The Women's Foundation of Nepal

Neplai Government Response to HIV/AIDS

Executive Summary, July 19th, 2002
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Behavioural and seroprevalence data indicate the high potential for a generalized epidemic in Nepal. In the absence of effective interventions, even a “low to moderate growth scenario” would make AIDS the leading cause of death in the 15-49 year old population over the coming years. For Nepal this would mean that around 100,000-200,000 young adults will become infected and that overall 10,000-15,000 annual AIDS cases and deaths may be expected.

For Nepal, a generalized epidemic with high mortality in the productive age group would start a “vicious circle”. The impact of HIV/AIDS would increase poverty and vulnerability. This increased vulnerability would lead to more HIV infections and a higher impact. Besides the negative impact on socio-economic development and the loss of productive life, the burden of disease would change dramatically over the next 10 years and would put further stress on the health sector and local communities.

There have been a number of important changes since the development of the “Strategic Plan for HIV and AIDS in Nepal 1997-2001” (1996: a) The epidemiological situation has dramatically changed between 1997 and 2001; b) Nepal has committed itself both to the Millennium Declaration and its Millennium Development Goals and to the time-bound targets spelled out in the Declaration of Commitment at the United Nations General Assembly Special Session on HIV/AIDS in July 2001; and c) Nepal’s Tenth Five-Year Development Plan has identified HIV/AIDS as a cross cutting issue affecting national development. This new National Strategy should guide the translation of these commitments into reality and to finally halt and reverse the spread of the epidemic in Nepal.

The overall objective of Nepal’s strategy for HIV/AIDS is to contain the HIV/AIDS epidemic in Nepal. The vision of the National Strategy is to expand the number of partners involved in the national response and to increase the effectiveness of the response. It will do this by focusing on activities within priority areas thereby optimising prevention and reducing the social impact of HIV/AIDS in the most cost-effective manner.

Nepal’s “National HIV/AIDS Strategy 2002-2006” has been designed to guide the expanded response to the HIV/AIDS epidemic in Nepal. An expanded response requires the commitment of all sectors, not just health, both within and outside government, and the coordinated support of external development partners. This strategy will promote and facilitate the coordination of their involvement.

HMG/N Ministries will use the National Strategy to develop and integrate relevant elements of this document into their respective sectoral plans and policies. Local authorities (for example DDCs and municipalities) will use the strategy as a basis for developing their own strategic and operational plans according to their own needs. This document also aims to guide private and social sector organisations (such as INGOs, NGOs, CBOs and businesses) and external development partners in defining their support and contribution to an expanded response. As this National Strategy describes the national priorities for the HIV/AIDS response, it will form the basis for future allocations of human, material and financial resources.

The priority areas identified in the Situation and Response Analysis that are addressed in the
National HIV/AIDS Strategy are:

Prevention of STIs and HIV infection among vulnerable groups (the groups identified as a possible nucleus for a generalized epidemic, because of their size, HIV seroprevalence and multiple interfaces to the general population are sex workers and their clients; injecting drug users; mobile populations – especially labour migrants to India; men who have sex with men; and prisoners because of their extreme conditions.
Prevention of new infections among young people.
Ensuring care and support services are available and accessible for all people infected and affected by HIV/AIDS
Expansion of a monitoring and evaluation frame through evidence based effective surveillance and research.
Establishment of an effective and efficient management and implementation mechanism for an expanded response

Yearly targets were defined for the priority areas and key-strategies, and in a next step the strategy will be costed to allow resource mobilization and re-prioritization.

The development of the national strategy was a participatory process involving government, non-governmental organizations, private sector, civil society (including people living with HIV/AIDS), and external development partners. Regional and national consultations provided the opportunity for stake-holders to contribute and finally to shape this strategy.

The main challenge for Nepal is now to respond immediately to a rapidly evolving HIV/AIDS epidemic. This has to be undertaken in the context of a civil conflict in the country, weak implementation capacity both within the public and the private sector, structural weaknesses with respect to multi-sector involvement, coordination, policy, monitoring and evaluation, and scarce internal resources.

Recognizing all the above, Nepal has embarked to broaden and to deepen political commitment. For example, establishing the National AIDS Council under the chairmanship of the Rt. Honorable Prime Minister, defining HIV/AIDS as priority “1” in the MTEP of the MoH and integrating HIV/AIDS in the 10th Development Plan. HMG is also committed to reforming and strengthening the management mechanisms of an expanded, i.e. multi-sector and scaled-up, response to HIV/AIDS within the framework of the National Strategy.

The challenge will be to sustain and to broaden the political commitment in terms of policy, involvement of new partners and stake-holders, and finally also to translate political commitment and leadership into action. As a resource poor country with additional security expenses, it is difficult for Nepal to demonstrate commitment through budgetary allocations, but higher allocations to an expanded response are foreseen in the MTEP of the MoH. The recent active involvement of law-makers and municipalities both in the strategy development and in policy issues signals broadening commitment that goes beyond parties.

The strategy tries throughout to address the issue of commitment, enabling environment at all levels, and local ownership. It seeks to increase the understanding of decision-makers and communities, especially as regards the most vulnerable groups, and to actively involve them in the response. In doing so, a broader base of commitment will be established and ultimately facilitate the implementation of the strategy. The involvement of local communities and vii authorities will also contribute to a public accountability as regards the implementation of the strategy.

Ideally, the National Strategy will be “programme” funded, i.e. pooled resources and/or earmarked contributions, to provide required resources. The future management and implementation structures will be designed to:

Support and strengthen the leading role of government, and the MoH as the technical line ministry, as regards: policy and strategy; monitoring and evaluation, including quality assurance and quality control; epidemiology and surveillance; involvement of other government structures, e.g. other line ministries, and coordination;
Provide the flexibility, accountability and results oriented management of a larger programme at the central and the decentralized level;
Establish new public-private partnerships at all levels to fight the epidemic;
e” De-medicalize” the response to HIV/AIDS;
Support decentralization and integration at the community level;
Increase responsiveness; and,
Provide the basis for sustainability through the involvement of the private sector and civil society.

The shift from individually funded “projects” to a “programme”, from outputs to results orientation, from donor interest to national priorities, from capacity building of central structures to strengthening of implementation capacity, and from a health sector response to a multi-sector approach will require time and resources. This is, however, the precondition for an effective and efficient national response.

Finally, in order to respond effectively, financial and human resources will be needed to translate the national strategy into action. As the epidemic advances day by day, the overall resource requirements to respond become bigger and bigger. Nepal will need the support by external development partners to fulfil the resource needs.

The strategy addresses sustainability in providing for innovative financing mechanisms (trust fund also to attract private sector contributions), and in strengthening the capacity and empowering vulnerable groups and communities. It is hoped that involvement of communities, decentralization, and integration in development programmes will also contribute to better sustainability.

Source: abconaids.org