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					             PartnershipFramework

betweenthe Govemmentofthe Republic of Angola
and the Governmentof the United Statesof America

             to CombatHIV/AIDS
                  2009-20t3
                                       o+afr   efr ot Pea@k6+ing opeation6
Mry No.3?{   Fev. 3   UNITED NATIANS
                                                          oato9raPhc sedion




                                                                  2
I.     PT]RPOSEAIID PRINCIPLES

The NationalCommission Fight HIV/AIDS andLargeEndemics
                          to                                      (CNLCSGE),led
by the Presidentof the Republic of Angola, and comprisedof ministers from all sectors
of government,was establishedlrn2002to coordinatethe national, multi-sectoral public
response HIV/AIDS. The national response the HIV/AIDS epidemic in Angola is
         to                                   to
led by the National AIDS Institute (INLS), which was set up in 2005 to implement
Ministry of Health (MOID policy on HIV/AIDS. The MOH hasa currentHIV National
Strategic Plan(NSP) for 2007-2010,   which shouldbe refinedand updated   through2013
underthe proposedpartnership.

ln 2008, the United StatesCongressreauthorizedthe President'sEmergencyPlan for
AIES Relief (PEPFAR)for five additional years. The goals of this phaseremain
increasingaccess antiretroviral therapy,preventingnew infections, and providing
                   to
careto peopleaffectedby AIDS, including orphansand vulnerablechildren. In
addition, this secondphaseof PEPFARplacesgreateremphasison strengthening
partnerships  with host country governments,strengtheningcoordinationwith other
donors,and building capacrtyfor a more sustainable response.

This Framework illustratesthe highJevel Govemmentof the Republic of Angola
(GRA) commitmenf national leadershipand continuedownershipof the national HIV
response.Recognizingthe importanceof country ownershipand sustainability,
PEPFARthrough this partnershipintendsto supportthe health priorities laid out in the
NSP and the principles of three onesthat are promotedby the INLS to fight the
HIV/AIDS epidemic in Angola.

The purposeof this PartnershipFrameworkon HIV/AIDS 2009-2013(Frameworkor
PF) is to provide a five-yearjoint strategicplan for cooperationamongthe GRA, the
Govemmentofthe United Statesof America (USG), and other stakeholders support to
achievement   ofthe  goalsof the NSP and, in so doing, also contributeto the PEPFAR
goals for prevention,care and treafrnent. The Angolan government'scurrentNSP for
HIV stipulatesthree goals,which guide Frameworkdesign,implementationand
evaluation.

           i.     Strengthencapacityfor an effective national response combat
                                                                      to
                  HTV/AIDS.
          ii.     Reducethe growth of the HIV/AIDS epidemic.
          iii.    Mitigate the socio-economicimpact of HIVIAIDS on the individual,
                  family andcommunity.

The Frameworkaims (1) to sustainan effective response    through proven strategiesand
approaches, (2)to expandand improve     preventiveactivitiesand servicedeliverywhile
enhancingcoverageand qualrty, (3) to strengthenlocal capacrty,(4) to promotepolicy
reform, and (5) to assistthe GRA in its coordinationof key stakeholders:
  o Harmonization: All Frameworkgoals and strategies  shouldbe in line with and
    advanceexisting national commitments,including the National HIV StrategicPlan
    (2007-2010and the yet-to-be-drafted2010-2014   extension),the grant requirements
    for the Global Fund to Fight AIDS, Tuberculosisand Malaria (GFATM), the Abuja
    Declaration,the Three OnesPrinciples,the Monterrey Accords and the Paris
    Declaration. The national HIV/AIDS action framework setsgoals for universal
    access preventionas well as careand treatmentfor peopleliving with HIV/AIDS.
           to

  o Collaboration: This Framework's designis guidedby the NSP and builds on an
     established relationship coordination
                             of              and collaboration  ilmongthe U.S. Mission
     Luanda interagencyPEPFARteamo       relevantGRA ministries and agencies,     various
     donors,and non-governmental    organizations(NGOs). The design,implementation
     and monitoring of this Frameworkare the result of a robust consultativeprocessthat
     engaged  relevantGRA Ministries, civil society,UN agencies,    bilateral and
     multilateral donors,and the private sector. This interactiveconsultativeprocess
     negotiated determined goals,objectives
                and             the                  andcommitrnents the of
    ''Framework.
                   This Frameworkintendsto maximize public-private partnerships
     (including workplace programs),to enhanceservicedelivery, sustainability,and
     coordination,and to promote sharingbest practicesamongdevelopmentpartners
     and implementers.

         FrameworkConsultative  Process:
            o As a result of regular$ scheduled  consultations, GRA decidedthat
                                                               the
              key interventions objectives
                                and            ofthe Frameworkshouldbe 100percent
              alignedwith the NSP.
            o Follow-up meetingswith the MOH and other relevantministries focused
              on key interventionsand specific roles and commitmentsofthe USG and
              the GRA.
            o Consultationsand work sessions    involved multilateral and bilateral
              organizations,civil societyand the private sectorduring the period of
              Juneand July 2009.
            . Key stakeholders donorsdescribedtheir current activities and future
                                and
              commitrnentsrelative to HIV/AIDS.
            o Follow up meetingswith GRA, developmentpartnersand key
              stakeholders  (multi-sectoral)focusedon key interventionsofthe
              Framework;gapsand priorities of the HIV program;useof the
              Frameworkto coordinateand fill identified gaps;policy reform issues;
              managementaccountabilityand oversightof the PF.
            o The GRA recognizedan opportunity to beffer coordinateand align
                                                                in
              supportand thus was fully involyed and engaged the feedbackand
              negotiationsthat contributedto the developmentof the PF.
            . Commitmentswere reachedfor closecollaborationon monitoring and
              evaluation(M&E), harmonaation, and elaborationof the new strategic
              plan.

  Accountability and transparency:lntendedcommitmentsand responsibilitiesare
  broadly outlined within the Framework. The Frameworkdocumentshouldbe made
  publicly available in both the United Statesand in Angola. The GRA, the USG and
  other k9y partnersshouldreview progressagainstbenchmarks a semi-annual
                                                               on             basis.
-l\l


                                                                                       4
CapacityDevelopment:Frameworkobjectivesand strategiesshouldbe defined and
implementedin a mannerthat encourages     local humanand institutional capacity
developmentwithin both the public and non-govemmentsectors. The GRA ueated a
                                                                      for
new Secretaryof Stateof Higher Educationto build Human Resources Health
(HRH) partnershipsand Human CapacrtyDevelopmentleadershipthat will focus on the
entire health and public servicesector. The GRA intendsto establishfive new medical
schools,severalnursing schoolsand technical institutions. The Frameworkshould
assistthe new Secretaryof Stateof Higher Educationon the HlV/health components    of
HRH. Policy reform shouldtarget recruitment retention and task shifting of HRH to
supportthe demandfor expansionof integratedHIV services.

Flexibility: The Frameworkshould havethe flexibility to respondto a dynamic
environmentand emergingissues,suchas changes funding commihnentsof partners
                                                   in
and new evidencefrom M&E and surveillanceinformation, specialstudiesand
operationalresearch   with regardto progressof the epidemic,programperformance,and
cost-effectiveness implementedinterventions. The FrameworkM&E plan shouldbe
                   of
moilified and updatedas actionableevidenceis obtainedand the national strategicplan
revised.

LeveragingGFATM iwestments:Achievingnationalscale-upand significantimpactis
dependent leveragingfulI implementationof GFATM requirements.The
         on
Frameworkshouldbe designedand implementedto promotethe success GRA's
                                                               of
GFATM grants.

Proven Strategiesand Approaches:All Frameworkprogrammingshouldbe
implementedwith evidence-based best-practice
                              and            approaches.

Expandingpireventiveactivities and servicefulivery while enharrcingcoverageand
quality: The Frameworkshouldbuild and improve programmingwhile ensuringthat the
coverageis maximized,basedon the epidemicand sustainingqualrty services. To do
this the Frameworkshould supportscale-upof preventionand HIV/AIDS services
through an integratedresponse that recognizes interdependence
                                              the                  ofeach part ofthe
health systemand encourages  continuity of care for an individual acrosslevels of care
and over a lifetime.

Building Policy: Policy level interventionsrepresentan importantpiece in the
sustainabilityof the Frameworkand the long-term success the HIV/AIDS program in
                                                         of
Angola. This Framework shouldwork to expandand improve policies to help this
program succeed.

Addressinggender ltorms and stigma; The Frameworkshouldpromoteand support
approaches ensureboth men and women have equal access prevention,care,
             that                                              to
treatment,and support;addresssocial and cultural nonns that fuel HfV transmissionand
promotethe adoptionand full implementationof national policies to address  these
drivers of the epidemic;and improve the statusand rights of peopleliving with
HIV/AIDS (PLWHA) and other groupsvulnerableto HIV/AIDS in Angola. Policy
reform shouldfocus on genderequity, stigma,and discrimination that impact access of
most at risk  populationsto HIV prevention,care and treatnent services.
tr.    FIVE.YEAR STRATEGIC OYERYIEW

Background:

The best information availableto date indicatesthat Angola hasa mixed epidemic;
therefore,both Most at Risk Populations(MARPs) and generalpopulation groups
shouldbe targetedunderthis Framework. Angola hasan estimatedHfV prevalenceof
2.1 percentamongadultsagedl5-49. Analysisfrom ante-natal         (ANC) studiesin2A04,
2005and 20i07reveals   increases  in prevalence over time.  Since2004,prevalence
amongyoungpregnant      womenhasrisen from2.7 to 3.1 percent.A countrywith an
estimated   populationof 17 million, Angola is bordered the high-prevalence
                                                         by                   countries
ofNamibia andZafi:'llria, well as the DemocraticRepublic of the Congoand the
                         as
Republic of the Congo (Brazzaville). It is separated only 40 kms of Namibian
                                                      by
territory from Botswana. A review of estimatedprevalenceby province reveals
                                                                 on
significantlyhigherratesalongthe border,especially Cunene Namibia's border,
                                                       in
wherethe    prevalence is estimated 9.6 percent.
                      rate              at

The main mode of transmissionis heterosexual      sex; and the commonpractice of
multiple concurrentpartnersis an important driver, though dataneedto be strengthened
to improve understanding the dynamicsof the epidemic. Commercialsexworkers
                           of
and mobile workers (including truck drivers, miners,military personneland the police)
are assumed be the most at risk populationsas they are in other sub-Saharan
             to
counkies. Little is known aboutmen who have sexwith men (MSM) in Angola. HW
prevalence  amongsexworkerswas reportedat23.l percent(UNAIDS, 2008). An
estimated percentofyoungpeopleagedl5-24 in the general
           77                                                     populationdid not
correctly identiff ways of preventingsexualtransmissionof HIV, and up to 32 percent
ofyouth initiatedintercourse  beforethe ageof 15 (JNAIDS, 2008). Low knowledgeof
HIV preventionand early sexualdebutreinforce the GRA focus on generalpopulation
                                                             in
youth as an important risk group. Young women engaged transactionalsex also
emergedas an important    population for further investigationin an unpublished
qualitative assessment Cunene,the province with the highestHfV prevalence. Male
                       in
circumcision(MC) is a cost-effective  biomedicalinterventionandan essential
componentof a comprehensive     combinationpreventionpackage. Although the
prevalence male circumcisionin Angola is thoughtto be high (UNAIDS), no
            of
concretedataarc currently available.

Angola sufferedcivil strife for four decades, it fought for independence
                                             as                            from
Portugal(1961-75)and engaged a protracted
                                  in            civil war until 2002. This contributedto
a devastated health infrastructure. Post-warAngola is also in dire needof qualified
personnelto perform almost all tasksrequiredfor appropriatehealth sectorfunctioning.
Angola currently hasone doctor, fourteennurses,one laboratorytechnician,and less
than onepharmacist 10,000people. Only 15 percentof the healthwork force
                      per
provides servicesin rural areas,where over half of the population lives. The useof the
nation's resources fight the waroalong with massivepopulation dislocation, led to
                   to
sustained high levelsof poverty,with 21 percentof the populationnow living in
extremepoverty. This poverty, coupledwith low access health services,translates
                                                         to                          to
poor health conditions,particularly for pregnantwomen. An estimated90 percentof
pregnantwomen living with HIV do not receiveantiretroviral therapy for preventing
mother-to-child transmission  (UNAIDS, 2008).


)v                                                                                    6
Tuberculosis(TB) is the most commonopportunisticinfection in HIV- infected
patients,resultingin significantmortality and morbidrty. The MoHNational TB
Control Program(PNCT")      estimateof HIV prevalenceamongTB patientswas up to
l5Yoin2007 blutlessthan 9 o/o'of TB patientsaretestedfor HIV, according national
                                                                            to
TB programdata. The numberof TB cases       notified to the WHO by the PNCT hasmore
than doubledbetween1990-2007,       from2l,634 to 48,777,  despitesignificantunder
reporting due to the fact that DOTS (the WHO stratery for global TB control) covers
only 70 percentof the country and lacks essentialsystemsfor M&E. TB prevalenceis
estimated be 294/ 100,000
          to                             (WHO, 2009).
                               inhabitants

Now, sevenyearsafter wars' end, increased mobility of the population,expanded
commercewith high-prevalence   countries,urban primacy, a largeyouth population,
high-risk sexualbehaviors,and the precariousstateof the health infrastructureplace
Angolans at heightenedrisk of HIV infection, seriousopportunisticinfections, and
AIDS.

        Focus
Strateeic

The strategicvision for this ParbrershipFrameworkis not only to scaleup HIV
prevention,care,and treatmentservicesin Angol4 but also to move toward increased
country ownershipand a more sustainable   response the HIV epidemic in Angola.
                                                 to
The Parhership Frameworkshouldwork toward this vision for increased    country
ownershipand sustainabilityby forging new types of relationshipsamongthe USG, the
GovemmentofAngola (GRA), and other implementingpartnersin supportofthe
principle of the three ones,wherein the USG and GRA, in consultationwith other
stakeholders,  intendto engage a joint decision-making
                               in                      process  aboutpriorities,
             and
approaches the allocationofresources.

The strategicfocus of the USG in this PartnershipFramework shouldbe on health
systemstrengthening,  strategicinformation, and preventionwith MARPS, youth (and
other groupsand/or drivers of the epidemicto be identified); on geographicborder
regionswith higher prevalence;and on specific programmaticareas(including PMTCT
andTBA{IV co-infection). Programming male circumcisionin Angola shouldfocus
                                         for
on building the evidence basefor decisionmaking. The strategic   focusshouldalso
addressstigmaand discrimination againstHIV positive people,and encourage    peopleto
get testedand stay negative. This partnershipshouldpromotethe inclusion of People
Living with HIV/AIDS (PLWI{A) at all levels of programplanning and
implementation.

Angola's National Strategic   Planfor HIV/AIDS (2007-2010) the nation'scurrent
                                                                is
plan. As a result of the devastated                      there is little to no baselinedata
                                    health infrastructureo
from which to formulate specific and measurable     goals. The National StrategicPlan in
its presentform measures    primarily outputsand someoutcomeindicators. The GRA
hasaskedthe USG to help build the evidence      basefor decisionmakingas a primary
componentof its contribution to the partnership. This Framework shouldfocus on
implementing  baseline   studies,includingthreebehavioralsurveillance      surveys (BSS)
with MARPS, an AIDS Indicator, and qualitative studieson sexualbehaviorand male
circumcision. Operationsand qualitative researchis also neededin order to increase      the

' TB Round Proposal
          9        for GFATM
efficiency and effectiveness preventionprogramming. Operationsresearchis
                             of
particularly important in the context of limited resources  and in conjunctionwith the
extraordinarily high cost of operationsin Angola. In addition to scalingup prevention
programming,contributing to the evidencebaseon what works programmaticallyin
Angola is an essentialcomponentof the national response the HIV epidemicover the
                                                             to
next five years,and shouldbe a major contribution of the USG underthis Framework.
Thesedata shouldbe usedin the subsequent       yearsof this partnershipto developdata
driven programmaticresponse the corresponding
                                and                     allocation of resources.

While collecting strategicinformation is a crucial first stepin mitigating the HIV
epidemic in Angola, it will be necessary respondprogrammaticallyto both existing
                                         to
and new information if the country is to achieveits goal of maintaining a population-
wide HIV prevalence   below 3%by the year 2013. Scalingup targeted,       cost-effective
and evidence-based  preventioninterventionsshouldbe a major contribution of the USG
underthis Framework. Initially the USG also plansto contributeto areaswhere there is
alreadysomeexistingdatato inform programs.This shouldincludeservicedeliveryin
TBIHIV and PMTCT as well as preventionprogrammingthat targetscommercialsex
workers, transactionalsex,military and educationprogramsfor youth.

Additionally, during the first year of this partnership,the GRA plansto begin the
development the upcomingNational Strategic
              of                                   Plan for HIV (2010-2014).UNAIDS
will providetechnicalassistance the GRA in the development this plan, andthe
                                  to                              of
USG should engage   in this process. At the outset,this PartnershipFrameworkintends
to adoptthe national targetsthat Angola set in the first National StrategicPlan and the
subsequent  modification madefor the Round 8 and Round 9 GFATM grants. The
Frameworkmanagement       team, at the moment comprisedof the INLS, USG and
L}NAIDS   (seealso SectionV: TechnicalOversightand Monitoring) shouldengage a        in
consultativeprocessto set specific and measurable    goals to measure progressof the
PartnershipFrameworkagainstthesetargetsover the next four years. The Partnership
Frameworkgoals shouldbe adjustedto align with the seconditeration of the National
StrategicPlan. The USG's contributionsin the areaof strategicinformation shouldhelp
the governmentto setmore specific and measurable      goals asthe evidencebaseis
established.

                                                    is
The strategicvision for health systemstrengthening to focus on sustainable
approaches rebuild the devastated
            to                      health infrastructurein Angola. To achievethe
goalsofthis Framework,an effective investmentin health systemand servicesis
necessary.The strategyfor health systemstrengtheningshouldbuild on the World
HealthOrganization's   (WHO) Frameworkfor Action elements.Diagnosisof health
systemconstraintsand policy analysisand management      shouldtarget priority areasthat
include laboratoryand supply chain management    systems. The long-term solution for
sustainable HRH capacitydevelopmentis to train Angolan health careworkers through
a partnershipthat improvescoordinationand collaborationwith the GRA, the private
sectorand other key stakeholders  suchasnational scientific and accreditationentities.
To build human capacityto confront the county's HIV epidemic,pre-serviceand in-
servicetraining shouldbe complemented    with proven clinical mentoringprogramsand
continuousHIV quality improvementinterventionsto facilitate task shifting and to
encornage  systemschangefor increased   efficiency that ensures provision of high-
                                                               the
qualrty careand treatment;and with work with healthcare facilities on systems
(\/
\
interventionsto improve servicedelivery; monitoring and evaluation;surveillance;
adherence prevention
           and           counseling; decenfialization
                                    and                  ofhealth services.

This Frameworkshouldbe supportedand leveraged          with other USG-fundedactivities in
Angola" namely the President'sMalaria Initiative,    Avian Influenza Program,
Tuberculosis,Matemal and Child Health, and ReproductiveHealth programs. The
Framework shouldbe complemented an implementationstrategyto be set forth in
                                         by
the PartnershipFrameworkImplementationPlan (PFIP), which is expectedto describe
the role of all partners, includingcivil society,in conjunctionwith INLS. The PFIP
should detail Health SystemStrengthening      (HSS); HRH; pollcy reforms; respective
partnercommitments;a comprehensive         monitoring and evaluationplan; and innovative
preventioninterventions,including the introduction of male circumcision, ifwarranted,
positive living initiatives with military, and addressing male nonns and behaviors.
PEPFAR'scomparative        advantage Angola lies in the initiative's global experience:
                                      in
providing evidence-based     technicalassistance, forming partnershipswith private sector
corporations,and leveragingresources      from other USG-fundedinitiatives.

CountryResponse

The Angolan government'sNational Health Policy is harmonizedwith the GRA
Poverty Reduction StrategyPlan and the Millennium DevelopmentGoals(MDGs).
With its own budgetaryline item in the health sectoroperationalplan, the INLS makes
patentthe Angolan government'scommitmentin this fight. The GRA financed 82
percentof total expenditures HIV, including an estimated50 percentof expenditures
                              for
targetedon HfV preventionprograms(IINAIDS 2009). The GRA's response HIV         to
was strengthened the creationof the INLS, the increasein the availability of funds,
                  by
and the partnerships with internationaland national organizations,  including the Global
Fund Round 4 grant,which hashelpedto financeHfV treatment,care and support. The
creationofthe AngolanNetwork of AIDS ServiceOrganizations          (ANASO), the
network of people living with HIV (RNP+), and a network of faith-basedorganizations
(RedeEsperanga)   enhanced   civil society's role in the HIV response.The Angolan
BusinessAlliance againstHIV/AIDS (CEC, Comite Empresarialde Combateao
VIIVSIDA in Portuguese)    was established 2006 to coordinatewith national and
                                             in
intemational companies   that promotepreventionand mitigation of HIV in both
workplace programsand the community.

Ia2007, HfV expendituresincluding prevention,treatnent and infrastructurewere
approximately $47.5million USD, of which 82.1percentwas providedby the GRA. Of
this amount $23.7million USD was spenton prevention activitiesand $17.1million
USD on careand treafrnent(IINAIDS 2009). Angola currently benefrtsfrom three
Global Fund grants,totalingalmost$200million USD. One grantis for HfV, one is for
malaria,andone is for tuberculosis.The HIV and TB grantswill end in 2010;
         Round 9 applicationswere submittedfor HIV and TB.
thereforeo

Sustainabilityrestson the GRA's commifinentto achievea high percentage budget
                                                                         of
executionof national health accounts. GRA's overall health expendituresincreased
from 4.1 percentof the nationalbudgetin20061'o6.7 percentin 2008,in line with the
govemment                                                plansfor health
             goal of 15 percentby 2015. Public investonent
infrastructureincreasedfrom 2. I percentn 2006to 7.6 percentin 2008 (R9 GFATM
Proposal). Under the conceptualframewort set out by the United Nations Development
Program(UNDP) on capacitybuilding, the United Nations will supportthe Government
in designinga comprehensive   capacitydevelopmentpackageensuringthe creation of a
broad coalition aroundthe MDGs through mobilization, partnerships,
                                                                 alliancesand
networking with the private sectorand civil society.

Geographic   focus
The MOH-designatedpriority provincesinclude Angola's borderprovinces,where
ANC data show highestprevalence;Luanda,Angola's capital,which containsroughly
one-thirdof the population;and Huambo,which hasanotherof Angola's major cities.
USG supportis alignedwith thoseprovincesdesignated priority areasby the MOH,
                                                        as
i.e.,Luand4 Huambo,Cuneneo      CuandoCubango,   LundaNorte,Lunda Sul, Moxico,
Zaire,Bengo,Huil4 and Cabinda. A strategicpreventionportfolio should focus its
efforts on key risk groupsand contexts. The collection of strategicinformation should
continually refine target geographicareas.

Kev intervention areas

Goal I:                  itv for an effective national resoonse combatHIV/AIDS.
                                                               to

During Angola's wars, a tremendousamountof health infrastructurewas destroyed;
sevenyearson, there is still limited access health services. Peoplemigrated en masse
                                            to
to urban centers,therebytaxing those   cities' precarioushealth systems. The task of re-
building and strengthening  Angola's health systemis enormous. An updatedHIV
National StrategicPlan is essentialto guide HIV/AIDS action for the next five years
and should also strengthen basisofthis PartnershipFramework. The USG intends
                           the
to supportthis upcomingefilort and also the ongoing decentralizationprocess[o
provincesand municipalities through TechnicalAssistance(TA) support. In
collaborationwith the GRA, the USG intendsto supportan assessment the National
                                                                       of
Health System.Existing and future GFATM        grantsneedTA supportin management
and proposalwriting. This partnershipshould strengthen    Angola's health systemin key
ways that build on the World Health Organization's(WHO) Frameworkfor Action
elements:l-health workforce, 2-health information, 3-servicedelivery, 4-medical
products,vaccineand technologies,5- health financing, and 6-leadershipand
governance:

Health Workforce: The long-term solution for sustainabilityis to train Angolan health
careworkers. As a first step,this partnershipwith USG technical assistance   should
conducta humanresources health (IRI{) assessment, supportthe creationof a
                             for                           and
national electronichealthworkforce information system(HRIS) to promotethe strategic
planning and humanresources                                              for
                                 developmentplanning that are necessary Angola to
meet its humanresources healthneeds. Basedon that plan, the Partnership
                           for
Framework shouldpromotepolicy reforms that focus on task shifting from doctorsto
nursesand from other specializedhealthworkers to community healthworkers (lay-
counseling);and addressconcemsrelating to recruifrnent retention,and administration
of humanresources.In collaborationwith UNICEF, the USG should continueto
supportcurriculum developmentand clinical mentoring in HIV preventionand care
servicesthat target community-based    midwives in high HfV prevalenceregionsto
support the MOH 2009 National ExecutivePlan goalsto reduceAngola's maternaland
infant mortality, one of the highestin the world, estirnated 1,400per 100,000and ll4
                                                            at
per.1,000 live-birth,respectively  (UNICEF 2009). In-service   trainingrelatedto
PMTCT, VCT and treafinentshouldbe expandedand linked to updated        job
responsibilitiesand capacityto have an impact on the qualrty of the servicesoffered.
USG responded the MOH's request strengthen public healthepidemiology
                 to                   to           the
workforce by supportinga Field Epidemiology and Laboratory Training Program
(FELTP) assessment.   Basedon the resultsof the assessment, Framework,in
                                                             the
partnershipwith the GRA and private sectorshould strengthenlaboratoryand public
healthworkforce capacrtyto address infectious disease
                                    the                   control priorities through
                and
evidence-based best-practice     approaches.

Health Information: The governmentof Angola recognizesthat monitoring and
evaluationare essentialprogramaspects determinewhether interventionsare having
                                        to
their plannedeffect and at what cost. The GRA launchedits national Health
Management    Information System(HMIS) in 2008,which will be harmonizedwith
existing information systemsfor HIV/AIDS and TB. The USG providestechnical
assistance the National AIDS Institute to improve its monitoring and evaluation
           to
system. Angola hastaken important stepsto improve its datacollection and health
information system,but the systemneedsadditional improvementto ensurehigh quality
of the production,analysis,disseminationand useof reliable and timely information on
health determinants and health systemperformance. The partnershipshouldhelp the
GRA meetthis challengein collaborationwith other key stakeholders inand
conjunctionwith other USG programsin malari4 reproductivehealth,tuberculosisand
matemaland child health. In collaborationwith IINAIDS and other multilateral
agencies, USG intendsto provide technical assistance
          the                                           targetedat HfV facility-based
and community-based   services,including PMTCT, TB/IilV, STI and prevention
services,to strengthen datacollection and monitoring systemsin the provinces
designated priorities by the MOH.
            as

Servicedelivery: Functional referral systemsare essentialfor the qualtty of health
servicedelivery. The USG plans to work with the GRA to improve referrals in quality
and quantity to ensurethat clients are linked to a comprehensiveconstellationof
services.The GRA has identified laboratoriesat the national and regional levels as
priority areasthat warrant continuedstrengthening.The partnershipshould supporta
strongnational laboratoryand establishreferral networks for decentralized  facilities that
require routine and specializedHIV and tuberculosislaboratory servicesin the
provincesdesignated priorities by the GRA. ln collaborationwith the World Health
                      as
Organization(WHO), the USG intendsto supportimprovementsand monitoring of the
                                                                       lab
quallty of HIV and TB diagnosisand supervisionin order to strengthen capacityas
well as PMTCT, VCT, careand treafrnentat the national and municipal levels in
targeted provinces.

Supply Chain System:A strongHIV/AIDS programrequiresa reliable supply of
commodities,amongthem HIV test kits, anti-retroviral drugsand condoms(GRA, USG
and UNFPA). Joining efforts with PMI, PEPFAR intendsto provide technical support
to conductan assessment the national HIV supply chain management
                        of                                              systemto
bridge gaps,to achieveeconomiesof scalein ARV procuremenf and to strengthen
capacrtyto forecastneedsof drugs and laboratorycommoditiesfor HIV and TB
services. Commodity security shouldbe bolsteredalong the entire supply chain through
GRA extra-healthsectorpolicy actionso including but not limited to the port of enby,
customs,warehousing,distribution to ths field, storage,useand monitoring.
      Health Financing: This PartnershipFrameworkplansto provide supportfor provincial
      level operationalplanning financial monitoring and gap analysis,including follow-up
      supportto the National Health Accounts already supportedwith PEPFAR funds during
      2009. The USG shouldprovidelong-termcomprehensive                            to
                                                              technicalassistance Global
      Fund grantsin relatedareas,including developingand analyzing   grant proposalsand
      work plans, improving financial managemen!accountabilrtyand planning systems,and
      identifuing ways to shengthenthe Country CoordinatingMechanism's(CCM) technical
      oversight. The partnershipshould respondto relatedneedsfor technicalassistance   that
      build Angola's capacityand leadto a sustained response.

      Leadershipand Governance

      USG technical assistance   should shengthenmanagement leadershipcapacityacross
                                                               and
      programareasthrough haining effcrts and policy reform relatedto HRH (task-shifting,
      provider- initiated testing and counseling,privacy and confidentiality, stigmaand
      discrimination, professional
                       and              ethics),andto genderinequities. The USG shouldalso
      supportprogrammaticmappingamongpartners,completing the inventory of all
                   s
      stakeholder' activities in HIV/AIDS.

      Civil SocietvStrengfhenine

      Underthis Framework, USG shouldhelp build the capacityof civil society
                               the
      organizationsthat seekto leadthe community-based      response HIV in Angola,
                                                                      to
      including NGO capacitybuilding for improved management M&E systems. The
                                                                     and
      Global Fund is currently providing support,through the GRA, to sexworker and other
      organizationsthat target MARP in the form of grants. The USG intendsto add to this
      effort by continuing to provide technical assistance community -basedorganizations
                                                          to
      in the form of technical and organnationalcapacitybuilding. In addition, USG support
      should strengthen  civil societycapacrtyin the developmentand roll-out of a national
      toolkit to guide preventioninterventionsthat target specific risk groups. The USG
      shouldalso supportfaith-basedorganizationsthat have a strongdesireto address     the
      HIV epidemic,but requiretechnical assistance    relatedto effective behaviorchange
      communicationand building management        capacity. Under this Framework,the USG
      shouldcontinueto supportcommunity-based        programsthat link HlV-positive pregnant
      women with PMTCT servicesas well as civil societyorganizationsthat work with
      youth in the areaof sexualprevention. The USG should also continueto support
      organizationsof peopleliving with HIV/AIDS that advocateincreased             to
                                                                             access care
      and treatmentand the right to live free of stigma and discrimination. USG should
      promotethrough its civil society implementingpartnersthe conceptof positive living
      across programareas.
              all

                                (PPP)
      Public PrivatePartrrerships

      The CEC was createdwith strongUSG involvement in 2006 to representand coordinate
      HIV/AIDS activitiesin the privatesector. Angola's CEC, with a membership    of
      approximately privatebusinesses corporations,
                     150                   and              shouldbe reinvigorated   under
      this Frameworkto carry out its chargeto coordinatewith national and international
      companies  that promotepreventionand mitigation of HIV in both workplaceprograms
      and the community. Especially in this time of economiccrisis, poverty exacerbates the
      impact of HIV. Employmentand income-generating     activities can mitigate this

'J
     iar
                                                                                          t2
              contributing force to the spreadof HIV in Angola. Under this FrameworkUSG support
              of HRH, SI and preventioninterventionsshouldbe leveragedwith existing and new
              PPP.


              Goal tr: Reduce growth of the HIV epidemicthroughcombination
                                the                                       preventionthat
              is cost-effective
                              and

              This partnershiprecognizes  that a combinationof preventionmethodsis requiredto
              address most effectively the biological, behavioraland structuralfactors that influence
              the courseofthe epidemic in Angola. The choice of combinationsdepends the target
                                                                                           on
              goup or the region. For example,a basicpackagefor CSW would include VCT and
              STI services,BCC, condomsdistribution, and family planning, complemented policy  by
              reform targeting discrimination and gender-basedviolence. Reducingthe vulnerability
              of women and addressing    genderinequality are alsocomponentsof the national
              strategicplan for prevention,as is focusing efforts in priority provinces,especiallyin
              bofder areas. The USG should coordinatewith UNAIDS and the GRA to conducta
              genderassessment developa joint plan for implementation. The USG and the
                                 and
              GFATM are currently working with MARPs, but funding shouldbe expanded have      to
              greatercoverageof thesepopulations. Refinementand implementationofadditional
              interventionscan be informed as the information from BSS and other studiesbecomes
              available.

              Target:High risk Broups (includineCSW and mobile populations.
                                                                          including
                          militarv. miners and police)
              transporters.

              o Biomedical -Male and female condompromotion, procurementand dishibution
                (GRA, USG and other stakeholders)     shouldbe included in all prevention
                interventionsthat target high risk groups. The lack of a basic packageof services,
                including VCT services,microbicidals, and STI diagnosis,referral and treatmentfor
                thesepopulations,and promotion of 'friendly' facilities are currentprogrammatic
                gapsthat this PartnershipFrameworkshouldaddress.

              o Behavioral -BCC and community outreachand health educationin underserved
                areasare important components     ofthis preventionstrategy(GRA and USG).
                Provincial healthworkers and NGO activists shouldbe trained to coordinateand
                implementprojects for sex workers (GRA, USG and civil society). Peereducators
                and activists should also be trained to conductmappingof MARPs and implement
                activities in all provinces(GRA and USG). Global Fun4 through the GRA,
                currently supportsorganizations   targeting MARPS. Under this partnershipthe USG
                shouldcontinue supportingthis effort by providing technical assistance
                                                                                     for
                or gannationalcapacitydevelopment.

           o Struetural - Under this Framework,the USG shouldprovide technical assistance    to
              the GRA to establisha basicpackageof servicesfor MARPS as a nonn within the
              existing public health system(USG and GRA) including to harmonizeand align at
              the provincial level activitiesand guidelines                           referral
                                                           relatedto STI/HIV diagnosis;
              to treatmentshouldbe strengthened sustainable
                                                   for            delivery (GRA). Developing
              STI sentinelsurveillanceto monitor STI trends in the country and amongMARPs
              would help monitor the impactof basicservices.Guidelines training curricula
                                                                            and
         a r,
----t*   \t
                                                                                                 l3
   on educationalinterventionsshouldbe reviewed and revisedas appropriate(GRA
   andUSG). A condomlogisticsmanagement      systemshouldbe developed  (GRA,
   USG and {.INFPA).

Target: GeneralPooulation

Youth

   Biomedicol- Procureand distribute condoms(GRA, USG and civil society
   organnations). Under this Framework,the USG shouldprovide technical assistance
   to the GRA to strengthen sustainable
                           the           delivery within the existing public health
   systemof VCT and STI diagnosisand treatmentthat is targetedto youth at high risk
   for infection (USG and GRA).

   Behcvioral - Produceand distribute IEC materialson HfV preventionto students.
   Organizepeer education,behaviorchangecommunication(BCC) and community-
   basedactivitieson HfV preventionin-schoolandout-of-school    youth, including
   gendernonns, genderinequality, and    gender-based
                                                    violence (GRA and USG).
   Supportsocial marketing,massmedia communicationand campaignstrategies        that
   raise realistic risk perceptions,awareness understanding risks associated
                                            and              of                  with
   multiple concurrentpartnersand transactionalsex,and that promotemessages    on
   genderequrty(USG). The USG shouldconducta BSS on youngwomenengaged               in
   transactionalsex in the southwherethe HIV prevalenceis highest. In addition a
   Priority for Local AIDS Control Effort (PLACE) study shouldbe conductedin
   venueswhere peoplemeetnew sexualpartnersto understand      sexualbehavior in its
   socio-culturalcontext. Thesedata shouldbe usedto inform future programming.

   Structural - Supportteachertraining and training of other school-based
   professionalson HIV prevention;and review and updatetraining materialsand
   guidelines school-based
                for             sexualhealtheducation.Train communityhealth
   workers to conductmappingof out-of-schoolyouth populationsand to implement
   activities in all provinces(GRA and UNICEF). Bring togetherthe complementary
   capabilitiesof the public, private, and civil society sectorsto uniff interventionsfor
   youth under a single strategyand sharedbrand, build on proven approaches       for
   changingbehavior,engage     youth andempower       them with a positivevision, provide
   access economicopportunities,
           to                          address  girls' uniquevulnerabilityto HIV (and
   specifically to reducetransactionalsex) and use strategicinformation, including
   market research, inform interventions(USG and UMCEF).
                      to

Men

o Biomedical -The findings of the recentMultiple Indicator Cluster Survey(MICS)
  and future AIS should help to determinethe prevalence MC in Angola at the
                                                        of
  provincial level. Secondary  dataanalysison socio-demographic  characteristics
  relatedto MC, as well as a geographicmapping using AIS data,shouldhelp
  determinewhetherfurther programmingis necessary.In addition, a qualitative
  situationalassessment circumcisionservicedelivery shouldbe conducted
                         of                                                    to
  understand  where malesare getting circumcised,at what age,the social-cultural
  factorsthat influence the decisionto be circumcised,what types of facilities and



                                                                                      I4
   providers are conductingcircumcision,the level of access circumcision,and the
                                                          to
   quality of circumcisionservices.

   Behavioral - This Framework shouldpromote interventionsthat address   male
   nonns and behaviorsthat increaseboth male and female vulnerability to HfV such
   as gender-basedviolence, engagement transactionalsex"men's weak
                                        in
   participation in PMTCT and reproductivehealth services. Condomuseand partner
   reduction shouldbe promotedunderthis Framework(GRA, USG and UNICEF).

   Structural - Country ownershipand leadershipare critical for formulating national
   policies, developingstrategies,and implementingrecommendations    aroundMC.
   OnceenoughactionabledataaboutMC are available,the GRA and partnersshould
   assess policy formulation, programplanning and implementation.


Goal III: Mitigate the socio-economicimpact of HIV/AIDS on the individual, family
and communitv.

Treatmentand careare supportedby the Angolan governmentin collaborationwith civil
society,a sharedresponsibility that shouldcontinueunder the Framework. The
governmentof Angola supportsthe majority of HIV careand treatmentprogramming.
The target population for careis people living with HIV/AIDS and their extended
families, including orphansand vulnerablechildren. Treatmentand careobjectivesare
to increase access people living with HIV/AIDS to treatmentservices;in
            the       of
collaborationwith the GRA, USG supportshould increase quantity and quality of
                                                          the
VCT centers. USG supportshouldalso improve the quality of diagnosisand treatment
of peopleco-infected                    in
                      with tuberculosis; coordination   with civil societyandthe
private sector,improve and strengthen health referral systemfor peopleinfected
                                      the
with and affectedby HIV/AIDS; and promote Provider- Initiated Testing and
Counseling.

The 2009-2013Angola National TuberculosisStratery seeksto promoteand expand
strategies increasingdiagnosisand management TB/FIIV co-infection by testing
          for                                     of
100percentof patientsdiagnosed   with tuberculosis.The USG intendsto provide
technicalassistance supportTB/I{V health systemstrengthening,
                    to                                            surveillanceand
integration. Through a thoroughassessment the national tuberculosisprogram,the
                                           of
Framework should identifr high-impact areaswhere synergiesinvolving the national
HIV/AIDS program,the national tuberculosisprogram,and the National Institute of
Public Health can increaseTB/HIV collaborativeactivities. Both TB and HIV
programsshouldbe entry points for the prompt identification and casemanagement  of
co-infectedpatients. Under this Framework,USG suppor[ in collaborationwith WHO,
should featuremonitoring the HIV epidemic in TB-positive individuals, strengthening
DOTS, and increasingthe country's capacityby training providers in the proper
management patientsinfectedwith TB/!ilV and multi-drug resistantTB (MDRTB).
              of
In coordinationwith WHO and Global Fund grants,the USG intendsto provide
technicalassistance assess electronic datacapturesystemthat should serveas a
                    to      the
patientmanagemen!    M&E, and surveillance tool. Community-based    resourcesshould
be engaged developfunctional referral systemsthat link HIV and tuberculosis
            to
services,therebyenablinghealth systemsto copewith the doubleburdenof HfV and
TB and shortages skilledhealthpersonnel.
                 of
ThroughoutAngol4 initiatives to supportorphansand vulnerablechildren are
implementedby govemmentand civil societyorganizations(Community-Based
Organizations,Non-GovernmentalOrganizations,and Faith-BasedOrganizations)with
supportfrom externalpartners. A successfulpriority interventionby the GRA is
keepingchildren in communitiesratherthan in orphanages.Theseprogfttmsprovide
psycho-social physicalhelp to wlnerable families.
             and

Mobile VCT and linkagesto care and treatmentshouldbe targetedat hard-to-reach
military personneland surroundingcommunities. The Angolan Armed Forces(FAA)
are concemedthat many of their HlV-positive personnelcome for medical assistance
too late to receivethe careneededto prolong and improve life. Most of them cannot
easily be tracked for follow-up purposes(e.g. sfengthen drug adherence).Under this
Framework,the USG shouldprovide technical assistance setting up a "positive
                                                         for
                                                                                  and
living" programin the military in addition to faining psychologists,lay counselors,
physicians ARV techniques development policiesto combatstigmaand
             on                 and               of
diserimination.

Prevelrtingmother-to-child transmission(PMTCT) is a key goal of the Angolan
                                                                    the
govemment'sHIV/AIDS plan, both to reducecontagionand attenuate socio-
economicimpact on individuals, families, and communitiesinfected and affectedby the
disease. Under this Frameworlgin partnershipwith the GRA and UMCEF, USG
supportshould scaleup the preventionof matemal-to-childtransmissionincluding
Early Infant Diagnosis(EID) as a way to evaluatethe impact of the PMTCT scaleup.
PMTCT supportshouldbe done in an integratedway with family planning and maternal
and child health servicesfocusedin high prevalenceborder regions.

o Biomedical -Male and female condomprocurement distribution and programming
  in the context of wider sexualand reproductivehealth services(GRA and USG).
  Expandingaccess PMTCT and EID servicesby targeting family planning and
                     to
  maternal-childhealth clinics as entry points and by implementingroutine opt-out
  provider-initiated testing for all women in antenatalclinics OSG). Treatmentof
  sexually transmittedinfections targetedto women in reproductivehealth clinics in
  selectprovinces(GRA).

o Behavioral -Promote community-basedinterventionsto increase ANC visits of
  pregnantwomen, PMTCT and adherence HfV
                                      to     prophylaxis in higft prevalence
  areas(USG, GRA).

c Stntcturol * Promotepolicy designfor task-shifting and lay-counseling,and
  strengthening linkageswith MCH, FP and HfV prevention,treatrnentand care
  services(USG). Establish  monitoringprocedures ensure
                                                   to       that all HlV-positive
  pregnantwomen and exposedinfants receiveappropriateprophylaxis (USG).
       trI.             ROLES AND COMMITMENTS
               PARTITERS'

       PartnershipParticipants:

       The central partnersfor this Frameworkare the GRA and the USG. Although signature
       of this Frameworkrestssolely with the GRA and USG, the spirit of the Framework is
       inclusiveand consultative.Achievement the Framework'sobjectivesis dependent
                                                   of
       on the  roles and contributionsof numerouskey stakeholders    including GFATM, civil
       society,UN agencies,                                    bilateral partners,NGO's and
                               ofher multilateral organizations,
       corporatepartners.

       Anqolan government:the Minister of Health, representing CNLCSGE; the Ministy
                                                                 the
       of Health, especiallythe National AIDS Institute (INLS), the National Directoratefor
       Public Health, and the network of Provincial Health Directorates;the Ministry of
       Defense/Angolan    Armed Forces;Ministry of Education;  Ministry of Family and
       Women'sPromotion;Ministry of Finance;Ministry of SocialWelfareandReinsertion;
       Ministry of Youth and Sports;Ministry of Planning;Ministry of Public Administration,
       Employmentand Social Security; Secretaryof Statefor Higher Education;National
       Children's Institute (INAC); the Secretaryof Statefor Rural Development;and the
       Ministry of lnterior.

       USG: Underthe leadership the U.S. Ambassador, diplomaticmissionof the USG
                                 of                     the
       in Angola Inter-Agency PEPFARteam, comprisedof the U.S. Agency for International
       Development   (USAID); the U.S. Department Healthand HumanServices'Centers
                                                 of
       for DiseaseControl andPrevention                          ofDefense(DOD); the
                                        (CDC); the U.S. Department
       U.S. Department State(DOS); and,potentiallyas of 2012,the U.S. Peace
                        of                                                  Corps.




To strensthen the capaciWof the national responseto fight the HIVand AIDS

By 2013 Angolaintends to (dependent on a successfulRound9 GFATM):
. Decentralize management the national response the 18 provinces
               the                of                     to
. Expand  and promotethe response fight HIV/A|DS 27 ministries
                                      to              by
. lncrease active participation in the network organization commerciatsector assistance
                                                           of                            (CEC) up to
                                                                                               by
    100companies that haveworkplaceprograms ptace (USG
                                                in            intendsto providetechnicatassistance 5
                                                                                                  to
             per
    companies year)
, Support surveiltance system 61 municipalities
                              in                   (basetine:36)
' Suooort information  svstems 18 orovinces 72 heatthunits
                               in              and
Hea lth System Strengtheni ng
                             Provideleadership  and         Support  pre-service in-
                                                                                  and
institutionalcapacityof      guidance strengthening
                                       for                  servicetraining efforts
the MOHand NGOs   to         supportiv-e supervisionand     throughquatity
respond the HIV
         to                  priority areasfor quatity      improvement
epidemic                     improvement                    interventions,task-
                                                            shifting, poticy reform and
                                                            clinicalmentoring   efforts;
                                                            TA supportfor
                                                            irnprovement   of
                                                            management    skitls,
                                                            leadership and quatity of

                                                                                           WHO:Support
                              taboratorystrategyin 2009     of integrated laboratory       implementation of
                              with supportfrom WHO          systems services,through       laboratory
                              and PEPFAR include
                                          to                qualityr-improvement           internationat
                              ptansfor scale-up CD4
                                                of          strategiesand relevant         regutationstandards.
                              testingand infant diagnosis   poticyassessment   and
                                                            reform; improveaccess   to     PPP:Strengthen
                                                                           for
                                                            TB diagnostics HIV-            laboratorysystems
                                                            positivepatients; provide
                                                            technicatassistance  to
                                                            strengthenlaboratory

                                                                     efforts to buitd      PPP:Estabtish and
                                                            humancapacityin the            developa fietd
                                                            pubtic heatth sector to        epidemiotogy
                                                            address  infectiousdisease     workforce
                                                            priorities;estabtish and
                                                            developa fietd

                              Reinforcethe technical        Strengthensystems  for
                              capacityof pharmacies and     supptychainmanagement; condomtogistics
                              the management ARV'S
                                              of            supportrelated poticy
                              and test kits                 reformsand GRAeffort to
                                                                              of
                                                            achieveeconomies scale

                              Reinforcethe management
                              of humanresources       administrationof the
                                                      heatthworkforce;
                                                      elaboratea HRstrategic
                                                      planand supportthe
                                                      establishment a Human
                                                                    of
                                                      Resource lnformation

lmprovemmt of information system ond surveillance
                                                                                            :ProvideM&E
studieson targeted            researchactivities            (AlS,ANCsurveittance,BSS TA to schoot-based
poputations, and                                                    sexualbehavior
                                                            lvlARP's,                prevention
strengthen M&Eand                                           and muttipteconcurrent   interventions,
informationsystems   to                                                              PMTCT.  OVC
increaseutilization of data                                 ProvideTA bv M&E
on HIV/AIDS planning,
            for                                             specialistto support     improvethe national
program  improvement    and                                 indicatorharmonization, M&Esystemand
surveiltance and cost-
effectiveness                                                   research.
                                                       operationat                   of the government to
                                                                                     evaluatethe
                                                                                              to
                                                                                     response the
                                                                                     epidemicbased  on
                                                                                     atl components of
                                                                                     the nationalolan
                                                       Providetechnical
                                                                to
                                                       assistance support
                                                       implementation aof
                                                       Demographic  HealthSurvey
                                                       (DHS)                for
                                                             andior training a
                                                       census
Global Fund
Increaseaccess support
              to           Guarantee role of the
                                     the               ProvideTA for proposal
from the GtobalFund        MoHas the Principal         writing and during
                           Recipient the
                                    by                 executionof GFATM  grants
                           functioning the
                                      of
                           Manasement  Unit
Decentralization
Harmonize coordinate
           and             Updatethe HIV/AIDS          ProvideTA for the revision    UNAIDS: support
the nationalresponse       Nationat StrategicPtan      and extensionof the           development new
                                                                                                  of
underone potiticatand      (NSP) 2010-2014
                                for                    National StrategicPlan        HIV/AIDS Strategic
technicalframework                                     (2010- 201'$; Framework       Plan,coordinate the
                                                       management   team to                 joint
                                                                                     UNAIDS teamon
                                                       harmonize indicators
                                                                  PF                 HIV/AID5
                                                       with nationalstrategicplan
                                                                                     UNICEF: Support
                                                                                          in
                                                                                     DPSs strategic
                                                                                     ptanning, for
                                                                                              TA
                                                                                     nationalstrategic
                                                                                     olan develooment
Etaborate provinciat       Guarantee budgetof
                                     the               supportthe government   in
strategicand operationat   the Operationat Ptans,and   its decentralizationprocess
plansbased the
            on             supervisetheir execution    by TA in financeand
NationalStrategicPtan                                  planning exercises; provide
                                                                  in
                                                       assistance the
                                                       coordination the process
                                                                     of
                                                       Support financiatptanning
                                                       and monitoring,  nationaI
                                                       heatthaccounts gap
                                                                        and
                                                       anatvsis




       (

                                                                                               t9
Civil Society
Strengthen  civit society      Promoteand organize          Pursue  heatth education
governance,  teadership  and   prevention campaigns  and    andconsciousness-   raising
partnership  mechanisms;       educational interventions    with a genderfocus,
(1) to monitorHIV/AIDS         to increaseHIVprevention     including gender-based
poticies; to imptement
         (2)                   knowtedge,  skitlsand safe   viotence,in schoots  and
careand support                practice amongAngotan        youth centersto promote
activities;(3) reduce
              to               generalpoputation;           detayedsexuatdebut and a
vutnerability and gender       developa nationat                       of
                                                            reduction muttipte
inequatity                     comprehensive   sexual       sexualpartners,and in
                               educationpolicy for att      other community
                               schoolcurricutumand for      structures,the mititary,
                               teacher training cotleges    andthe policeand the
                                                            workotace.
                               Scateup access heatth
                                                to          Support  capacitybuilding
                               promotion   and STllHlV                      to
                                                            of locatNGO's manage
                               preventionamongmost at       action in the fight against
                               risk poputations, focusing   HV/AIDS,  enable
                               on commercialsex             fundraisingcapacity,
                               workers,truck driversand     improveM&Eandfinancial
                               lvlSli,within 11 priority    management
                               orovinces
                               lmprovecivit societyand      Support nationaland           UNAIDS, IOlt ond
                               PLWHA   partnership          community-based  efforts      Civil Society
                               mechanisms                   to increaseaccess to          Organizotiots: I
                                                            quatityHIViAIDS care and      Cotlaborate to
                                                            treatment for PLWHA   as      supportthe
                                                            welt asvutnerable and         devetopment   and
                                                            most at risk poputations      estabtishment  of
                                                                                          protection policies
                                                                                          for PLWHA  and
                                                                                          vutnerable
                                                                                          poputations
                            Reduce   stigmaand              Promotestigma reduction       UNAIDS:  Monitor
                            discriminationaswetl as         interventionsfor hidden       poticiesto reduce
                            womenand girts'                 populations (e.g., A,ISM)     HIV/AIDS-retated
                            vutnerabitity gender
                                          and                                             stigmaand
                            inequalities, based aon                                       discriminationand
                            mutti-sectorat  aooroach                                      senderineoualities.
lnvolvement of public and private companies
Expansion the numberof Guarantee functioning
         of                             the                 Provide technical         PPP:Provide
pubticand private           of the CEC   and supportthe               to
                                                            assistance the CEC  and   teadership the CEC
                                                                                               to
companies that promote                        of
                            imptementation their            its partners BCC
                                                                        in    and IEC
btoodsafety, PMTCT, STI     activities
treatment, and VCTin
the workplaceand in the
communiW




Gq/
                                                                                                    2A
Five-YearGoal2 -
To reduce the spread of the HIVepidemic

By 2013 Angolaintends to (dependent on a successfulRound9 GFATIil):
. Organize annualHIVprevention
             10                                     50
                                        tampaigns, intervention    projectsfor sexworkersand educational
    interventions duringnationaland provincial   events(USG   intendsto contributeto 2 eventsper year)
. lncrease numberof condoms
            the                       acquiredby 2.5 times per year to satisfythe demands   from the health
    services,civil society, ministries,and public and private companies (basetine:30,0m,000 /year; (USG
                                              per
    intendsto contribute15 million condoms year)
. Reduce vulnerabitityof youth by reaching343,200
           the                                             youth in pubtic schoot,as wetl as out-of-school
                                        to contributeto reach100.000



llost at Risk Populations tlARPs
                                                           Provideinterventionsfor
promotion and STI/HlV                                              -sex
                                                           MARPS workers,
preventionamongmost at                                     womenengaged      in
riskpoputations,focusing                                   transactionat  sex, mobile
on professionalsex                                         workers(truck drivers,
workers,truck driversand                                   mititarypersonnet,    miners)
[15M,within 11 priority                                              in
                                                           and MSA,I defined hot
provinces                                                  spots,including  a
                                                           comprehensive    package : of
                                                           condom(maleand femate)
                                                           promotion,procurement
                                                           and distribution;outreach
                                                           for mapping   and
                                                           preventionmessaging;
                                                           promotionand provisionof
                                                           HIVcounseling testing
                                                                           and
                                                           services with referral and
                                                           provisionof treatment aM
                                                           care for those persons
                                                           testing positive; and
                                                           diagnosis treatment of
                                                                      and
                                                           sexualtytransmitted
                                                           infections. Estabtish  5Tl
                                                                                  in
                                                           sentinelsurveitlance key
                                                           geographical  areasfor
                                                           lvlARPs
                              Managepubtic sector          Purchase   condoms   for        UNFPA:  Integratethe
marketing condoms
         of                   condomdistribution           gratis distribution and         strategieson HIV
                                                           commerciatization    and        preventionand
                                                           expanddistribution              Reproductive Health.

Health Education
                                                                                        'ATti gront:
Educategenera[and most        Coordinate implementation
at risk populations about     of a nationalsociatand       and behavior change for   supportprevention
the epidemic  with aim to     behaviorat change            the generatpoputation and efforts targeted at
promotebehaviorchange,        communication  strategyfor   with a genderfocusfor     youth, PLWHA,   Most
targeted at high risk areas   HIVprevention                vulnerabte mostat-risk at risk populations,
                                                                     and
of the countryand with                                     populations;target youth  community   and faith-
specialemphasis gender
                 on                                        and the genera[population based organizations;
considerations                                             with preventionand
                                                                                     UNICEF:   Enhance HIV
                                                        interventions               preventionmessages
                                                                                    throughschoots and
                                                                                    community
                                                                                                in
                                                                                    interventions 16
                                                                                    target municipatities

                                                                                    UNFPA: Promote
                                                                                    behaviorchange
                                                                                    amongyouth

                                                                                    UNESCO:   Advocate
                                                                                    for the adoptionand
                                                                                                   of
                                                                                    imptementation a
                                                                                    oreventionstrateqv
Lxptoretne rote ol mate     Developa polrcydecrsron     Assistwith the
circumcision Angota's
             in             basedon the situational     imptementation aof
epidemicand devetop  and    anatysis mate
                                   for                  situationaIanatysis
imptement poticies          circumcision                (quatitativeand
accordingly                                             quantitative)of mate
           -
                                                        circumcision.
Stigmaand discrimination
Reduce and AIDS
        HIV               Developpoticiesto reduce Reduce  womenand 9l1|'s
retated stigmaand        womenand girls            vutnerabilityand gender
discrimination gender vutnerabitity,
              and                     stigmaand    inequalities;reduce
inequalities             discrimination            stigmaand discrimination
                                                   basedon mutti-sectoral
                                                   aooroach

Five -Year Goal 3 -
                        impact of HIV/AIDS individuats,the family and the community
Mitigatethe socioeconomic                 on

By 2013 Angolaintends to (dependent on a successfulRound9 GFATM):
. Offer VCTat new seryicepoints,lnctuding heatthunits, 18 MititaryZones
                                              200                               and 17 NGOs (basetine:
                                                                                                     237)
    (USG intendsto contributeto 10 new VCTcentersper year)
. Wil[ have reatizeda total of 5.2 mittion HIVtests (basetine:500,000tests per year); (USGintendsto
    contribute to 50,000tests per year)
. Offer ARV'sto 100% HIV+pregnantwomenattending prenatatservices(basetine:67%)
                        of
. Conduct100%     testingof registered patientsfor HIV(basetine:
                                      TB                           107")
. Conduct100%     screening HIV+ care or treatmentsettingfor TB (basetine:
                            of     in                                          unavaitable)
. Provide   services STImanagement 18 provinces
                    for                 in
' Ensure   universalaccess the 1stand 2nd line ARVdruesfor 62,133
                           to                                         PLWHA

Objective                   GOAlntends to:                   intends to:
                                                        PEPFAR                      Other Partner Roles
Yoluntary Counseling and Testing
Expand Voluntary           Provideteadershlpfor         Supportan integrated
Counseting Testing
          and             VCT/ PMTCT   expansion in             to
                                                        response scateup
      to
access contribute         a[[ prenatatunitsand                 and
                                                        PMTCT VCT,and
towardsthe country's      detiveryrooms;guidethe        strengthenlinkageswith
nationalVCTgoatsof 85% process mapping
                                  of         and        both Maternat-ChitdHeatth
coverage                              g
                          strengthenin referrats        and FamityPtanning at
                                                        HIV/AIDS preventionand
                                                        seMce detivervpoints
                            Purchase miltionrapid
                                      6.2               Supportestablishments of  GFATTA    Provide:
                            tests to diagnoseHIV        VCTin key geographic      Round4-supptyof
                                                        regions                   test kits


    )v                                                                                        22
Prevention llother to Child Tronsmission
Scaleup preventionof        Devetop poticies                                           UNICEF:   Support
mother-to- chitd            shiftingand lay-counseting; high prevatence   provinces;   provincialheatth
transmission,inctuding      expandPMTCT 100%
                                           to           improveM&Eof PMTCT;            directoratesin the
eartyinfant diagnosis       coverage.of pregnant        promotetask-shifting;          implementation   of
                            women                       supportcivil society                     of
                                                                                       scate-up PMTCT+
                                                        initiatives to identify        and Pediatric AIDS
                                                        pregnant  womenin the          services in
                                                       community,      promotetheir    revitalization
                                                       ANC    and CT, increase         provinces,mobilize
                                                        adherence HIV+
                                                                     for               community
                                                        pregnantwomento                organizations,
                                                        prophylaxis                    advocacy,   TA,
                                                                                       coordination INLS
                                                                                                     of
                                                                                       and other
                                                                                       stakehotders
                                                         Asan adiunctto
                                                         scaleup ElD,which is at
                                                         the sametime an excettent
                                                         toot to monitorthe imoact
                                                         of PMTCT
Treatment, Core and *tpport
Ensure universataccess to  Ensure access ARV's
                                         to                pport quatity of care and GFATII Pravide:
treatment of PLWHA   and   drugsfor Ol (Opportunistic    treatment;supportCSO's R o u n d 4 - s u p p t y o f
guaranteecare              Infections)to 100% the
                                              of         that increaseadherence   to ARVdrugs
                           peoplewith identified HIV     treatment
                           andwho requiretreatment
TB co-infection and H,VIAIDS
Promoteand expand                                        Support nationatand
strategiesfor increasing   strategyto improve            community-based  programs
diagnosis management linkages
         and                       and coordination      to monitor and improve
of TB/HlVco-infections by to increasediagnosis  and      HIVtesting and prevention
testing 100%; atsoincrease management TB/HlVco-
                                        of               of TB/HlVco- infection.
diagnosis management infection
         and
of HIVwith STI's.                                        Support  ctinicatmentoring
                                                         activities to strengthen
                                                         diagnosis,  care and
                                                         treatmentof TB/HIV.
                            Estabtish poticies HIV
                                              for                                         and GFATtt:
                            testing in TB patientsand    assessment identify
                                                                      to             supportsurveitlance
                            vice-versa                   high-impact   areaswhere    and management  of
                                                         synergies be
                                                                   can               TB/HlVco-infection
                                                         capitalizedamongkey MOH
                                                         institutionsto effectively
                                                         tink HIVand TB servicesto
                                                         improvetesting and
                                                         prevention patientsin
                                                                     for
                                                         thoseprograms.
                                                         Assess existing
                                                                the
                                                         electronic data capture
                                                         systemthat servesas
                                                         patientmanagement,     M&E,
                                                         and surveiltance toot.
lntegrateSTIserviceson      lmproveand expand
municipallevel              preventionand control of     heatth package in
                            STI'sinctuding
                                         congenital      municipatities
$tpport to vulnerable families
Devetop and estabtish       Estabtish
                                    cooperatives for                            GFATII gront
protection policiesfor      incomegenerationfor                                 providesupportfor
9,145familiesand most       vulnerabtefamitiesin 11                             the MoHto
vutnerabte chitdren         provinces                                           imptement  OVC
throughincomegeneration                                                         servicesthroughcivil
projects                                                                        society
                                                                                organizations.

                                                                                UNICEF:Assist  poticy
                                                                                devetopment  to
                                                                                enhanceOVCaccess
                                                                                to basicservices:
                                                                                food, education,
                                                                                heatth; protection
                                                                                from abuse/
                                                                                exptoitation;
                                                                                strengthen the
                                                                                capacityof civit
                                                                                societyto identify
                                                                                OVC;providecare
                                                                                and supoort
                                                                                PPP:Supportincome
                                                                                qenerationDroiects



       IV.            FINAFICIAL COMMITMENTS:

       The USG and GRA recognizethat resources limited and that financial commitments
                                                    are
       are subject the availability of funds. Both furtherrecognize
                   to                                                 that achievementof
       Frameworkgoals requiresresourceflows beyondthe abilify of any one partner,and that
       constraintson availability of funding from either signatoryor from other key partners
       oould leadto a review and revision of goals. After the formulation ofthe new strategic
       plan and after the disclosureof the decisionof the board of the GFATM in relation to
       the submittedproposalfor Round 9oreassessment re-prioritization of the activities
                                                          and
       of all stakeholders shouldbe realized. Details regardingthe GRA and USG financial
       and in-kind contributionsto programsunderthis Frameworkare to be provided in the
       PartnershipFrameworkImplementationPlan.


       v.             MANAGEMENT, MOIYTTORTNGAltD COMMIIMCATTONS

       The Frameworkpresents opportunity and an instrumentto strengthen
                              an                                            collaboration,
       coordinationand accountabilityby ensuringa focus on key mutually defuredstrategies
       and measures success.The govemancesystemto managethe Frameworkbuilds on
                     of
       existing structures provide oversight for the national HIV response.
                          to

       TechnicalOversightand Monitoring: In2005, the National AIDS Institute (lnstituto
       Nacional de Luta contra SIDA or INLS) was established  within the Minisfiy of Health
       and designated lead technical implementingbody and coordinatorof all national
                       the
       HIV/AIDS programs. Withinthe GRA, INLS is expectedto have primary
       responsibility for monitoring Frameworkimplementationbasedon mutually defined
       strategies measures success.I-INAIDS in collaborationwith the MOH intendsto
                 and           of
       establisha multi-sectoraltechnical forum subdividedin Technical Working Groups(for


                                                                                          24
exampleM&E, preventionand Health SystemStrengthening)       that will meetregularly to
monitorthe full spectrum HWIAIDS activitiesin country. Technicaloversightand
                          of
monitoring of the PF shouldtake placewithin this forum that will meetat leastquarterly
with USG participation. The Frameworkmanagement      team which currently comprises
the INLS, USG and UNAIDS, shouldhaveprimaryresponsibilityto propose
modifications for the PartnershipFrameworkdocumentespeciallyfor the modification
of the Framework goalsand objectivesin the secondand subsequent    years.

Strategic Oversight:In November2006,the National AIDS Institute, in partnership
with UNAIDS, coordinated    aNational Strategic   PlanReview Workshop. With the
supportof the Angolan Ministry of Health, the Global Fund, the World Bank, the USG,
a host of private contractors,and a broad coalition of public, private and civil society
organizations, workshopassessed
               the                     progressto dateof the National StrategicPlan
toward Millennium DevelopmentGoal targets. The INLS subsequently          established  a
semi-annualcoordinatingworkshopthat provides a forum for all implementingpartners
ofthe Angolan national HMAIDS progmm to communicate,report on progress,and
realignstrategies.  The development the next HIV National Strategic
                                      of                                  Plan(2010-
2014), supportedby this PartnershipFramework,shouldallow for coursecorrections
and modifications to this PartnershipFramework.

GRA and USG representatives intendto meet semi-annuallywith leadersfrom civil
                   and private sectorand other bilateral agencies, appropriatg to
society,UN agencies,                                             as
discuss       towardsgoalsand objectives.
       progress

Global Fund Harmonization: UNDP is the Principal Recipientof the GFATM funds
but the Ministry of Health hasthe lead in donor coordinationand implementation. The
                                                       is
USG, which provides30 percentof GFATM resources, an activememberofthe
GFATM Country CoordinationMechanism(CCIO. At the quarterly CCM meetings,
membersshouldreview the integrationof the Frameworkactivities with Global Fund
grantsand national priorities.

High Level Oversight: The national HIV/AIDS coordinatingauthority is the Angolan
NationalCommission Fight HIV/AIDS and LargeEpidemics(CNLCSGE),created
                      to                                                         in
late 2002. The commissionis underthe direct mandateof the Presidentof Angola and
is the highestpolicy-makingbody on HIV/AIDS. Oversightshouldbe provided
throughmeetings   between MOH, representing CNLCSGE,andthe U.S.
                         the                  the
             to
Ambassador Angola.

Modifications to this Frameworkmay be madein writing with the consentof both
signatories.
  L , , t q n J o , l t l " ^ S U . b +l o t T o o f

                                                       Signature:




GRA
                                                       ||il^*3.ll"*CA+*
                                                       USG (J

                                                                                     25