Progress Report of UN Joint Programme in 2008

2008 is the second year in which the UN Joint Programme on AIDS has been operational in China. The milestones, achievements, challenges and priorities for 2009 are summarized below.

IKey achievements

Joint programme management

1.Tracking of accountability: The joint two-year work plan, which includes details of project activities and thebudget-available, was updated at the beginning of the year.To strengthen programme management, especially financial accountability of the UNJP, tools have been developed to systematically and transparently monitor the implementation progress of activities against set targets.Quarterly reports have been used to assess financial disbursements and identify challenges faced. A web-based monitoring system was launched on 10th September 2008on the UNAIDS China websiteand participating agencieshave been uploading individual progress reports to share with one other since this date. Based on these reports, 87% of planned activities with deliverables were fully or partially achieved; 80.7% of the total budget was delivered to the national counterparts. Mapping of the UNJP project sites showed that 24 provinces were covered by UN agencies. A UNJP focus area-based progress update was compiled based on individual quarterly reports from all UN agencies. For details, please see attached annexes 1-4 to this report.

2.Coordination with national counterpart: A coordination meeting with SCAWCO was convened in July 2008 and established a working mechanism. Following the agreement reached, serving as the UNJP secretariat, UNAIDS updated SCAWCO in early December on the general progress including achievements and challenges preliminarily identified by the mid-term assessment mission. SCAWCOalso expressed its idea forastandard reporting format to allow UN agencies to share information on the progress of the Joint Programme and was requested by the UN to coordinate with the International Cooperation Programme Department of NCAIDS to set out aunique format to be used for reporting.

3.Resource mobilization and management:The 3rdallocation of funding, was amounting to £500,000,was applied forfrom DFID in October 2008. Together with a total fund of £800,000 received by UNAIDS HQ before this allocation, UNAIDS disbursed £1,249,036 to all 9 executing agencies who were implementing 13 projects in year 2008. In addition to the DFID funding, a total of $265,000 was also mobilized from PAF 5 in 2008 to support 5 initiatives under the joint programme which focus on strengthening the participation of civil society and eliminating stigma and discrimination against women living with HIV.

4.Assessment of the Joint Programme:An independent mid-term assessment to the UN joint programme was conducted in November and December of 2008. The consultant developed and delivered a report based on individual discussions held with all agencies, in many cases including the HOA; group discussions with the joint team to review progress and interim assessment findings; a very fruitful working session held with SCAWCO; and feedback received from all agencies on the draft and incorporated into the final report. The suggestions in the report to the joint UN team and the joint programme will contribute to the forward looking strategy of the next UNJP two-year workplan for 2009 – 2010.

Preliminary achievements of the joint programme

  1. Supported the operationalization of a Comprehensive Response Management Information System:The National M&E Framework was launched by the Government in June 2007. To respond to this framework and strengthen monitoring activities, the NationalCenter for AIDS/STD Control and Prevention of China CDC developed an online reporting system, called the Comprehensive Response Management Information System on HIV/AIDS (CRMIS). The purpose of this system is to collect original data through standardised forms in order to ensure the accuracy and reliability of reporting data; strengthen management of information on PLHIV to prevent further transmission of HIV, and to promote service provision for follow-ups, treatment, care and support to PLHIV. CRMIS was operationalized in January 2008 by all provinces and counties in China. While challenges remain, the system has greatly improved working efficacy, especially through strengthening data management and analysis at all levels.
  2. Organized anti-stigma and prevention education campaign for the Beijing Olympic Games: In collaboration with the IOC and the BOCOG Department of Medical Services, an overall HIV prevention and anti-stigma campaign prior to and during the Olympics was conducted. The Joint UN Team on AIDS was also mobilized, and in collaboration with people living with HIV and other partners, successfullydeliveredanti-stigma and anti-discrimination training in around 15 universities to 7,500 Olympic volunteers. An HIV and AIDS information package on Universal Precautions and other clinical prevention for BOCOG health and dental staff and Olympic volunteers was distributed. HIV awareness during and after the Games was promoted, targeting national Olympic delegations with: a fact sheet, two video PSAs on flash sticks and in the Olympic Village health clinic; posters; an HIV prevention anti-stigma package with two condoms. All materials were in English, Chinese, and French. Chinese basketball player Yao Ming endorsed the campaign. Within the Olympic Village, 50,000 packages with 100,000 condoms were made available free of charge. Under the support and coordination of UNAIDS, three giant red ribbons, hung from the iconic National Olympic Stadium, also known as the Bird’s Nest,were unveiled to mark World AIDS Day 2008. The display illustrated China’s commitment to the AIDS response and in particular, to the fight against stigma and discrimination.
  3. Developed Guidelines for introduction of second line ARV drugs: China rapidly expanded its antiretroviral therapy treatment programme. More AIDS patients required second-line ART regimens. In collaboration with UNJP,the MoH and the NationalCenter for AIDS Control and Preventionpilotedsecond-line ARV treatment in Hubei, Anhui and Henan from August 2007 to December 2008. 384 AIDS patients were recruited and treated with second-line ART formularies available in China, based on programmatic efficiencies and costs. Data and evidence collected from the pilot programme was reviewed by national and international experts. An Implementing Guidance for Second-line ARV Treatment in China was developed and issued at the end of 2008 in line with the “Report of a WHO Working Group Meeting on Prioritizing Second-Line Antiretroviral Drugs for Adults and Adolescents with a Public Health Approach.” These guidelines forChina introduced international standardsto the local context and will greatly contribute to the expansion of second-line treatment to a national level.
  4. Highlighted AIDS prevention in workplaces. The workplace has been seen as an effective strategic focus in the Chinese context for reaching a mass audience for HIV prevention interventions and reducing stigma and discrimination.A short film to reduce stigma and discrimination among migrant workers was released before World AIDS Day. It has been promoted and distributed to pilot enterprises, trade unions andnational and international media for further advocacy campaigns. Stigma and discrimination in the health sector were addressed.Meanwhile, HIV prevention in railway work places was also strengthened. Within the UN system in China, in early 2008, the UNCT decided to reach 100 percent staff orientation on HIV by the end of the year. During the autumn, UN Cares in China radically accelerated support towards this goal and a number of UN Cares initiatives were taken to encourage progress towards 100 percent staff orientation. Key initiatives included an assessment of the progress already made by individual agencies and support to agencies taking new steps towards this goal. Support included providing trainers forstaff orientation sessions and arranging visits by “Positive Talks” who contributed significantly to training sessions and compellingly addressed stigma and discrimination.

IIMajor Challenges

  1. The Sichuan earthquake in May and the Beijing Olympic Games in August affected the implementation of some planned activities, and some programmes had to be postponed.
  2. Clarification of the roles of Joint UN Team members and the accountability of the Joint UN Team needs to be strengthened.
  3. Much more rigor is required to focus on larger activities in priority areas where the UN can make a difference in the forthcoming work plan, particularly the development of joint activities involving two or more agencies.
  4. A shift to a ‘results management culture’ will require a shift in joint programme planning and reporting to focus on strategic results that the UN is responsible for delivering, rather than reporting progress in terms of activities or against performance indicators covering the combined results of several partners.
  5. Proven effective strategies are required toaddress cross-cutting issues, particularly reducing stigma and discrimination, addressing gender perspectives in HIV interventions and establishing the rights of those living with HIV and affected by AIDS.
  6. Closer linkages need to be forged with SCAWCO to review the overall national response and the contribution of the UNJP to this response.
  7. In the important area of improving UN performance in identifying and promoting ‘best practice’, an inter-agency task team should be established to review the present situation and to prepare guidelines for the identification, documentation and dissemination of good practices in the China context.
  8. The lack ofparticipation bythe World Bank inthe joint programme is a challenge to the coherence of the team, and to the implementation of the programme. The World Bank’scommitment to participating in the 2009-2010 UNJP work plan should be further confirmed.

IIIStrategic Priorities for 2009

  1. Formation of a Core Management Team (CMT).The agencies participating in the UNJP should designate a senior member of staff as the manager or supervisor on behalf of that agency to aCMT of the Joint UN Team on AIDS. The CMT would meet on a regular basis to review progress towards the core strategic priorities of the UNJP, address any constraints in implementing and achieving desired outcomes, share information on progress and challenges
  2. Develop the 2009-2010 work plan to cover only core strategic priorities focusing on results-based objectives and indicators that reflect China’s national programme and international best practice.Provide a practical results-based management training opportunity for the joint team members to ensure practical development of measurable indicators for the outcomes/outputs in the 2009-2010 UNJP work plan that the UN is responsible for delivering.
  3. Support the national epidemic estimation and the submission of the UNGASS report. With support fromthe UN system, China conducted an epidemic estimation exercise in 2007, and published a Joint Assessment of HIV/AIDS Prevention, Treatment, and Care in China. The Joint Assessment Report also constituted the narrative part of the UNGASS report that was submitted to UNAIDS HQ at the end of January 2008. In 2009, a new round of estimations and UNGASS reporting shouldbe conducted and delivered by the Chinese government, with the further support of the UN system.
  4. Strengthen national and provincial level capacity for strategic planning and analysis to identify gaps in the response through the Rolling Continuation Channel of the Global Fund.This grant of up to 500 million USD was approved by the Board of the Global Fund in March 2009. This is a critical step which will bring very significant resources and opportunities to China. The work ahead, however, carries enormous challenges which will need continuous support at national and provincial levelsfor strategic planning.This will be one of the priorities for2009.
  5. Scale up interventions with a focus on populations most at risk and vulnerable to AIDS. StrengthenHIV prevention interventions in closed settings through partnership betweenUN agencies and the Ministry of Public Security (MOPS) and the Ministry of Justice (MoJ) for extending HIV prevention, treatment and care to IDUs.
  6. Continue to support the full integration of second-line ARV drugs in the roll-out of the “Four Frees one Care” policy. Promote the availability of second-line drugs from the pilot provinces to other provinces of China.
  7. Promote greater civil society involvement through building networks and improving the capacity of civil society organizations. Promote all efforts aimed at reducing stigma and discrimination related to AIDS.
  8. Highlight cross-cutting issues, including gender and human rights-based approaches,results and evidence based management, maximizing aid effectiveness. Bring international standards and expertise to China’s local contextin all related UNJP support. In the delivery of health services, apply the principles of a public health approach to health sector interventions to address populations and risks, rather than symptoms or diseases.

Annex 1: Progress Updates based on Quarterly Reports from All UN Agencies

IUNJP Key Achievements

1Focus Area One: Strengthening leadership and improved planning, monitoring and coordination of a multi-sector response

1.1Improved national policy framework and coordinating mechanisms:

  • International best practices and guidelines introduced to China such as guidelines on HIV/AIDS and human rights
  • Supported development of guidelines for laboratory diagnosis and treatment of STDs, national congenital syphilis management, provider-initiated HIV testing and counseling (PITC) and national HIV testing guideline revisions, national implementing guidelines on second line ARV treatment and published a National Free ARV Manual
  • Assisted Ministry of Labour withdrafting guidelines on HIV/AIDS in the workplace
  • Updated AIDS Laws and Regulations for NPC for the harmonization process
  • Supported the national framework forstrengthening linkages between HIV prevention and RH/FP services
  • Developed technical guidelines on community care for women and children living with HIV and affected families
  • Supported MOCA in drafting national policy to support children affected by AIDS and issued regular newsletters on children, youth and AIDS campaigns

1.2Enhanced support to local government response to AIDS

  • Supported the issuing of provincial Workplace HIV Policies released after joint efforts by the Department of Labour, ACFTU and CEC in Yunnan and Anhui
  • Supported capacity building to implement Guangdong Workplace HIV Guidelines issued in 2007
  • Supported tailored provincial action plans designed for Hunan and Gansu which were endorsed by local governments, and designed with local conditions in mind in order to meet local needs
  • Conducted a socioeconomic impact study ofover 2000 households in five provinces and created a draft report currentlyunder review
  • Set up a local coordination mechanismto address HIV and mobility along China's northern border in four provinces. Conducted IEC advocacy involvingfamily planning, health, entry-exit inspection and quarantine bureaus, media, leisure establishments and promoted condom use and peer education

1.3Expanded engagement ofCSOs in the AIDS response

  • Supported the developmentby MOCA of NGO registration guidelines aiming to engage civil society in the AIDS response at all levels. These were submitted to the State Council for review and approval
  • China Tongzhi Health Forum and MSM Business Owner Mechanism in place
  • About 30 positive speakers trained in advocacy and media skills. Some of them actively engaged in training Beijing Olympic volunteers, teachers and students in vocational schools, labour inspectors and coalmine safety inspectors, as well as being involved as trainers in GF programme training
  • Developed options for the next GF CCM elections and examined potential structures to strengthen civil society engagement at the national level
  • Supported CSO engagement in UNGASS reporting and participation in High Level Meetings and International AIDS Conference

1.4 Increased mobilization and better prioritization and utilization of resources

  • Supported national GF costed strategic plan via RCC/grant consolidation following four work streams: GF mapping, epidemic mapping and projections, response analysis and resource needs estimates. The proposal was approved by GF in early 2009

1.5Strengthened monitoring of the epidemic and the effectiveness of response to it

  • Supported CRMIS development to facilitate the setting and measurement of Universal Access targets
  • Supported national UNGASS report preparation and national epidemic projection exercises

2Focus Area Two: Increasing awareness of HIV and reduced stigma, discrimination, vulnerability and risk behaviour relating to HIV

2.1 Improved blood safety and implementation of Universal Precautions

  • Documented best practices in blood safety at provincial level
  • Supported training and documented experiences on blood donation and blood administration in Hunan

2.2 Increased access for high-risk groups to effective HIV prevention approaches

  • Trained 1,873 rural women with husbands who had migrated to cities for work and 1,082 migrant workers (80% male migrants)Linquan, Anhuiproviding them with their first ever training on gender and HIV knowledge and HIV prevention skills.
  • Conducted peer education training for youths not in school, targeting over 6,500 people
  • Supported NCAIDS field implementation and evaluation of national HIV interventional guidelines among MSM in 3 cities: Nanchang, Zhengzhou and Ningbo

2.3 Strengthened capacity of law enforcement agencies in China's AIDS response

  • Collected and analyzed international and national legislation, regulation and policies on HIV related to drug use and in closed settings and drug relapse.Assessed the situation at field level and drafted a comprehensive situational assessment report

2.4 Expanded awareness, policies and prevention of HIV in the work place

  • Launched the Hometown Fellow campaign based on extensive quantitative and qualitative research and targeting 7 million migrant workers, to reduce stigma and high-risk behaviour among migrant workers
  • Developed an online resource center to provide practical tools to enterprises and organizations to develop policies and programmes on STIs and AIDS. So far, 10 large scale enterprises have developed comprehensive policies on AIDS
  • Developed a range of IEC materials and integrated HIV into existing communication channels in 19 pilot companies targeting 200,000 workers
  • Mobilized 5 pilot hospitals to develop policies and programmes to protect rights of health care workers and patients, reduce transmission risks and eliminate stigma and discrimination in Guangdong and Yunnan
  • Trained 850 teachers in 6 provinces to presentHIV/STI information to students in Ministry of Labour managed vocational schools
  • Trained 500 doctors and nurses (90% women) on anti-stigma. Improved their knowledge on occupational safety and procedures for post exposure prophylaxis

2.5 Strengthened HIV awareness and reduced discrimination among young people