB, Department of State Sanitary and Epidemiological Supervision,
Ministry of Education and Culture, Ministry of Defense, Ministry of Internal Affairs establishments, private,
nongovernmental and community-based organizations. The National Narcological Centre and similar oblast
structures being major governmental organizations also work on issues of HIV/AIDS and drug addiction.
In line with the UNDP rules and regulations and jointly with the main counterparts (CCM, governmental and
nongovernmental organizations) organizations for subcontracting will be identified (e.g., for development of
educational programmes, prevention interventions on the basis of peer education, and improving IEC
strategy). Criteria for selection will include work experience on HIV/AIDS, tuberculosis and malaria
prevention. Each organization should prepare a work plan that becomes a basis for its participation in
competitive bidding for grant financing.
The above-mentioned personnel will procure goods and services in accordance with the UNDP rules and
procedures and manage the procedures on preparation of information materials and making contracts to
implement different kinds of services. The personnel will be responsible for consolidation of the work plan,
prepared by each counterpart, financial estimate (forecast) and financial reporting on funds used. An
important aspect of this activity is provision for targeted spending of the Global Fund resources and exclusion
of unjustified costs related to violation of the existing goods and services procurement procedures.
42. Detail in the table below any additional sources from which the applicant plans to obtain products
relevant to this component, whether additional requests have been requested or granted already.
(For each source, indicate a contact person at the program in question, the volume of product in the request
of grant, and the duration of support. Examples of such programmes are the Global TB Drug Facility or
product donations from pharmaceutical manufacturers), (Guidelines para. VIII.88):
Programme name
TB Control in the
Kyrgyz Republic
Tuberculosis 3
Contact
person
telephone
&
information)
Mr. K.B. Mambetov
(996 312) 66 24 14
[email protected]
Ms. Natalia Hilt
(996 312) 22 73 67
66 06 85
[email protected]
Joint UN Agencies
Programme
on
Expanded Response
to HIV/AIDS in the
Kyrgyz Republic
(with
email
Resources requested
(R)
or granted (G)
5 DM mln (G)
30% for drugs
70% for equipment
5 DM mln (R)
USD510 000 (G)
USD 490 000 (R)
Multisectoral
approach
to
HIV/AIDS,
mobilization of NGO
and civil society
Table VIII.42
Timeframe
and
duration
of
request or grant
2002-2004
2004-2006
2002-2004
42.1. Explain how the resources requested from the Global Fund for the products relevant to this
component will be complementary and not duplicative to the additional sources, if any,
described above (1 paragraph):
Page 109 of 111
109
LIST OF ATTACHMENTS
Please note:
The list of attachments is divided into two parts: the first part lists the attachments requested by the Global
Fund as support for Sections III and IV.
The second part is for applicants to list attachments related to other Sections such as the Information on
applicants (Section II), Detailed Budget (Section IV), or other relevant information.
Please note which documents are being included with your proposal by indicating a document number.
General documentation:
1.
2.
3.
4.
Attachment #1
National Poverty Redaction Strategy
KYRGYZ REPUBLIC: NEW HORIZONS. Comprehensive Development
Framework till 2010: National Strategy
Kyrgyzstan: Common Country Assessment
National Human Development Report
1.1
1.2
1.3
1.4
HIV/AIDS specific documentation:
5. The State Programme on the Prevention of AIDS, Infections Transmitted
Sexually and through Injecting Way in the Kyrgyz Republic for 2001-2005
6. Situation Analysis on Measures on Prevention of Sexually Transmitted Diseases
and HIV/AIDS in the Kyrgyz Republic (1997-2000)
7. Response Analysis on Measures on Prevention of Sexually Transmitted
Diseases and HIV/AIDS in the Kyrgyz Republic (1997-2000)
8. Strategic Plan of National Response to the Epidemic of HIV/AIDS in the
Kyrgyz Republic
9. Law “On AIDS Prevention in the Kyrgyz Republic” (Kyrgyz& Russian texts)
10. Decree of President of the Kyrgyz Republic “On Measures of Effective
Safeguarding Basic Human and Citizen’s Rights in the Kyrgyz Republic”
11. Ordinance of President of the Kyrgyz Republic (Kyrgyz &Russian texts)
12. UNODCCP: Rapid Situation Assessment (RSA) on drug abuse in the Central
Asian countries
13. Global Change: Kyrgyzstan’s Response
14. Publications
Attachment #2
2.1
TB specific documentation:
15. Governmental Decree “On National Programme of the Kyrgyz Republic
‘Tuberculosis –II’ for 2001-2005”
16. National Programme of the Kyrgyz Republic ‘Tuberculosis –II’ for 2001-2005
17. Information on TB in the Kyrgyz Republic
18. Regulations on Kyrgyz Research Institute of Tuberculosis of the Ministry of
Health of the Kyrgyz Republic
Attachment #3
3.1
3.2
Page 110 of 111
2.2
2.3
2.4
2.5
2.6
2.7
2.8
3.3
3.4
110
Malaria specific documentation:
19. Targeted Comprehensive Programme “Malaria” for 2001-2005 with plan
(Russian)
20. Order of the Minister of Health on amendments in the Targeted Comprehensive
Programme “Malaria” for 2001-2005 (Russian)
21. Targeted Comprehensive Programme “Malaria” for 2001-2005 (Russian)
22. Malaria in Kyrgyzstan -Situation analysis
General documentation:
23. Minutes of the First Sitting of the Country Coordinating Committee
24. Government Decree “Approval of the Country Coordinating Committee
25. Charter of the Social Foundation “Tais Plus”
26. Charter of the NGO Social Foundation for Social Development and Adaptation
of Man in Society “SOCIUM” (Russian)
27. Charter of the NGO Social Foundation for Protection of Interests of PLWA and
AIDS Patients and Prevention of HIV/AIDS Spread “Koz-Karash” (Russian)
28. Charter of “Almaz” LTD Co. (Russian)
29. Charter of “Pyramid” TV and Radio PLC (Russian)
30. Incorporation Agreement of “AVANCO” LTD Co. (Russian)
31. “Ilim” Educational Facility (Russian)
32. Charter of the Social Foundation “Project HOPE”
32. Procurement Plan form
HIV/AIDS specific documentation: Detailed Budget, Objectives 1-5
Detailed Budget Objective 1 . Strengthening political and legal support to AIDS
prevention programmes based on multisectoral approach
Detailed Budget Objective 2 Reducing vulnerability of young people
Detailed Budget Objective 3.1 Reducing vulnerability of injecting drug use
Detailed Budget Objective 3.2 Reducing vulnerability of sex workers
Detailed Budget Objective 3.3 Reducing vulnerability of prison inmates
Detailed Budget Objective 3.4 Reducing vulnerability of MSM
Detailed Budget Objective 4 Ensuring safety of donors blood
Detailed Budget Objective 5 Provision of medical and social support to people living
with HIV/AIDS and affected by them
Detailed Budget for Section VII – Monitoring and Evaluation Information
TB specific documentation:
Detailed Budget of TB component
Page 111 of 111
Attachment #4
4.1
4.2
4.3
4.4
Attachment #5
5.1.1
5.1.2
5.2.7.1
5.2.7.2
5.2.7.3
5.2.7.4
5.2.7.5
5.2.7.6
5.2.7.7
5.2.7.8
5.2.39.15.2.39.
Attachment #6
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
Attachment #7
7.32
111

Proposal Form (R02 - ) (KGZ-R02-HA)

Transcription

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