SECTION I Summary of the proposal direction Remark the

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SECTION I Summary of the proposal direction Remark the Powered By Docstoc
					SECTION I: Summary of the proposal direction

Remark: the guiding summary will be used to present an overview of the proposal to several
members of the Secretariat, the Technical Examination Group and the Committee of the Global


General information                                                      Table I.a
Title of the proposal   Decentralisation of for the overall management of people living
(The title must         with HIV/AIDS
convey the scope of     (former title: Networked inter-hospital treatment solidarity for
the proposal):          HIV/AIDS illnesses in Rwanda (ESTHER INITIATIVE)
Country or region        Rwanda
Applicant name:         Rwanda Ministry of Health
Groups represented      X Government - Ministry of         X UN/Multilateral Institution
in the GFC                Health
(indicate the number    X Government - Other ministries    X Bilateral Institution
of members from
each category):
                        X NGO/Community                       Academic/educational
                          Organisations                       Organisations
                        X Private Sector                      Religious/faith Groups
                        X People with HIV/TB/malaria*         Other (please specify):
If the proposal is
NOT submitted
through a GFC,
explain why:

Specify which component (s) is/are targeted by this proposal and the amount requested
from the Global Fund**:                                                             Table
                                         Amount requested from the GF per year (in
                                         thousands of US dollars)
                                         Year 1 Year 2 Year 3 Year 4 Year 5 Total
Component(s)         X HIV/AIDS          5.760. 9.100.     11.991 13.558 16.235 56.646
                                         465     270       .690   .310    .730     .465
(indicate by a X):      TB
                        Total            5.760.   9.100.    11.991   13.558    16.235   56.64
                                         465      270       .690     .310      .730     6.465
Total of funds from other sources for    13.900   12.600    10.800   N/A       N/A
activities relating to the proposal      .000     .00       .000
Please specify how you wish to see this proposal evaluated** (mark with a cross):
The Proposal must be evaluated globally
The Proposal must be evaluated as separate components                               X
Brief summary of the proposal (1 page)(please include quantitative data if possible):
•   Describe the aims, objectives, and general activities by component, including the expected
    results and the schedule to attain these results:

    The proposal aims to improve the quality and life expectancy of people with HIV/AIDS while
    strengthening prevention by a family approach.

    It will enable access to quality care to be increased, including access to antiretrovirals, by
    decentralisation of their deliverance and patient monitoring The care system will be centred around 30
    health centres, 5 district hospitals and the CHU/CHK as national reference which benefits from an
    ESTHER twinning with Luxembourg. This management is supported by strengthening psychosocial and
    nutritional monitoring (6,000 families) via 40 local associations under the new National Network of
    PLWHIV and via sponsoring and support groups.

    An initial investment of 9 months in health structures and human resources will prepare the
     decentralised management phase; enrolment of patients will then be done gradually, up to 50 new
    patients per month and per district hospital and 100 new patients per month at CHU/CHK level.

    At programme end, more people will benefit from better management; this will be spread geographically
    in a more equitable way; family screening will be promoted and will strengthen the prevention actions;
    the entire population will benefit from the strengthened health structures at every level of the system.

•   Indicate the beneficiaries of the proposal by component and the advantages to be derived from
    it (including target populations and an estimate of their number):

    Management plans a significant coverage of province requirements, in the region of 15 - 30% of affected
    people, while at the same time pursuing coverage in Kigali via the CHU/CHK, or a total of 19,350 people
    on ARVs and 50,000 people on prophylaxis and treated for their opportunist infections. It is
    supplemented by psychosocial and nutritional support (6,000 families) via 40 local associations under
    the New National System of PLWHIV who will be institutionally supported in their action capacity
    (training, equipment, operation). The programme medical staff will see their capacity also strengthened,
    whether it is TRAC (policy making, laboratory quality, SIS, and co-ordination), Camerwa (drug
    distribution system), district hospitals (more of better trained staff).

•   If there are several components, describe if appropriate, the expected synergy from the
    combining of the various components (By synergy, is understood the added value that the various
    components bring mutually or the manner in which combining components can lower the scope of each
    component taken individually):

    Family screening is the nucleus of the proposal: this family “knowledge” limits the factors of
    stigmatisation detrimental to adhering to the programme, strengthens the support potential of people on
    ARVs and transforms the Rwanda family into a key entity to widen community based prevention.
    Strengthening the care offer is a chance to promote this screening; it is coupled with the local raising
    awareness actions accomplished by the PLWHIV associations to create demand. Treatment and
    prevention thus strengthen each other. This family aspect is strengthened by an operational research
    dynamic to improve knowledge of causes of family stigmatisation and to derive from this the tools best
    suited to alter behaviour.

•   Indicate whether the proposal is an extension of current measures or the start of new activities.
    Explain how education and good practices acquired at the time of the preceding phase are
    integrated into this proposal; and describe the innovative aspects of the proposal.

    The initial financing instalment from the Global Fund enables the setting up of a nationally integrated
    VCT (including STD, PMTCT, OI); moreover various pilot projects for treatment management including
    ARV are pending, in particular to the CHK (reference hospital) and in Kigali. The proposals enables
    these acquired elements to be capitalised on to extend the management beyond Kigali while
    strengthening the second level, the district hospitals, to create an integrated care system of national size
    that currently does not exist.

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