BOTSWANA RED CROSS SOCIETY

INTEGRATED HIV and AIDS PROGRAMME 2006 - 2010

November 2006

Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

EXECUTIVE SUMMARY

Botswana Red Cross Society (BRCS) works in 2006-2010. The HIV and AIDS programme is an auxiliary role to government of Botswana, in part of the Southern Africa Regional HIV and the implementation of humanitarian activities. AIDS programme which is a component of the The HIV and AIDS programme is implemented International Federation Global HIV and AIDS in line with the government framework and Alliance. The Southern Africa: Regional HIV policies on HIV and AIDS. In 1988, BRCS and AIDS Programme Appeal number established an HIV and AIDS counselling (MAA63003) was launched on 1 November programme for blood donors, and later on 2006. The International Federation is scaling-up established the first HIV and AIDS Voluntary its response to HIV and is committed to Counselling and Testing Centre (VCT) in reducing vulnerability to HIV and its impact Gaborone. The National Society’s peer through: education in schools has so far reached 40,000 · Preventing further infections; youth in over 30 schools. BRCS is running a · Expanding care, treatment, and support; home-based care (HBC) projects in · Reducing stigma and discrimination. Kasane/Kazungula of Chobe district and at Dukwi refugee camp. However, BRCS is In order to achieve these three outputs, the phasing out of the HBC activities, except in National Society’s capacity will be strengthened Dukwi refugee camp because the government to enable effective, expanded, direct outreach to has established a similar HBC programmes in under-served communities. This programme will most parts of the country. However, the National target 700,000 people (youth, women, general Society is actively involved in monitoring population, high-risk groups and HBC clients) in adherence to ART and tuberculosis (TB) direct all the project areas with HIV prevention observation treatment strategy (DOTS) at interventions, 250 PLHIV in Dukwi refugee household level. BRCS runs 11 day care centres camp and 12,000 OVC in 12 project sites by for pre-school children and a mentoring 2010. programme for orphans and vulnerable children (OVC). The Integrated HIV and AIDS programme seeks CHF 16,366,503 towards a total budget of BRCS is planning to scale up its response under CHF 17,225,948 for the five-year the new Integrated HIV and AIDS Programme implementation period (2006 – 2010)

2 1. Background

Botswana has an estimated total population of 1,765,000 of which 49% is residing in urban areas. Botswana has transformed itself from one of the poorest countries in the world to a middle-income country with a per capita gross domestic product (GDP) of USD 8,920, but ironically 50.1% of its population lives on less than USD 2 per day. The country also has a high unemployment rate of 21%, but unofficial estimates place it closer to 40%. The high levels of HIV infection rates threaten Botswana's impressive economic gains. Life expectancy has dropped from 65 years in 1990-1995 to 40 years in 2005- a figure of 28 years less than it would have been without AIDS (United Nation population division)

1.1. HIV situation Botswana’s pandemic is showing no signs of decline yet. In 2005, the national adult HIV prevalence was estimated at 24.1% (23.0% to 32%) with 1,765,000 people estimated to be living with HIV. Among pregnant women attending antenatal clinics, in 2004, HIV prevalence was 24% and close to 50% among those aged 30-34 years. HIV prevalence among pregnant women seems to be stabilizing at between 34% and 37% since 2001. According to Joint United Nations Programme on AIDS (UNAIDS), 270,000 people were living with HIV in 2005, of which 260,000 were adults aged 15 years and over. Women account for 54% of all the adults aged 15 years and over living with HIV (see table below).

Botswana, which used to have one of the lowest child mortality rates in Sub-Saharan Africa, has seen an increase in the children under five years’ mortality rates, from 63 deaths per 1,000 in 1990-1995 to 104 deaths per 1,000 births in 2003. The number of OVC is increasing and this is largely attributed to HIV and AIDS. There were 120,000 children orphaned due to AIDS in 2005, accounting for almost 7% of the total population. Marked increases of about 2.5 times in pulmonary tuberculosis (TB) notification rates have been observed and 60% the TB patients are HIV infected.

Table 1: Statistics on HIV and AIDS as at the end of 2005 in Botswana

Number of people living with HIV 270,000 Adult (aged 15-49 years) HIV prevalence rate 24.1% Adults aged 15 years and over living with HIV 260,000 Women aged 15 years and over living with HIV 140,000 Children aged 0-14 years living with HIV 14,000 Deaths to AIDS (children and adults) 18,000 Orphans (0-17 years) due to AIDS 120,000 Percentage of women (15-24 years) who correctly identify ways to prevent HIV infection 40% Percentage of men (15-24 years) who correctly identify ways to prevent HIV infection 33% Percentage of women aged 15-24 years reporting use of a condom at last sex with a non- 75% regular partner ‘casual sex’ Percentage of men aged 15-24 years reporting use of a condom at last sex with a non- 88% regular partner ‘casual sex’ Percentage of HIV infected women and men receiving antiretroviral therapy 85% Source: UNAIDS 2006 Report on the global AIDS pandemic 1.2. Determinants of the pandemic The pandemic in Botswana is fuelled by several factors such as the mobility of the population, poverty, gender inequalities and rapid urbanization. The Batswana are highly mobile people as they travel regularly between their cattle posts, lands where they plough, and their homes in villages or towns. Many

Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

Botswana also travel widely in the southern Africa region. Separation of spouses is influencing the spread of HIV as it increases the temptation to engage in high-risk behaviour. Poverty is a key determinant of HIV transmission. Poor women and vulnerable children such as orphans are forced into sex work or transactional sex as a means of survival. Poverty is also causing many Batswana to move to urban areas to look for work. Unfortunately, the traditional mechanisms, which are often used in rural villages, for controlling social and sexual behaviour, are not always observed in urban settings. Lack of parental or societal supervision in urban areas increases the chances of engaging in high risk sexual behaviour and vulnerability to HIV infection.

Ignorance of HIV prevention methods, especially among young people aged 15-24 years makes people vulnerable to transmission of HIV. In contrast, however, a large percentage of young people aged 15-24 years reported using a condom at last casual sex (75% for women, and 88% for men-UNAIDS Global report on AIDS, 2006).

Gender inequalities arising from socio-cultural factors make women vulnerable to HIV infection. Culturally, women are expected to be submissive to their husbands. In Botswana, marital rape is not legally considered to be a crime, and some women are forced into sexual relations by dominant males, or by economic desperation. This exposes them to the risk of HIV transmission. In addition, women are unable to negotiate for safer sex, even when they know they are putting themselves at risk of HIV infection because they fear being thrown out of homes, as many of them are economically dependant on men.

1.3. The impact of the pandemic The AIDS pandemic has increased adult mortality in Botswana. Crude death rates have risen from 301 per 100,000 people in 1995 to 486 per 100,000 people in 2000 (Botswana surveillance report, 2003). Life expectancy has dropped from 65 years in 1990-1995 to 40 years. Botswana, which used to have one of the lowest child mortality rates in Sub-Saharan Africa, has seen an increase in the under-5 mortality rates, from 63 deaths per 1000 in 1990-1995 to 104 deaths per 1000 births in 2003 (WHO/ AFRO Epi 2005 update). The number of orphans in the country is increasing and this is mainly attributed to HIV and AIDS. There were 120,000 orphans due to AIDS in 2005, accounting for almost 7% of the total population. Most of these orphans are being cared for by elderly grandparents, who are often frail and poor. Some of the orphans have to care for their young siblings, or work to support their families.

AIDS is having a devastating impact on households, particularly among the poorest people as they lose productive members of their households. AIDS increases household expenditures on medical care, in instances where there is a family member who is chronically ill. Other expenses include burials and memorial services. Households affected by AIDS are usually diverted from growing crops, which need intense labour, to less labour intensive crops. This has an impact on the income and food production of the family. The public health sector is increasingly being overwhelmed as it struggles to cope with providing health care to patients with HIV and AIDS related illness. Marked increases in pulmonary tuberculosis notification rates have been observed in the country. This increased by 2.5 times from 1990 to 2001 (WHO/AFRO Epi, Sept 2003). A study conducted in the country showed that among 2,425 TB patients, 60% were HIV infected.

The situation in the public sector is made worse by deaths of health care providers, absenteeism caused by illnesses, and retirement of some on medical grounds. The pandemic also affects other sectors. A good number of children who lose their parents, drop out of school due to lack of school fees or they have to take care of a sick family member. HIV and AIDS pandemic are affecting the educational systems as some of the teachers are dying from AIDS-related illnesses.

Botswana is naturally a dry country and like most of the countries in southern Africa has experienced a series of droughts. Food insecurity may make people, especially women; engage in sex work or transactional sex as a means of earning money to procure food. Thus, food insecurity increases the vulnerability of people to HIV infection.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

1.4. National HIV and AIDS Response The Government of Botswana is implementing a multi-sectoral national HIV and AIDS response involving government, bilateral and multilateral agencies, private sector, associations of PLHIV, non- governmental organization (NGOs) and other civil society organizations. The country has developed and implemented a series of national HIV and AIDS plans. The Botswana government after realizing the catastrophic magnitude of the pandemic, put in place a national HBC programme, whereby every clinic or health post identified and trained ten HBC volunteers, who follow up patients at home and educate communities about HIV and AIDS, and other related issues in their homes. The volunteers are monitored by family welfare educators, who are based at the health centres.

In 1999; a Short Term Plan of Action for the care of OVC was adopted to provide material support. The implementation of this plan is currently being evaluated and currently, Botswana has no national plan on OVC. PPTCT and VCT are offered in all clinics nationwide. In 2005, 85% of all the men and living with HIV in Botswana were receiving ARVs. A new National Strategic Framework (NSF) has been developed and one of its priorities is prevention of HIV Infection, mainly aimed at increasing the number of persons within the sexually active population; especially those aged 15 – 24 years to adopt safer sexual behaviours by 2009.

2.0. Botswana Red Cross Society: Track Record and Lessons Learned

After the adoption of the Strategy 2010 at the Federation General Assembly in 1999, the International Federation Africa team developed an African Red Cross and Red Crescent Health Initiative (ARCHI 2010) to implement ten public health priorities on the Africa continent aiming at reducing the mortality by 5% in 2010. All African National Societies including Malawi signed the Ouagadougou Declaration during the 5th Pan African Conference in September 2000 engaging all societies to focus on health and care issues, particularly HIV and AIDS, food security and volunteer management. Four years later in September 2004, at the 6th Pan African Conference, African Red Cross Societies reiterated this commitment and priorities in the Algiers Plan of Action.

As a response to these commitments, BRCS scaled-up its HIV and AIDS response in the areas of education for prevention of HIV and AIDS, reproductive health including sexually transmitted infections (STIs) and other communicable diseases, ART, counselling for adherence to treatment, support for OVC and advocacy for access to services and for the rights of PLHIV, OVC and vulnerable people infected and affected by HIV and AIDS. This was in addition to its HIV and AIDS counselling programme for blood donors that it had initiated in 1988. In 1992, BRCS established the first VCT centre in Gaborone; this was handed over to government and Botswana United States of America Project (BOTUSA) in 2000.

BRCS is conducting youth peer education (YPE) activities in Kanye, Tonota, Dukwi and Moshupa. There are a total of 124 trained peer educators, currently reaching over 40,000 youths in schools. In Moshupa and Kanye alone, the YPE initiative covers over 32 schools. The National Society has a HBC project in Kasane/Kazungula in Chobe district, with 15 care facilitators, providing care and support services to 94 clients. Most of these clients are on ARVs, which is part of the cross border project that included Zambia (Sesheke district), Namibia (Caprivi region) and Zimbabwe (Victoria Falls district). They are also running a HBC project in Dukwi Refugee Camp. BRCS has made a conscious decision to phase out the HBC project in Kasane and avoid duplication of services since the government has established strong HBC programme in most parts of the country. However the National Society continues with monitoring adherence to ART at household level.

BRCS runs 11 day care centres for pre-school children and two are for children with mental disabilities. Some of the new OVC projects will be strongly linked to the existing day care centres, using the same facilities. In addition, 120 OVC are being provided with psychological and emotional support. The National Society also has a mentoring programme for OVC and so far 20 children are participating in the initiative, which is being implemented within the HBC context.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

An OVC situation analysis was conducted in Kasane/Kazungula, Kanye and Moshupa which will form the basis for establishing new holistic OVC support initiatives. A project proposal is being written to mobilise resources for OVC care and support. The BRCS conducts anti-stigma campaigns to promote the rights and dignity of PLHIV and OVC. The activities are mainly carried out during the World Red Cross Day, World AIDS Day and AIDS Fairs.

2.1. Comparative advantages of SARCS BRCS has a network of volunteers throughout the country in 24 divisions. Though not all the divisions are yet active, plans are there to revive them through the capacity building interventions with support from the Danish Red Cross, and the Federation Secretariat. The government of Botswana supports the National Society in many activities and it is on this basis that the National Society is confident that it would receive good support from the government during implementation of the new integrated HIV and AIDS programme 2006-2010. BRCS has had experience in implementation of prevention activities though targeting youths in Kanye, Moshupa and Tonota.

2.2. Impact of the HIV and AIDS programme Discussions with children in the mentoring programme have revealed that the programme is beginning to transform their lives. The children said that they were feeling more secure, loved and care for. Discussions with the HBC clients who have received psychological support, referral services and support in ARV drug adherence, report that these measures are contributing to improvement in their quality of life.

2.3. Lessons learned · HBC activities are not a priority for the BRCS since the government is implementing a comprehensive HBC project throughout the country · With the introduction of ARVs by the government, most of the HBC clients are mobile and active again, thus the need for provision of care is significantly reduced. · The major role for the Red Cross volunteers is monitoring adherence, treatment preparedness and education for clients and communities. · The National Society recognizes that HIV prevention, care and support for OVC are the areas on which they should focus their interventions · Revival of Red Cross divisions and branches is critical to the success of any National Society programme as programmes should be implemented and directed at branch level.

2.4. Challenges · Volunteer retention has posed a major challenge to the programme as many of BRCS project volunteers are young and leave for further studies. · Botswana is an expensive country; therefore budget lines sometimes are not sufficient to cover the real costs, especially overheads. · Unsuccessful resource mobilization, particularly to support infrastructure. BRCS buildings at division level need expansion and /or refurbishment. · Skills in establishing, and increasing partnerships at all levels need strengthening. · Skills in proposal writing, planning, and management of projects, monitoring and reporting all require strengthening. · Previous course content to prepare volunteers for the work did not include information on other common diseases such as TB, malaria and on interventions like ART, PPTCT, OVC, and VCT. Yet BRCS volunteers are now faced with these issues and situations that require them to understand them and respond appropriately.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

· The large number of OVC is another challenge. OVC not only need material support, counselling and education, they also need role models or parental figures to guide them. Grandparents are overwhelmed by the responsibility of looking after orphaned grandchildren. The government does not have the capacity to handle this challenge. Thus it requires the concerted effort of a variety of stakeholders including the Botswana Red Cross to ensure a holistic approach to OVC support.

2.5. Recommendation Based on the impact of the programme, lessons learnt and challenges, the following recommendations have been made-: · BRCS will consolidate and strengthen new partnerships with a hope of mobilizing more resources for its response and also providing care and support for the increasing numbers of OVC. · BRCS shall ensure that the retraining of old volunteers and training of new volunteers and staff on ART, PPTCT, VCT, OVC care and support, malaria, TB, sexual reproductive health and other related issues, in addition to HIV and AIDS. · BRCS shall endeavour to revive and establish new branches. · BRCS will scale up its HIV prevention activities, monitoring adherence, treatment preparedness and education for clients and communities, and OVC care and support and have less focus on home based care (except in Dukwi refugee camp), as other areas are well catered for by Government.

3.0 The New HIV and AIDS Programme 2006-2010

This new Integrated HIV and AIDS programme 2006-2010 is part of the Southern Africa Regional HIV and AIDS Programme, which is a component of the International Federation Global HIV and AIDS Alliance. The activities under this programme are within the context of the country’s national HIV and AIDS policies and programmes and will be in line with the Fundamental Principles of the International Red Cross and Red Crescent Movement. Specific scope of the activities in the programme has been developed based on the National Strategic Plan and harmonised with tasks agreed under the international assistance arrangements in Botswana including UNAIDS, and other United Nations agencies, NGOs and civil society groups, and donors.

The purpose of the HIV and AIDS Programme 2006-2010 is to reduce vulnerability to HIV and its impact in Botswana through achieving the following outputs: · Prevention of HIV infection · Expansion of care, treatment, and support · Reduction of stigma and discrimination

These will be bolstered by a fourth output: · The National Society’s capacity is strengthened to enable effective, expanded, direct outreach to underserved communities.

The new HIV and AIDS programme 2006 to 2010 will target all the communities and HBC clients in all the project areas, 250 PLHIV in Dukwi refugee camp and 12,000 OVC in 12 project sites by 2010.

Output 1: HIV infections are prevented among 700,000 people in the project sites by 2010.

Strategy 1: Promote safer sexual behaviours among the general population, youth and high-risk groups using targeted culturally and sensitive information, education and communication (IEC) on HIV and AIDS, peer education and mass media approaches.

Activities · Conducting baseline and end of programme Knowledge, Attitude, Behaviour and Practice (KABP) surveys.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

· Conducting targeted community mobilisation on HIV and AIDS, sexual reproductive health, gender issues, TB, malaria, hygiene and other related issues using drama, role and plays in all the project areas through talks, radio, television, drama and print media. · Engaging people in one-on-one dialogues (general population, chiefs, traditional leaders, youth, parents) to debate, educate and share information on HIV and AIDS, safer sexual behaviour, sexual reproductive health, gender issues, TB, malaria, hygiene and other related issues using drama, role and plays in all the project areas. · Training at least 500 youth peer educators in each of the project areas over a period of five years. · Supporting trained youth peer educators to carry out peer education among their peers. · Training school-going youth and school leavers. · Producing and distributing targeted culturally sensitive IEC materials. · Training all community mobilisation volunteers on HIV prevention, YPE, sexual reproductive health, life skills gender, gender-based violence, TB, malaria, first aid and other health issues.

Strategy 2: Improve condom promotion, provision and distribution in all the project areas

Activities · Training volunteers on promotion of correct and consistent use of condoms, condom distribution (male and female). · Establishing 60 condom distribution networks and outlets in all the project areas · Conducting community sensitisation seminars on correct and consistent use of condoms using the trained volunteers

Strategy 3: Promote increased uptake of VCT, PPTCT and ART services among the general population, youth and high-risk groups using peer-to-peer information and community mobilization approaches.

Activities · Training all community mobilisation volunteers and staff on VCT, ART and PPTCT. · Sensitizing and mobilising communities and HBC clients to utilize VCT, PPTCT and ART services. · Encouraging the formation of buddy, trios and groups for ART adherence and DOTS support including sexual reproductive health, TB control services including malaria control programmes. · Developing and supporting drama, radio, television programmes and educational materials informing people about VCT, PPTCT, ART and other related services.

Output 2: Care, treatment and support are expanded and reached 250 PLHIV in the refugee camp and 12,000 OVC by 2010.

Strategy 1: Provide care, treatment and support through HBC approach

Activities · Conducting end of programme surveys on care and support in all in Kasane and Dukwi refugee Camp. · Conducting community mobilization and awareness sessions on ART, DOTS, and malaria treatment including adherence treatment. · Training 20 care facilitators to provide HBC for PLHIV in Dukwi camp. · Supporting the trained care facilitators to conduct home visits to HBC clients in Dukwi refugee camp · Procuring HBC kits and other supplies for HBC in Dukwi camp. · Training all volunteers on ART literacy, DOTS, monitoring of adherence to treatment protocol.

Strategy 2: Provide material assistance including school materials and psychosocial – economic support to OVC.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

Activities · Conducting 15 situation analyses on OVC in new project areas and where there are existing day care centres (three in 2006, five in 2007, five in 2008 and two in 2009). · Training 320 volunteers in OVC support. · Establishing 15 OVC care and support projects by 2010. · Conducting consultative meetings with Social and Community Development department on a regular basis regarding criteria for selection of OVC and to discuss other related issues (four consultative meetings for North, Central, South and West regions). · Establishing mentoring programmes (one training per year per site i.e. three in 2006, five in 2007, five in 2008 and two in 2009) · Holding 15 life skills camps (one per year per site i.e. three in 2006, five in 2007, five in 2008 and two in 2009. · Conducting 15 Memory1 and Hero work training (three in 2006, five in 2007, five in 2008 and two in 2009). · Establishing children clubs/OVC support groups at least three per project area. · Providing education support materials to OVC (three times per year) · Providing material support to OVC not covered under the government programme, to be established after the situational analysis. · Establishing 15“grannies clubs” and provide guardians with HIV and AIDS education, material and psychological support. · Conducting 15 grannies workshops (three in 2006, eight in 2007, 13 in 2008 and 15 in 2009) on HIV and AIDS issues, care and support of OVC.

Output 3: Stigma and discrimination associated with HIV and AIDS reduced

Strategy 1: Intensify awareness on the rights of PLHIV, children, OVC and women in the area of HIV and AIDS

Activities · Conducting anti-stigma campaigns at community level, including education talks on the rights of PLHIV, OVC, children and women. · Supporting the production of radio/television programmes, drama and print media on anti-stigma and discrimination messages and the rights of PLHIV, children. OVC and women. · Integrating messages on the rights of PLHIV, OVC, children and women, anti-stigma and discrimination into the World AIDS Day, TB day and other national and district events. · Training volunteers on the rights of PLHIV, OVC, children and women.

Output 4: Capacity strengthened to enable more effective, expanded, direct outreach to served communities

Strategy 1: Strengthen staff and volunteer management systems

Activities · Reviewing and implement volunteer management and human resources policies. · Developing and/or implementing guidelines on volunteer management and branch development. · Conducting volunteer mobilisation and recruitment in all project areas.

1 Memory Box - is one of the Red Cross initiatives to help mothers and fathers, powerless in the face of death due to HIV and AIDS, to communicate with their children by making a treasure chest of information such as family, photographs, letters, stories and history. The memory box also serves as an important vehicle in the AIDS education battle, by allowing people to talk openly about the disease

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

· Recruiting and retaining appropriately skilled staff in project areas and National Society headquarters. · Training all staff and volunteers in branches on Red Cross Red Crescent Fundamental Principles and humanitarian values.

Strategy 2: Strengthen the capacity of staff and volunteers to plan, implement, monitor and evaluate HIV and AIDS activities and programmes

Activities · Train staff and volunteers in project planning, implementation, monitoring, evaluation and reporting. · Developing checklists, monitoring tools and reporting formats for the various levels. · Supporting supervision visits at the various levels.

Strategy 3: Provide logistical and administrative support to the National Society for effective running of the HIV and AIDS programme

Activities · Providing administrative and office supplies. · Establishing communication facilities in all project sites and train staff on computers, and emails.

Strategy 4: improve information sharing and knowledge management

Activities · Supporting intra and inter-country study trips. · Conducting of operational research and documentation of best practices.

Strategy 5: Resource mobilization and develop strategic partnerships and alliances with relevant organizations

Activities · Conducting fundraising activities. · Developing marketing materials and work plans at national, provincial and branch levels. · Developing and forging relevant and effective strategic partnerships with key stakeholders. · Holding partnership review meetings twice per year.

4.0 Implementation and Management

This new HIV and AIDS programme will be implemented by BRCS, as part of the Federation Global alliance on HIV and AIDS in Botswana. The National Society currently works in collaboration with the government of Botswana, Botswana Network for People Living with HIV and AIDS (BONEPWA), Salvation Army Psychosocial Support Initiative (SAPSSI), the International Federation of Red Cross and Red Crescent Societies, United Nations agencies, the business community and churches to implement HIV and AIDS interventions and it’s hoped the Society will continue working with these partners in the new programme.

The Integrated HIV and AIDS programme will use the existing management and administrative structures of the National Society. The secretary general will provide overall management of the programme. The national HIV and AIDS programme manager will be responsible for the overall programme implementation and coordination at national and provincial level. The health and HIV coordinator will provide technical support to the programmes at the various levels-: national, district and lower levels. S/he will be assisted by the district field OVC and HIV prevention officers will provide overall technical assistance, supervision and monitoring within their respective districts. They will liaise with the

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010 supervisors, who in turn will be training, supervising and monitoring the coaches and the community based volunteers. Due to the expansion of the HIV and AIDS programmes, there will be a need to recruit more staff to boost the current staffing at the national level and in the field. Under the national HIV and AIDS coordinator, there will be a prevention/partnership officer and an OVC officer to assist in the implementation of activities. More volunteers will be recruited as well, to carry out the implementation of activities at community level.

The National Society through its finance department will have overall responsibility for financial management and reporting. The national HIV and AIDS programme manager working with the secretary general and the HIV and AIDS finance officer (who will be recruited in 2006) will monitor the release of funds to the district projects. Decentralization of handling project finances with capacity building of the branches will be promoted and supported. At national level, a separate account will be held for these funds in order to track income and expenditure. The Federation working advance system will be maintained for funds received through the Federation. Monthly statements will be produced by the relevant officers and presented to management regularly. Quarterly internal audits and annual external audits will be conducted according to the National Society rules and regulations. All financial accounting and reporting will also be done in accordance with the National Society’s financial policies and procedures. The project managers will be responsible for making monthly financial reports that will be submitted through the management structures to the national level.

5.0 Monitoring, Evaluation and Reporting

Monitoring and evaluation (M and E) of this programme will be very crucial to gather accurate information that will guide planning, implementation, assessment of the performance and impact of the programme. The National Society will develop M and E system that will ensure feedback into the programme. Feasible and simple process indicators have been developed and are in the log frame to assess the implementation and outcomes of the programme. Data for assessing some of the outcome and the impact indicators will be generated from surveys such as HIV sentinel surveillance surveys and Demographic and Health surveys conducted by other partners. Key recipients under this programme will be trained on monitoring and evaluation of the programme, indicators, use of data collection and reporting formats. BRCS will develop simple data collection and reporting formats for the various levels. A client, OVC and programme activity database for each project area will be developed and confidentially maintained. All databases will then be compiled, collated and consolidated into a quarterly report at district level. The district coordinators will be responsible for compiling, making the quarterly reports on the projects under their respective districts. At national level, the national HIV and AIDS manager together with staff in his/her unit will compile, collate analyse and make national quarterly and annual programme reports.

At the community level, volunteers will produce monthly reports and hold monthly debriefing meetings with their supervisors. The supervisors will also produce monthly reports and hold debriefing meetings with the district. The national HIV and AIDS programme manager will give a feedback to the district coordinators who will in turn provide the same to the volunteers and the community. All national and annual programme progress reports will be distributed to the partners and the Federation Secretariat.

There will be three project reviews; the baseline assessment/review in each of the project areas, midterm output review and end of the project review. These reviews will be conducted internally by BRCS, as evaluation tools to measure progress of implementation and any issues related to implementation of the programme. Participatory methods will be used in the reviews. There will be an external evaluation using participatory method, at mid term i.e. after the first two years to measure progress towards the set objectives, and then plan the next project phase accordingly. A final evaluation will be conducted at the end of the five-year period. To complement data from programme monitoring and evaluation, operational research will be conducted to provide information for consolidating and improving service delivery and the operations of the National Society.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

6.0 Important Assumptions and Risks

The successful implementation of this programme will depend on a number of factors. BRCS assumes that; · It will mobilize adequate financial resources to implement all the planned activities, and that there will be smooth flow of adequate funds throughout the five years of implementation of the programme from 2006-2010; · All the partners intend to work within its framework and will remain committed to HIV and AIDS; · Its governance and management will remain committed to fighting HIV and AIDS; · Communities will be committed to fighting HIV and AIDS, and receptive to the interventions. If stigma and discrimination are not reduced, there is a risk that the uptake of services will be undermined; · Patients who will be put on ARVs and TB treatment will adhere to the treatment regimes. This will significantly reduce morbidity and mortality in PLHIV and reduce resistance to ARVs and TB drugs; · The government will continue having a strong HBC programme that caters for the care and support of PLHIV. It also assumes that the government will continue providing material, food and educational support to the OVC.

7.0 Programme Budget

The estimated budget for this Integrated HIV and AIDS programme 2006 - 2010 is CHF 17,225,948. The programme is currently 4,99% covered and is therefore seeking CHF 16,366,503 to support implementation, the needs of the National Society and the Federation Secretariat’s programme support cost.

Summary Budget for 2006-2010

Activity 2006 2007 2008 2009 2010 TOTAL

PREVENTION 89,939 10,586 14,094 18,624 0 133,243 ACTIVITIES CARE SUPPORT AND 344,760 1,072,866 1,701,720 2,314,955 2,752,772 8,187,073 TREATMENT REDUCING STIGMA 109,880 385,792 575,768 804,326 1,069,965 2,945,731 AND DISRIMINATION INSTITUTIONAL 447,902 794,139 1,031,535 1,184,956 1,075,603 4,534,135 STRENGTHENING FEDERATION SECRETARIAT 79,611 205,762 302,102 392,987 445,304 1,425,766 SUPPORT Activities Total in CHF 1,072,092 2,469,145 3,625,219 4,715,848 5,343,644 17,225,948

COMMITTED FUNDING 859,445

FUNDING GAP IN CHF 16,366,503

% GAP 95.01%

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

Contact information For further information related to this programme please contact: · Botswana Red Cross Society, Gaborone; Email: [email protected]/[email protected]; Phone +267.35.24.65; Fax; +267 391 2352 · In Botswana: Secretary General, Botswana Red Cross Society, Gaborone Email: [email protected]; Phone +267. 35.24.65; Fax +267.35.23.52 · In Zimbabwe: Françoise Le Goff, Head of Southern Africa Regional Delegation, Harare; Email [email protected]; Phone +263.4.70.61.55, +263.4.72.03.15; Fax +263.4.70.87.84 · In Geneva: John Roche, Federation Regional Officer for Southern Africa, Africa Dept., Geneva; Email: [email protected]; Phone: +41.22.730.44.40, Fax: +41.22.733.03.95

For information on the International Federation Global HIV and AIDS Alliance contact: · In Geneva: Dr Mukesh Kapila, Special Representative of the Secretary General for HIV and AIDS; Email [email protected]; Phone +41.22.73.43.41, Fax +41.22.733.03.95

13 Appendix 1: Logframe Botswana Red Cross Society HIV and AIDS Programme 2006-2010

Narrative Summary Objectively Verifiable Indicators Means of Important (OVI) Verification (MOV) Assumptions Goal: · Declining HIV prevalence rates for · UNAIDS Global To reduce vulnerability to HIV and its impact in Southern Africa the general population HIV and AIDS · Declining HIV prevalence rates pandemic reports among pregnant women aged 15-24 · National years Demographic and · Survival and improved quality of life Health Survey (NDH) Purpose · Reduced incidence of HIV among · Population surveys · Sufficient national To reduce vulnerability to HIV and its impact in Botswana target population (700,000) · Programme review budgetary allocations, · Percentage of pregnant women aged and assessment and international 15-24 years who are HIV positive. reports donor assistance · Survival and improved quality of life resources provided, for 250 PLHIV in refugee camp and and access to targeted 12,000 OVC. populations achieved

Outputs Objectively Verifiable Indicators Means of Important (OVI) Verification (MOV) Assumptions · Population surveys · Willingness of target 1.1 Percentage of women and men aged 1. HIV infections are prevented among 700,000 people in project sites by · National population to modify 15-24 years who correctly identify 2010. demographic their cultural beliefs ways to prevent HIV infection health surveys about sexual 1.2 Percentage of women and men aged · Health facility behaviour 15-24 years reporting use of a reports · Availability of donor condom at last sex with a non-regular support to implement partner ‘casual sex’. · National Society the programme. 1.3 Delayed sexual debut among youths Reports in target population · Interviews with target groups

2. Care, treatment, and support services are expanded and reach 250 PLHIV 2.1 100% PLHIV receive care, treatment · Programme reports · Willingness of in Dukwi refugee camp and 12,000 OVC by 2010. and support by 2010 · Health facility government to support 2.2 90% of PLHIV on ART from records expansion of care Government health facilities are · Key informant treatment and support adequately supported with Interviews interventions.

Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

adherence, treatment literacy and · Focus group · Availability of preparedness discussions programme resources 2.3 3,200 households affected by HIV to implement the receive food assistance (quarterly) activities. and involved in livelihood approaches 2.4 100% of OVC receive material, psychosocial, and educational support annually

3.1 80% of households and communities · Interviews with · Willingness and 3. Stigma and discrimination associated with HIV and AIDS are reduced. expressing accepting attitudes Key informants commitment by towards PLHIV · Household and government 3.2 100% of employers in the impact area community institutions and not discriminating employees due to surveys stakeholders including HIV · Focus group communities to 3.3. Increased uptake of VCT, PPTCT, discussions reduce stigma and ART, TB and STIs services in the · DHS discrimination impact area by 2010. · Records of the health facilities, VCT centres and employers.

4.1 80% staff and volunteers recruited · Programme reports · National society 4. Capacity of BRCS is strengthened to enable more effective, expanded, and retained in the programme · reviews and integrity and dignity direct outreach to served communities. throughout the period. evaluations issues may hamper 4.2 Volunteer management and human · Interviews with implementation. resource policies developed, staff and reviewed and implemented volunteers · Willingness of NS 4.3 Timely, quality and accurate reports management to are produced as required culture of work to fit 4.4 100% staff and volunteers trained in into 21st century planning, reporting, monitoring and approaches to evaluation management. 4.5 100% of project offices are provided with administrative support, equipment and infrastructure. 4.6 Information sharing, operation research, documentation conducted. 4.7 Number of policies produced and 15

Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

implemented – Volunteer and human resources 4.8 Resource mobilization conducted and strategic partnerships and alliances established. Activities Objectively Verifiable Indicators Sources of Activity to output (OVI) information Output 1 · Conducting baseline and end of programme KABP surveys. · Number of baseline surveys · Programme · Willingness of the · Conducting targeted community mobilisation on HIV and AIDS, sexual conducted quarterly reports, local governments to reproductive health, gender and gender based violence issues, TB, · IEC materials developed and reviews and support the malaria, hygiene and other related issues using drama, role and plays in distributed and the number of people evaluation implementation of all the project areas through talks, radio, television, drama and print who have received materials · Focus group the projects at local media. · Number of peer educators trained discussions level · Engaging people in one-on-one dialogues (general population, chiefs, · Number of mass media campaigns · Interviews and · Availability of traditional leaders, youth, and parents) to debate, educate and share conducted observations qualified staff at information on HIV and AIDS, safer sexual behaviour, sexual · Number of people attending VCT · Health facility district and reproductive health, gender and gender-based violence issues, TB, and receiving PPTCT and ART records provincial level to malaria, hygiene using drama, role and plays in all the project areas. services · Assessment manage the projects · Training at least 500 youth peer educators in each of the project areas · Number of youth groups/centres reports · Availability of over a period of five years. established volunteers who are · Supporting trained youth peer educators to carry out peer education willing to participate among their peers. Total budget: CHF 133,243 in the programme. · Training in and out of school youths in life skills. · Producing and distributing targeted culturally sensitive IEC materials. · Training all community mobilisation volunteers on HIV prevention, peer education, sexual reproductive health, life skills gender, gender-based violence, TB, malaria, first aid and other health issues. · Distributing condoms (male and female). · Establishing 60 condom distribution networks and outlets in all the project areas. · Conducting sensitisation community seminars on correct and consistent use of condoms using the trained volunteers.

· Training all community mobilisation volunteers and staff on VCT, ART

and PPTCT. · Sensitising and mobilizing communities and HBC clients to utilize VCT, PPTCT and ART services. · Encouraging formation of buddy, trios and groups for ART adherence and DOTS support including sexual reproductive health, TB control

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

services including malaria control programmes. · Developing and supporting drama, radio, television programmes and educational materials informing people about VCT, PPTCT, ART and other related services. Output 2 · Conducting end of programme surveys on care and support in all in · HBC materials procured and · Programme reports Kasane and Dukwi Camp. distributed · Training reports · Conducting community mobilization and awareness sessions on ART, · No. of volunteers trained on ART · Assessment and DOTS, and malaria treatment including adherence to ART and TB training package situation analysis treatment and treatment preparedness. · Number of family members trained reports · Training 200 care facilitators to provide HBC for PLHIV in Dukwi · Number of support groups refugee camp. established per province · Supporting the trained care facilitators to conduct home visits to HBC · Number of coaches trained clients in Chobe district and Dukwi refugee camp. · Number of food security and · Procuring HBC kits and other supplies for HBC in Dukwi camp. nutrition assessments conducted · Training all volunteers on ART literacy, DOTs, monitoring of adherence · Number of volunteers trained on treatment protocol. food security , livelihoods · Conducting 15 situation analyses on OVC in new project areas and · Number of gardens established where there are existing day care centres (three in 2006, five in 2007, five · Number of OVC receiving support in 2008 and two in 2009). · Number of situational analysis · Training 3,200 volunteers in OVC support. conducted · Establishing 15 OVC care and support projects by 2010. · Holding consultative meetings with Social and Community Development Total budget: CHF 8,187,073 department on a regular basis regarding criteria for selection of OVC and to discuss other related issues (four consultative meetings for North, Central, South and West regions.) · Establishing mentoring programmes training per year per site i.e. three in 2006, five in 2007, five in 2008 and two in 2009). · Holding 15 life skills camps (three in 2006, five in 2007, five in 2008 and two in 2009). · Conducting 15 Memory and Hero work training (three in 2006, three in 2007, five in 2008 and two in 2009). · Establish kids clubs/OVC support groups at least three per project area · Providing education support materials to 12,000 OVC (three times per year). · Providing material support to OVC not covered under the government programme, to be established after the situational analysis. · Establishing 15“grannies clubs” and provide guardians with HIV and AIDS education, material and psychological support.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

· Conducting 15 grannies workshops (three in 2006, eight in 2007, 13 in 2008 and 15 in 2009) on HIV and AIDS issues, care and support of OVC. Output 3 · IEC materials developed and · Programme reports · Conducting anti-stigma campaigns at community level, including distributed · Household surveys education talks on the rights of PLHIV, OVC, children and women. · Number of anti-stigma campaigns · Interviews · Supporting the production of radio/television programmes, drama and conducted · Availability of print media on anti-stigma and discrimination messages and the rights of · Number of volunteers trained on the policies PLHIV, OVC and women. rights of PLHIV and children · Integrating messages on the rights of PLHIV, OVC, children and women, · Number of NS policies developed anti-stigma and discrimination into the World AIDS day, TB day and and implemented other national and district events. · Training volunteers on the rights of PLHIV, OVC, children and women. Total budget: CHF 2,945,731 Output 4 · Reviewing and implementing volunteer management and human · Number of staff and volunteers · National Society resources policies. retained volunteer data base · Developing and/or implementing guidelines on volunteer management · Number of staff and volunteers and human and branch development trained on planning, reporting, M&E resources reports · Conducting volunteer mobilisation and recruitment in all project areas · Funds raised · Availability of · Recruiting and retaining appropriately skilled staff in project areas and · Number of support visits conducted MoU with partners headquarters. · Partnerships developed and MOU and donor · Training all staff and volunteers in branches on Red Cross Red Crescent including fundraising activities. agreements Fundamental Principles and Humanitarian Values. · Training staff and volunteers in project planning, implementation, M & Total budget: CHF 851,270 E, and reporting. · Developing checklists, monitoring tools and reporting formats for the Other costs related to capital, transport various levels. and storage, personnel and · Supporting supervision visits at the various levels. administration amount to: · Providing administrative and office supplies. CHF 3,682,865 · Establishing communication facilities in all project sites and train staff on computers, and emails. Federation Secretariat support cost: · Conducting of operational research and documenting best practices. CHF 1,425,766

· Conducting fundraising activities. · Marketing materials and work plans developed at national, provincial and branch levels. · Developing and strengthening relevant and effective strategic partnerships with key stakeholders. · Holding partnership review meetings twice per year.

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Botswana Red Cross Society: Integrated HIV and AIDS Programme 2006-2010

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