1. health and fitness
2. disease
3. aids and hiv

KINGDOM OF CAMBODIA
NATION RELIGION KING
Stakeholders' Consultation
Strategic Plan for HIV/AIDS and STI Prevention and Control
in the Health Sector in Cambodia 2014-2020
on 20-21 October 2014,
at Sunway Hotel
Phnom Penh
MINISTRY OF HEALTH
NATIONAL CENTER FOR HIV/AIDS, DERMATOLOGY AND STD
List of Acronyms
ACM
ANC
AEM
AOCP
ART
ARV
B-CoC
B-CoPCT
BSS
CBOs
CBPCS
CENAT
CNM
CQI
CSV
DPHI
DPs
EES
EW
GF
HC
HEF
HIV
HSS
HTC
IBBSS
IO
IPD
IPT
JANS
KP
LFA
LR
LSM
LTFU
M&E
MoH
MoI
MoLVT
MMT
MSM
MTCT
NAA
NCD
Active Case Management
Antenatal Clinic
Asian Epidemic Modeling
Annual Operational Comprehensive Plan
Antiretroviral Therapy
Antiretroviral
Boosted Continuum of Care
Boosted Continuum of Prevention, Care and Treatment
Behavioral Sentinel Surveillance
Community-Based organization
Community-Based Prevention, Care and Support
Centre National Anti-tuberculeuse
National Center of Malaria
Continuous Quality Improvement
Community Support Volunteers
Department of Planning and Health Information
Development Partners
Entertainment Establishment Services
Entertainment Worker
Global Fund
Health Centre
Health Equity Fund
Human Immunodeficiency Virus
HIV Sentinel Surveillance
HIV Testing and Counseling
Integrated Bio-Behavioural Sentinel Surveys
International Organization
In-Patient Department
Isoniazid Prevention Therapy
Joint Assessment of National Strategies
Key Population
Local Fund Agency
Linked Response
Logistics Supply Management
Lost To Follow Up
Monitoring and Evaluation
Ministry of Health
Ministry of Information
Ministry of Labour and Vocational Training
Methadone Maintenance Therapy
Men who have Sex with Men
Mother-to-Child Transmission [of HIV]
National AIDS Authority
Non-communicable diseases
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NCHADS
NGO
NIPH
NMCHC
NSP
OD
OI
OW
PAC
PASP
PITC
PLHIV
PEP
PMTCT
PNTT
PSM
PWID
PWUD
POC
PrEP
PR
QC
RH
RMAA
RTI
SAPAC
SI
SOP
SRs
SSS
STI
TasP
TB
TWG
UIC
UN
UNAIDS
VCCT
WHO
National Center for HIV/AIDS Dermatology and STD
Non-Governmental Organization
National Institute of Public Health
National Maternal Child Health Centre
Needle Syringe Programme
Operational District
Opportunistic Infection
Outreach worker
Pediatric AIDS Care
Provincial AIDS and STI Program
Peer Initiated HIV Testing and Counseling
People Living with HIV
Post Exposure Prophylaxis
Prevention of Mother-to-Child Transmission [of HIV]
Partner Notification, Testing and Tracking
Procurement Supply Management
People who injection Drug
People who use Drug
Point of Care
Pre-exposure prophylaxis
Principle- Recipients
Quality Control
Referral Hospital
Rapid Monitoring and Analysis for Action
Reproductive Tract Infection
Safe Abortion and Post-Abortion Care
Strategic Information
Standard Operating Procedure
Sub-Recipients
STI Sentinel Surveillance
Sexually Transmitted Infection
Treatment as Prevention
Tuberculosis
Technical Working Group
Unique Identifier Code
United nation
United Nations Joint Programme on AIDS
Voluntary Confidential Counseling and Testing
World Health Organization
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Stakeholders' Consultation
Strategic Plan for HIV/AIDS and STI Prevention and Control
in the Health Sector in Cambodia 2014-2020
on 20-21 October 2014,
at Sunway Hotel
Phnom Penh
*********
I.
Introduction:
The draft Strategic Plan for HIV/AIDS and STI Prevention and Control in the Health Sector
in Cambodia (2014-2020) was developed by NCHADS and key stakeholders through a great
many TWG meetings. This strategic plan will establish a comprehensive foundation for
achieving the Cambodia 3.0 Initiative – elimination of new infections by 2020. In addition, it
will support the development of the Concept Note for the Global Fund (GF) to be submitted
by 15th January 2015. To achieve elimination, and given the serious financial constraints
related to the recent reduction of GF funding to Cambodia’s HIV program, the National HIV
Health Sector Strategic Plan requires rigorous prioritization, streamlining, and integration,
which would provide useful lessons for other countries. To ensure a fully participatory
process for such prioritization and streamlining, NCHADS organized a National Consultation
on the draft strategic Plan with the key stakeholders and key populations.
On 20-21 October, the two-day consultation workshop was held at Sunway Hotel, hosted by
NCHADS and partners with technical and financial support from WHO Cambodia. Around
150 participants joined the consultation: representatives of development partners,
stakeholders, key populations, relevant Ministries such as Ministry of Planning, National
Authority Combatting Droug (NACD), National AIDS Authority (NAA), National Centres and
Departments of Ministry of Health, such as NMCHC, CNM, CENAT, DPHI, Preventive
Medicine, Department of Hospital, NIPH, National Hospital and Provincial Health
Departments of Battambang, Siem Reap and Phnom Penh. The list of participants, agenda
and results of group discussions of the consultation workshop are included as Annexes.
II.
Objectives of the consultation:
The stakeholder’s consultation workshop aimed:
1. To share the vision for 2015-2020 with all stakeholders
2. To review the evidence that underpins the Strategic Plan
3. To discuss key strategic issues such as prioritisation, streamlining, and the long-term
view of the future post-2020
4. To familiarise stakeholders with the contents of the Strategic Plan
5. To get input from stakeholders into the Strategic Plan
6. To conduct a JANS assessment of the Strategic Plan
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III.
Process of the consultation:
Day I:
Opening Ceremony:
Welcome remarks were given during the opening ceremony by: Dr. Oum Sopheap
(Executive Director of KHANA), Dr. Fujita Masami (Team Leader HIV-TB of WHO
Cambodia) Dr. Perry Killam (US-CDC), Ms Michelle Lang-Alli (USAID), and HE. Dr.
Mean Chhi Vun, Director of NCHADS.
The key notes addresses during the opening were highlighted as following:
Dr. Oum Sopheap stressed on the success that has made Cambodia proud in the
fight against HIV/AIDS in which the prevalence rate has kept falling, and high
coverage of ART for PLHIV reached. By doing the right way for 20 years, the
experiences and lesson learned from our implementations, and our effort, we will
able to achieve HIV elimination by 2020. He also added that, with the decline of
external resources due to the world facing new challenges including financial crisis,
new public health issues etc, so, we need to focus on “doing more, and better, with
less” by continuing to improve the sustainable partnerships, collaboration and
integration of services to reach our goals.
“We need to sustain human resources, to improve the quality of services because of
increasing of PLHIV in care services, even with decline of new HIV transmission” said
Dr. Perry.
“We should focus the HIV/AIDS response by priority interventions (Focus, Focus,
Focus), streamline activities, and integration. If we want to go fast, we should go
alone, but if we want to go far, we should go together. It means that we need to
work together.” Said Dr. Fujita.
Finally, HE. Dr. Mean Chhi Vun, opened the consultation workshop by welcoming
participants. He thanked the WHO, development partners, civil society, NCHADS’s
colleague for their contributions to this strategic plan. The development of this
strategic plan took around 1 year -starting with assessment, collection of data and
information; and drafting with small groups, medium sized groups, and large groups.
All aimed to make this plan properly comprehensive so it can be smoothly
implemented.
“Now, the world has changed the target of HIV elimination from 2020 to 2030;
however, Cambodia has not changed – we stick to 2020. Our elimination does not
mean Zero HIV, but less or equal to 300 new infections per year. ”said Dr. Mean Chhi
Vun.
The two-day workshop was organized in plenary and break-out parallel sessions and group
discussion to cover the six objectives above.
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Session 1: The Panel Discussion on the vision of Strategic Plan 2014-2020:
The Guests who were invited to share their views of the vision were Dr. Mean Chhi
Vun, Dr. Perry, as a representative of development partners, and Mr. Sorn
Sothearidh, as a representative of PLHIVs and Key Population networks (EWs, MSM,
TG and IDU).
“The vision of this strategic plan is not for NCHADS alone, but it is a health sector
vision, andthat of stakeholders who are involved in HIV/AIDS programme as well.”
said by Drs. Vun and Perry.
Mr. Sothearidh highlighted the need to focus interventions to the migrant MARPs
especially for EWs as we know that only 70% use condom, and for 30% who did not
use, can transmit to others. Family Planning among this group is important. For Care
and Treatment, we have increased the targets for viral load and CD4 count to >95%,
if we can reach these targets, it will improve the quality of care services.
The key points addressed by all panelists during discussion were:
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Prioritization (Focus, Focus, Focus ): it means that we need to prioritize on
high burden of location, high risk of key population, and greatest need of key
population.
Streamlining
Mainstreaming
Integration
Decentralization
Strong leadership and partnership
Community participation and engagement
Efficiency
Sustainability by integrate as a primary health care in the existing system by
using the Commune Committee, Village Health Support Group etc...
HIV/AIDS will be no longer a public health problem in Cambodia by 2020
(virtual elimination.
Session 2: Presentation of AEM analysis and its implications, by Dr. Saleem (UNAIDS):
Key points addressed:
• Prioritization and focused approach for more impact with less investment
• Adopt cost-efficient/integrated service delivery models where possible for long term
sustainability
• Sustain prevention services among KP: consistent condom use among sex
workers/MSM, and safe injecting practices among PWID
• Treatment costs will further increase with more people on ART; access to generic
drug requires legislation to avoid TRIPS related restrictions.
• Track Bio-Behavioural trends among KP regularly - better do it simultaneously for all
KPs for cost-efficiency and monitoring trends.
• Address data gaps- size estimation- EW/PWID, Bio data - EW and MSM
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Session 3: Presentation on the prioritization of strategies and interventions to get more
cost-efficient intervention for the strategic plan, by Dr. Fujita (WHO), and Mr. Chamroeun
and Dr. Khimuy from KHANA.
Key points addressed by Dr Fujita:
• To achieve more impact with less funding, we should focus, streamline and integrate
the interventions.
• For example, based on the AEM Scenario on EWs, if we classify EWs based on their
risk (EWs who have >7 clients per week and ≤ 7 clients per week) and location, with
the different interventions for these groups such as minimize services to lower risk,
and a more integrated approach, we can reduce the cost for prevention a lot.
• Based on 2014 GIS Mapping, among total estimated of 34,000 EWs, there were
24,500 (72%) of EWs in 11 ODs, some EWs in 21 ODs and only few EWs in another 50
ODs.
• Suggest for next steps:
• Draft criteria for choosing higher risk venues, overlapping risk
• Collect venue data
• Validate and adjust the venue criteria using individual risk information from
each venue
• Use the unique identifier code (UIC) to avoid the overlap interventions
• Implement the Focused & Streamlined model
• Monitor and evaluate the model
The KHANA representative presented the new, more prioritized approach for key
population groups (EWs, MSM, TG, PWUD and PWID) and highlighted the Streamline
of CBPCS Model.
Session 4: Group Discussion of the draft strategic plan
For the whole afternoon session of day 1, the participants were divided in to 6
groups for discussions on completeness, roles and responsibilities, and prioritization,
for each component of the draft strategic plan.
• Completeness: Is the component complete – strategies, activities, etc? Are
any things missing? Is anything unclear or ambiguous?
• Roles and responsibility: what are the roles and responsibilities of various
stakeholders with respect to this component?
• Prioritization: how will we prioritize within this component?
Day II:
Session 5: Presentation of Group Discussion
The representatives of each group were asked to present the result of Group
Discussion. These are in Annex 3.
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Session 6: Group work with JANS tool
The participants were divided into 4 groups to use Joint Assessment of National
Strategies (JANS) tool to assess the strengths and weaknesses of the draft strategic
plan. The tool identifies 5 aspects of a strategic plan to assess and 16 Attributes of a
good strategy across the 5 aspects, and 44 Characteristics of these Attributes. The
groups were asked to assess the current strategy against each of the attributes, by
scoring from 1 (weak) to 5 (very strong). They were asked to use the characteristics
to explore the attributes. For score at 3 or below, they were to indicate or comment
what is required to raise the score.
1. Group 1: Situation Analysis and Programming
2. Group 2: Process
3. Costs and Budget framework - excluded since the draft strategic plan has not
been costed yet
4. Group 3: Implementation and Management
5. Group 4: Monitoring, Evaluation & Review
The overall score of 14 attributes were ranked from 2.75 to 5, as shown in the graph
below. The table of detailed scores and comments is attached at Annex 4.
The graph 1: Score of Attributes of JANS’s tool
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Session 7: General Discussion
The floor discussion was opened for questions, comments, recommendations and
suggestions from the participants. A number of issues were raised. In summary:
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In this strategic plan, NCHADS focuses only on the out-patients, but does not
focus on in-patients. Most of the patients are poor and have no family or
relatives, which makes it difficult for health care providers at that service. The
health equity fund is not easy to access – it require a lot of documents, and
one case is only for 80,000 Riel, whether the patient is hospitalized for 2 days
or 2 months. So, NCHADS should coordinate and collaborate with some NGOs
that can help on these issues.
Should include the nutrition package for in-patient PLHIV, as a poor diet
causes PLHAs to quickly deteriorate, and die; with was not of no ART or other
medicine anymore.
Should focus on staff motivation.
Overall gaps in this strategic plan including:
No costing; should add Health Financing Component included SOA, HEF,
User fee, contribution of Donors, Stakeholders, and National Budget
etc...
No exit plan
Some terminology still not updated
Indicators for HSS have only Pre-ART and ART , but not linked to the
MoH system
Should reflect some recommendation from Health Sector Review
Program in 2013 into this plan.
No mention on the capacity building to CBOs, because there is still need
for capacity building on Grant Management, Monitoring etc.., when we
switch from NGOs to CBOs; yet capacity building was a sensitive point
for donors.
What are model interventions for Human Rights and Legal Rights of key
populations? Should specify in this plan or in SOP? Or by NAA?
What are the needs from HEF for PLHIV? Should detail.
Care is free for PLHIV, including ARV, OI, HIV testing, CD4, Viral load, and STI
care for key populations. The needed support from HEF includes
transportation, blood transmission, hospitalization and some services related,
eg. Liver function test...
Need to strengthen the coordination between Health Equity Fund Operators
(HEFO) with Health services, because some HEFO still misunderstand the new
guidelines of HEF.
HEF is still unclear for implementers and receivers, so suggest to have the
orientation workshop on HEF.
Suggestion to have ID poor for PLHIV and MARPs especially for those who are
mobile from home.
Because we need inputs from Key Populations, should have documents
translated, and speak in Khmer with simple words during the meeting or
group discussion.
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Session 8: Panel Discussion on moving towards the future – post 2020
The panelist in this session included Dr. Oum Sopheap (Executive Director of KHANA), Dr.
Prak Piseth Raingsey (Director of Department of Preventive Medicine), Dr. Sok Kanha
(Deputy Director DPHI), Dr. Khol Khemrary (DPHI), and HE. Dr. Mean Chhi Vun, Director of
NCHADS. The panelists were offered 5 questions to stimulate their discussion; they could
answer any, or all, or none if they had better questions to answer.
•
•
•
•
•
How to get SI, LMS and labs integrated into MoH systems?
Can the CoC become part of chronic care systems?
The role of HEF in the HIV programmme?
What is a National Programme for HIV when incidence is eliminated?
How does HBC become part of MoH community approaches?
Dr. Oum Sopheap raised the point that we should adapt and integrate the lessons learned
and experience gained from the HIV/AIDS program to the existing system. These include the
importance of awareness and behavior change in the community, and linked coordination
and collaboration between partners and services. This will be important for noncommunicable diseases (NCD) which till now have only had limited attention and response.
In moving towards the post-2020, Dr. Piseth Raing Sey stressed the need to integrate the
HIV/AIDS activities into existing systems, starting from now; including outreach and health
services at the community, to ensure continued service after no more funds from donors.
Dr. Sok Kanha talked about the long-term vision of health financing under Universal Health
Coverage. She talked about the importance of reducing transaction costs, harmonizing, and
avoiding fragmentation of schemes. She described the efforts to extend and expand the
health equity funding (HEF), and the need to ensure these cover PLHIV. She also discussed
the introduction of health insurance and financial protection schemes.
Dr. Khol Khemrary, suggested to start integration of the health information system, by
linking the database of the HIV programme to the MoH database, and with other related
programmes. MoH has been developing the Patient Medical Record, starting in 10 RHs.
When this code is finalized, it will be easy for the integration of patient monitoring. She also
added, the indicators of the HIV/AIDS programme are still important, especially for
treatment and care, even with the elimination of new HIV transmission.
Dr. Mean Chhi Vun, thanked all panelists for raising all these key points that we need to
address, such as linkages, integration and decentralization. He noted that NCHADS had
started integration and linked some activities and services with other national programmes
since 2002:
•
•
NMCHC for reproductive health,
CNAT for screening TB among PLHIV, and HIV testing among TB patients and then
with Malaria.
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•
•
•
•
IV.
In 2007, we integrated HIV/AIDS laboratory into the laboratory of RH; up to now 17
labs have been integrated.
Pediatric AIDS care into the Pediatric services
Improved the quality of services by reviewing the data through CQI activities.
Community integration, and community based support important for the chronic
patients, including AIDS patients
Conclusion:
Finally, the workshop was closed by the Director of NCHADS, with extended his warmest
gratitude to all of the participants for their clear dedication and invaluable contribution to
the strategic plan development and ongoing work on the forthcoming concept note
development.
V.
Next steps:
•
•
•
•
•
NCHADS will incorporate inputs from stakeholders to come up with a revised draft
strategy plan by next week
NCHADS will circulate the final draft of strategic plan to stakeholders for comment.
The draft revised of the strategic plan will be used for :
– Costing exercise which will start from 23 October 2014
– Developing the concept note for submission to GF.
The final version of the Strategic Plan will then be submitted for approval to the
Ministry of Health. Following approval it will be submitted to the Council of Ministers
of the Government of Cambodia for the highest level endorsement.
NAA will be requested to incorporate of Health Sector Strategic Plan for HIV as a part
of National Strategic Plan IV.
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