Part II The AMTP IV Strategic Plan

A. GUIDING PRICIPLES

The formulation of the AMTP IV aws guided by the following principles:

1. The formulation anf implementation of socio-economis development policies and programs should include consideration of the impact of HIV/AIDS infection. Responses to STI/HIV/AIDS should be mainstreamed in national and local development plans. Resources should be equitabl;y allocated taking into consideration the needs of different populations;

2. Multi-sectoral involvement is essential to the planning, execution and monitoring of the national and local responses to HIV infection. People should be empowered to prevent further STI/HIV transmission in all settings and situations;

3. Mainstreaming of treament,care and support services for the infected and affected into existing health and social services should likewise be pursued;

4. The dignity and rights of persons infected and affected by HIV/AIDS and that of health care providers must, at all times, be promoted and respected;

5. All efforts should be harnessed to ensure the genuine and meaningful involvement of the persons infected and affected by HIV/AIDS at all levels of policy-making, project design, implementation, monitoring and evaluation;

6. HIV interventions should be voluntary with quality information and guaranteed with utmost confidentiality; and,

7. Efforts should be constantly improve HIV-related programs and adopt gender-responsive and rights-based approaches.

B. POLICY DIRECTIONS

The directions of AMTP IV for 2005-2010 will be geared towards the following:

1. Efforts must be geared towards the prevention of the further spread of HIV infection and to reduce the impact of the disease on individuals, families and communities;

2. It must ensure that measures and programs undertaken are responsive to the identified needs of concerned sectors, individuals and groups;

3. Priority must be given to the infected and affected as well as to existing and emergent highly-vulnerable groups, especially those not covered in the AMTP III, which include OFWs, youth, infected and affected children;

4. Quality improvement in the design and implementation of STI/HIV/AIDS interventions must be given due attention. Systems to monitor and measure quality of every intervention must be put in place;

5. Scaling-up and expansion of effective intervention measures must be pursued and given ample resource support;

6. It shall embody all on-going assisted projects and programs on HIV/AIDS to ensure integration, harmony of purpose and direction and avoid overlaps;

7. It must include mechanisms to ensure a protected level of funding support to pursue its goals and objectives;

8. The implementation, coordination, monitoring and evaluation mechanisms of the AMTP IV should build on existing structures and systems, particularly those provided by the Local Government Code; and

9. The directions and goals shall be aligned with the vision, goals and purposes of the Medium Term Philippine Development Plan (MTPDP), the Millennium Development Goals (MDGs), UNGASS Declaration of Committment on HIV/AIDS, and the ASEAN Joint Ministerial Statement and other international commitments that are considered relevant to the country.

C. VISION

HIV/AIDS 2010: Greater access to holistic response

D. GOAL

To prevent the further spread of HIV/AIDS infection and reduce the impact of the disease on individuals, families and communities

E. OBJECTIVES

1. To increase the proportion of the population with risk-free practices;

2. To increase the access of people infected and affected by HIV/AIDS to quality information, treatment, care and support services;

3. To improve accepting attitudes towards people infected and affected by HIV/AIDS; and,

4. To improve the efficiency and quality of management systems in support of HIV/AIDS programs and services.

F. TARGET GROUPS & SECTORS

The AMTP IV shall take into consideration the different population groups and sectors in mounting the national response against HIV/AIDS in the next six years. It will continue to focus interventions on: (a) the sex workers, both registered and non-registered, including their clients, (b) the IDUs and (c) MSMs. Equal consideration will be provided to PLWHAs and those affected b7y the disease. Providing HIV prevention information and services will continue among the workforce, in-school youth and the general public. The AMTP IV will give ample attention to emerging population groups becoming more vulnerable to STI/HIV/AIDS - the OFWs, young people and children.

Considering that everyone is susceptible to HIV/AIDS and differs in their degree of vulnerability to the infection, the various sectors of women, men, youth, children and the workforce must be equally mobilized to take into account the vulnerability of their respective local sector(s) to HIV infection.

G. KEY STRATEGIES

The AMTP IV will pursue the following key strategies:

Strategy 1: Scaling-up and quality improvement of preventive interventions, targeted to identified highly vulnerable groups (sex workers and their clients, IDUs, MSMs and OFWs)

Strategy 2: Strengthening intitutional and general public preventive interventions

Strategy 3: Scaling-up and quality improvement of treatment, care and support (TCS) services for people infected and affected with HIV/AIDS

Strategy 4: Integrate stigma reduction measures in the preventive treatment, care and support services and in the design of management systems

Strategy 5: Strengthening and intitutionalization of management systems in support of the delivery of HIV/AIDS information and preventive services

H. OPERATIONAL STRATEGIES, KEY RESULT AREAS & MAJOR ACTIVITIES

Strategy 1

Scaling-up and quality improvement of preventive interventions targeted at population segments with risk beahviors and those identified as highly vulnerable.

Epidemiological studies have identified risk behaviors and vulnerability factors that facilitate the transmission of HIV/AIDS like unprotected sex as frequently practiced by MSMs, sex workers and their clients and the use of infected needles among IDUs. Specific population groups like OFWs are also identified as vulnerable to infection. These groups are rendered highly vulnerable to HIV infection because of the socio-economic and occupational contexsts they are in. Though the country lacks solid data on the number of highly vulnerable populations, studies show an increased prevalence of unprotected sex among them, and some occupational groups are emerging as more vulnerable than others.

OPERATIONAL STRATEGIES

Improving the quality of prevention interventions among HRGs and expanding coverage would contribute significantly to halting the further spread of HIV. There is an urgent need to assess existing interventions in terms of their responsiveness and quality. Due attention will be given to the promotion of 100% CUP while BCC will be made inherent in every prevention effort. The Harm Reduction Program will be expanded to other areas where the number of IDUs is increasing. Aside from strenthening the existing health facilities as providers of STI/HIV/AIDS information and service, efforts weill be undertaken to widen the outreach network that will proactively reach and serve the vulnerable groups. This would require intensive mobilization and organization of the target groups as well as capacity building of outreach workers and other stakeholders.

In support, the criteria and process for identifying high-risk areas (See Annex1) will be refined and reapplied. The AMTP IV aims to cover all the 43 identified areas, phasing coverage from 2005 to 2010. Partnerships between the local governments and NGOs will be strongly advocated while the establishment of LACs will be fully encouraged. Efforts will be undertaken to mobilize resources to support local response in the identified high-risk areas. Particular attention will be devoted to enhancing existing programs for OFWs while establishing new measures to facilitate their access to services abroad.

KEY RESULT AREAS

KRA 1: All migrant workers are provided with STI/HIV/AIDS preventive information and services

KRA 2: PIPs are provided with focused STI/HIV/AIDS preventive education, skills and services

KRA 3: Clients of PIPs are provided with STI/HIV/AIDS preventive information and services

KRA 4: MSMs are provided with focused preventive information, skills and services

KRA 5: IDUs are provided with focused STI/HIV/AIDS preventive education and skills and services

Key Result Area 1: All migrant wokers are provided with STI/HIV/AIDS preventive information and services
Activity	2005	2006	2007	2008	2009	2010
1. expand and improve PDOS/PEOS for departing migrant workers
2. develop institutional policies and programs to ensure provision of STI/HIV/AIDS service for migrant workers
3. establish HIV/AIDS information and referral sites abroad
4. explore regional initiatives to address HIV/AIDS, migration and cross-border issues
5. develop comprehensive reintegration strategy for HIV+ OFWs
6. quality assurance of testing centers through quality monitoring visits and regular conduct of client feedback survey
7. expand network of STI/HIV/AIDS service providers in both the public and private sectors
8. implement community=based HIV/AIDS education and BCC activities with families of migrant workers

Key Result Area 2: PIPs are provided with focused STI/HIV/AIDS preventive education, skills and servcies
Activity	2005	2006	2007	2008	2009	2010
1. assessment of current prevention initiatives for the PIPs and other HRGs
2. improve criteria and process in mapping and identifying needs of PIPs/other HRGs
3. enhance existing training modules to be gender sensitive
4. enhance IEC/advocacy support materials
5. orientation/advocacy among local officials/influentials on STI/HIV/AIDS prevention
6. establish and expand community outreach and peer education programs
7. sustain and expand 100% condom use
a) advocacy among local officials and program stakeholders to adopt/support CPU
b) meetings/orientation/training on condom use among involved implementers
c) procurement/making available condoms through social marketing of condoms
8. sustain/improve provision of STI/HIV/AIDS information and services by SHCs
9. strengthen referral of PIPs for other needs
10. assist LGUs establish Local AIDS Council

Key Result Area 3: Clients of PIPs are provided with STI/HIV/AIDS preventive informationa nd services.
Activity	2005	2006	2007	2008	2009	2010
1. expand community outreach (in red light districts and entertainment establishments)
2. dialogue/advocacy among owners and managers of commercial sex establishments
3. strengthen partnership and linkage among NGOs, PNP and DSWD at the local level
4. promote condom use and training on negotiation skills for condom use

Key Result Area 4: MSMs are provided with focused preventive education, skills and services
Activity	2005	2006	2007	2008	2009	2010
1. continuous dialogue/conferences to evolve best mechanisms to reach MSMs
2. design and establish measures to creatively reach the MSMs for HIV preventive information and services
Target No: high risk areas	18	5	5	5	5	5
3. mapping and need identification of MSMs
4. organize outreach service network
5. promote condom use

Key Result Area 5: IDUs are provided with focused STI/HIV/AIDS preventive education and skills and services
Activity	2005	2006	2007	2008	2009	2010
1. develop and adopt risk assessment response system
2. explore policy support for harm reduction program - exchange needle
3. sustain harm reduction program in identified high risk areas
a) advocacy among local officials and program stakeholders to support harm reduction program
b) identify and capacitate NGOs to assist LGUs implement the program
c) training of program implementers and service providers/outreach workers
d) dialogues with local police, PDEA officials and other concerned agencies
e) procurement or making available needles and syringes for exchange
4. strengthen partnership among agencies at the local level (PNP, LGUs, NGOs, PDEA)
5. strengthen referral mechanisms for IDUs requiring special care and services

Strategy 2

Strengthening institutional and general general public reventive interventions.

Prevention interventions apply not only to HRGs but to everyone since every individual is vulnerable to the infection. Unsafe sexual behavior, particularly unprotected sex, is reportedly increasing especially among young people. Substance and sexual abuse among children and youth is also on the rise. Majority of HIV recorded infections were among the age group 20-49, considered the most economically productive segment of the population. Awareness of the correct ways of preventing HIV transmission among the general public remains low. The extent of coverage of STI/HIV/AIDS preventive interventions, given the large population size of target groups, is still limited. Quality of service requires further improvement.

OPERATIONAL STRATEGIES

Prevention interventions among general public is an integral part of the national response in line with the thrust of laying a strong foundation for long-term impact. It complements the thrust to engender a non-discriminatory environment for persons living with HIV/AIDS. The AMTP IV will support the scaling up of STI/HIV/AIDS prevention information and service delivery in the workplace. It will be expanded to cater to those employed in the public or government service and to those working in the informal sector. This would entail mobilizing the Civil Service Commission for government workers and other stakeholders for the informal sector.

The extent and quality of previous interventions will be assessed, the results of which will serve as basis in developing an integrated approach in reaching young people, both in-and-out-of-school. Efforts to reach young people in schools will be doubled and partnership with community-based organizations involved in out-of-school youth programs will be established. Existing networks of young people (e.g. SK) and other youth-oriented organizations will be tapped to integrate STI/HIV/AIDS prevention information and services.

On the other hand, STI/HIV/AIDS prevention for children will be given equal attention, with focus on thsoe whoe are in high-risk situations. A more specific program for preventing mother to child transmission will eb developed. Startegic key messgaes will be communicated to the general public through the mobilization of media practitioners, media network and conduct of tri-media campaigns and other information/promotional activities. These will be based on the enhanced Communications Plan. Coverage will follow the priority areas of the concerned institutions but will consider realigning with the targets of the other strategic interventions for convergence of efforts and impact.

KEY RESULT AREAS

KRA 1:	Children in rsiky situations are provided with appropriate STI/HIV/AIDS preventive information, life skills and services
KRA 2:	Children and young people in school (formal, non-formal, alternative learning systems) are provided with appropriate STI/HIV/AIDS preventive information, life skills and services
KRA 3:	Children and young people out of school provided with appropriate information and services on STI/HIV/AIDS
KRA 4:	Local (public, private and informal) employees provided with appropriate information and services on STI/HIV/AIDS
KRA 5:	Other relevant sectors/groups (outside identified sectors) provided with basic HIV/AIDS information on prevention and control

Key Result Area 1: Children in risky situations are provided with appropriate STI/HIV/AIDS preventive information, life skills and services
Activity	2005	2006	2007	2008	2009	2010
1. develop guidelines in communicating, reporting and monitoring children regarding HIV
2. build capacity and gender sensitivity of GO-NGO child-focused institutions on provisions of STI/HIV/AIDS preventive information/services
3. develop training and advocacy modules for service providers
4. capacitate children in risky situations through counseling and life skills training
5. formulate policy on HIV/AIDS for children
6. advocate and integrate STI/HIV/AIDS information and services into existing policy and program framework on children
7. strengthen referral network system for other needs

Key Result Area 2: Children and young people in school (formal, non-formal, alternative learning systems) are provided with appropriate STI/HIV/AIDS preventive information, life skills and services
Activity	2005	2006	2007	2008	2009	2010
1. assess quality and scope of intervention coverage for in school and out of school youth
2. Integrate life skills approach in STI/HIV/AIDS modules of DepEd, CHED, TESDA and NGOs with similar activites for children and/or parents
3. build capacity in STI/HIV/AIDS life skills education of school-based service providers
4. expand the implementation of school-based HIV/AIDS instruction and information
5. ensure accessibility of school youths to quality STI counseling and services

Key Result Area 3: Children and young people out of school provided with appropriate information and services on STI/HIV/AIDS
Activity	2005	2006	2007	2008	2009	2010
1. develop capacity of civil society organizations and youth organizations (e.g. SK) to provide information and education services
2. integrate STI/HIV/AIDS information and services into the local government's and existing community-based programs
3. establish community outreach and peer education programs for out-of-school youth

Key Result Area 4: Local (public, private and informal) employees provided with appropriate information and services on STI/HIV/AIDS
Activity	2005	2006	2007	2008	2009	2010
1. expand the implementation of STI/HIV/AIDS program in the workplace in the private sector
2. enforce the mandate of the Civil Service Commission to implement STI/HIV/AIDS program in the government sector
3. establish LGU-NGO-PO-informal sector network at the community level for STI/HIV/AIDS prevention

Key Result Area 5: Other relevant sectors/groups (outside identified sectors) provided with basic HIV/AIDS information on prevention and control
Activity	2005	2006	2007	2008	2009	2010
1. enhance the national STI/HIV/AIDS Communications Plan for AMTP IV (key messages, channels and information materials)
2. undertake sustainable campaign with evaluation to check on the impact and effect
3. sustain and build on national mobilization activities and special events like AIDS Day celebration and Candle Light Memorial
4. continue development of capacities of media practitioners in handling STI/HIV/AIDS reporting and as advocates for HIV/AIDS prevention
5. advocate among media networks and other key stakeholders to mobilize support for STI/HIV/AIDS prevention
6. integrate STI/HIV/AIDS preventive information and services into other social development programs (e.g. Voluntary Safe Blood Program)
a) identify strategic programs where STI/HIV/AIDS could be integrated
b) advocate for integration of STI/HIV/AIDS
c) develop materials or other mechanisms to operationalize the integration

Strategy 3

Scaling-up and improving the quality of treatment, care and support services targeted at those infected and affected

Access to health services is a basic human right, and empowering citizens to be productive is a basic duty of the state. Providing care and support services wille nable PLWHAs to lead positive and productive lives. The country recognizes that TCS services, as articulated in the MDGs, UNGASS Declaratio, and ASEAN Joint Minsterial Statement as well as in RA 8504, are just as necessary as prevention interventions. These are to be given equal priority as integral parts of the national response while placing the HIV-positive community at the core of the response. Access, however, to good quality TCS is limited. Only a few tertiary government and private hospitals in major urban centers offer institutional care. While community care and support programs exist to address the diverse needs of PLWHAs, these are still limited.

OPERATIONAL STRATEGIES

The AMTP IV will endeavor to make TCS more accessible to the infected and affected. It will continue to support the establishment of three sub-national STI/HIV/AIDS centers in Luzon, Visayas and Mindanao. The procurement scheme for ARV drugs and medicines for opportunistic infections will be reviewed and redefined. Options to be pursued in procurement will be brought to the PNAC leadership. Quality of care, treatment and support being provided by hospital facilities and other institutions will be assessed and further improved. Ways to inculcate respect for PLWHAs and gender sensitivity in serving them will be a continuing effort among service providers. The turn-around time of confirmatory test/results will be reviewed and ncessary miprovement in protocols will be employed. Continuous training/retraining of the core hospital teams will be judiciously prioritized.

Working with affected families who are also in need of care and support services is essential to engendering a culture of care for PLWHAs. In this regard, capacities of affected families to cope with their situation will be strengthened. Community-based support will be expanded while the network of NGOs, the local government and community volunteers or outreach workers will be mobilized and capacitated to provide quality and timely care. Critical in all these efforts is a well-defined and strenghtened referral scheme that would allow HIV positive individuals to seek and avail of necessary care. Advocacy for the involvement of NGOs, church and local governments will be undertaken. Policies necessary to create a more conducive support environment will be developed and promoted for adoption at the local level. The participation of the PLWHAs will be consciously pursued at every opportunity.

KEY RESULT AREAS

KRA 1:	High quality diagnostic, treatment and care are provided to HIV infected and affected persons.
KRA 2:	PLWHAs are provided with support services and referred for further intervention.

MAJOR ACTIVITIES

Key Result Area 1: High quality diagnostic, treatment and care are provided to HIV infected and affected persons
Activity	2005	2006	2007	2008	2009	2010
1. expand and improve centers for STI/HIV/AIDS treatment and care
a) develop capacity of hospitals to manage STI/HIV/AIDS cases (KAP)
b) develop concrete national programs and policies on TCS including PMTC and accidental exposure to HIV
c) facilitate procurement of logistics/supplies
d) establish quality assurance programs in hospitals
2. expand provision of community-based and home care and support
a) conduct training of outreach/community workers
b) orient/train family members on home-based care for those infected and affected
c) establish alternative family care for infected and affected children
3. establish strong inter-agency linkage (e.g. DOH, NGOs and church-based groups)
a) define referral system at the community-level to ensure continuous TCS for those infected and affected at all levels
b) advocate among key stakeholders to participate in the delivery of community-based TCS

Key Result Area 2: PLWHAs are provided with support services and referred for further intervention
Activity	2005	2006	2007	2008	2009	2010
1. organize, educate and build capacity of PLWHAs support groups
2. establish PHA-friendly community-based TCS system tapping existing community structures or facilities
3. establish referral scheme for employment, livelihood training and micro-finance assistance
4. advocate for PHA-friendly, sensitive and affordable HIV/AIDS legal and para-legal services as well as other services required (e.g. psychosocial services)
5. advocate for Greater Involvement of Persons with HIV/AIDS (GIPA) in the planning, design, implementation and monitoring of programs and projects in support of HIV/AIDS

Strategy 4

Integrate stigma reduction measures in preventive, treatment, care and support services and in the design and installation of management support systems

HIV/AIDS stigma is defines as "prejudice, discounting, discrediting and discrimination directed at people perceived to have AIDS or HIV and at individuals, groups and communities with whom they are associated." (1996 Herek, G.M., et. al, 1996). Stigma and the discrimination that accompanies it negate efforts to combat HIV/AIDS. It drives the epidemic by blocking the public's understanding of its causes and makes it more difficult for men and women, especially those infected and affected, to adopt preventive behaviors such as condom use and voluntary counseling and testing (VCT), It also affects the quality of care given and the perception of PLWHAs by coomunities, families and partners. In the health care setting, stigma and discrimination happens because, more often than not, health workers themselves have not been prepared to come to terms with their fears, anxieties and prejudices.

OPERATIONAL STRATEGIES

Reducing stigma is essential in making care, treatment and support more readily accessible tot hose who are infected and affected. While it may be unrealistic to think that stigma and discrimination can be eliminated, it can be reduced through a mix of interventions that include supportive policies as well as information, education and counseling, among others. The AMTP IV will support the continuous conduct of gender and development workshops/training among service providers, policy-makers and the general public. Gender ersponsiveness of policies, standards and protocols including training modules, IEC materials and advocacy documents will be inherent in their design and dissemination. Management support systems such as planning, monitoring and evaluation, surveillance and reporting could significantly reduce the stigma against PLWHAs if properly designed and with gender perspective in mind.

Having adequate and correct information about HIV transmission is key to understanding PLWHAs and appreciating their conditions and neds. Iedntifying credible individuals as champions in the cause of the PLWHAs is essential in propagating accepting behaviors and attitudes towards PLWHAs. Engaging PLWHAs themselves in the campaign and other HIV/AIDS-related work will help delystify and correct misconceptions about them. Note that the following key ersult areas and activities are already integrated in the other key strategies and interventions. They are only presented here to emphasize and to highlight that stigma reduction efforts must be relentlessly pursued.

KEY RESULT AREAS

KRA 1:	Supportive non-discriminatory policies, guidelines and systems are developed and enforced at the national, sub-national and local levels.
KRA 2:	Service providers, key stakeholders and the general public are educated regarding stigma and discrimination.
KRA 3:	PLWHAs are empowered as effective advocates and educators

MAJOR ACTIVITIES

Key Result Area 1: Supportive non-discriminatory policies, guidelines and systems are developed and enforced at the national, sub-national and local levels.
Activity	2005	2006	2007	2008	2009	2010
1. review, amend if needed, and enforce compliance with the provisions of RA 8504, and other policies, standards, protocols and guidelines specifically on discrimination
2. review, revise as neede, and/or develop gender-sensitive and rights-based IEC and advocacy materials that promote accepting attitude towards people with HIV/AIDS
3. review, revise as needed, and/or develop training manuals and materials that promote gender sensitivity and reduce stigma against the HIV positives and the affected

Key Result Area 2: Service providers, key stakeholders and the general public are educated regarding stigma and discrimination.
Activity	2005	2006	2007	2008	2009	2010
1. training/orientation of service providers (schools, hospitals, health facilities, NGOs, communities etc.) on gender sensitive STI/HIV/AIDS response to include the emotive part of coming to terms with their own fears, anxieties, sexuality, prejudices	c/o Strategy 1, 2 and 3
2. educate policy-makers, program implementers and other influential re gender-sensitive HIV/AIDS response	c/o Strategy 1, 2 and 3
3. conduct mass media campaign for the general public emphasizing accepting attitudes toward the STI/HIV/AIDS positives and affected	c/o Strategy 2 KRA 5

Key Result Area 3: PHAs are empowered as effective advocates and educators
Activity	2005	2006	2007	2008	2009	2010
1. provide assistance to develop capacities of PHAs as advocates and educators
2. strengthen capacity of PHAs' network and organizations in providing support to positive members

Strategic Area 5:

Strengthening and institutionalization of management systems in support of the delivery of information and preventive services, treatment, care and support

Effective governance is now acknowledged as a result of the capability to generate and utilize information, make evidence-based decisions and exert influence or effect social mobilization for development. Exercising these three key functions is dependent on the existence of functional management systems (e.g., information, planning and policy-making, financing, coordinating, monitoring and evaluation). These systems hold together the various component thrusts of the national response, and hopefully propel the national response to a higher and sustainable level.

OPERATIONAL STRATEGIES

In view of the multi-faceted nature of the infection, there is a need to strengthen the coordination of the response at the national, sub-national and local levels. For this purpose, efforts will be undertaken to further strengthen PNAC as a coordinating body and the PNAC secretariat as its support. An organizational development process will be undertaken, including a reorientation of mandates among member agencies, role clarification and team building exercises. more proactive functioning of the committees should take place along a clear delineation of areas and scope of responsibilities relative to the components of AMTP IV. Critical to this strengthening is the strong support by the top PNAC leadership and the commitment of respective heads of the member agencies. Restucturing PNAC and placing it outside the DOH will be explored. Further consultations with key players for the sub-national level will be undertaken using the three options of coordination mechanisms in Annex 2 as a start. Sub-national level coordination will be piloted and expansion will be pursued towards the latter part of AMTP IV. Support to local level coordination will be given due consideration in streamlining the functions of the various committees.

Enhancement of the surveillance system will continue and expansion of its implementation to other high-risk areas will be supported. Review of the reporting system on STI/HIV/AIDS will be undertaken and necessary improvements need to be instituted. The development of the M & E system which started under AMTP III will be completed and further refined. Resources will be mobilized to establish key indicators and set the target levels. a research agenda will be developed anew and efforts to intitutionalize a 2% allocation of total budget will be done. Review of policies affecting the provision of TCS and prevention information and services especially among children, young people and OFWs will be carried out. After almost two decades from its passage, the RA 8504 will be reviewed and amended as needed. Resource mobilization is critical to the implementation of AMTP IV. A more coherent and purposive resource generation campaign will be pushed.

KEY RESULT AREA

KRA 1:	National-sub-national-local coordination mechanisms are rationalized, established and functioning
KRA 2:	Supportive and more responsive policies and guidelines are formulated and enforced at the national and local levels
KRA 3:	Management systems in support of evidence-based advocacy, planning, policy formulation and decision-making are installed and operational
KRA 4:	Funds for strategic interventions are generated, appropriately allocated and effectively utilized

Key Result Area 1: National-sub-national-local coordination mechanisms are rationalized, established and functioning
Activity	2005	2006	2007	2008	2009	2010
1. organization development review
2. design overall coordination mechanism
3. strengthen coordination of response at the national level
a) role clarification/team building workshop among PNAC members and secretariat
b) streamline PNAC secretariat leadership, staffing and tasking
c) annual program review, operational planning and tasking
d) PNAC plenary and committee meetings
e) cabinet level advocacy by PNAC chair for member agency participation in PNAC meetings and other related activities
4. establish sub-national coordinating mechanism
a) review options surfaced from regional consultations and develop overal scheme
b) pilot sub-national coordination scheme in selected regions/clusters
c) advocate and mobilize resources for the sub-national level coordination
d) assess pilot initiative and expand as needed
5. strengthen local capacity for coordinating and managing local response
a) define mechanism and identify committee/tak force to assist establishment of LACs
b) reproduction and dissemination of guide for coordination of HIV response at the local level
c) conduct technical advocacy and technical assistance for selected areas
d) coordinate with LGUs and NGOs alike for the local level coordination

Key Result Area 2: Supportive and more responsive policies and guidelines are formulated and enforced at the national and local levels
Activity	2005	2006	2007	2008	2009	2010
1. inventory, review of policies, amend as needed, and/or develop new policies
2. advocate for the adoption of policies and guidelines
3. monitor progress and enforcement of policies and guidelines

Key Result Area 3: Management systems in support of evidence-based advocacy, planning, policy formulation and decision-making are installed and operational
Activity	2005	2006	2007	2008	2009	2010
1. establish risk assessment and mapping (to include the development of MIS and GIS to generate vital information for decision making and planning)
2. strengthen surveillance system and expand to additional sites based on results of risk-assessment
3. review, update and implement research agenda with the institutionalization of 2% allocation from total budget
4. establish STI/HIV/AIDS resource center
5. design and establish a training network on HIV/AIDS
6. put in place a working program review, planning and monitoring and evaluation system at the national, sub-national and local levels
7. establish procurement system for ARVs and meds for OIs/others

Key Result Area 4: Funds for strategic interventions are generated, appropriately allocated and effectively utilized
Activity	2005	2006	2007	2008	2009	2010
1. clarify role of PNAC with regard to resource mobilization
2. define and establish guidelines in the utilization and allocation of mobilized resources
3. advocate for budget allocation or HIV/AIDS-related programs and projects, including a protected level of funding for PNAC, based on mandates of NGAs,as embodied in RA 8504
4. develop an investment plan to encourage the participation of local and foreign donors
5. scale-up national and local response mobilization efforts (e.g., advocacy meetings)
6. explore other mechanisms for mobilizing and managing resources at the national, sub-national and local levels for STI/HIV/AIDS (e.g. user fees, sponsorship, PhilHealth, etc.)

I. IMPLEMENTATION ARRANGEMENTS

The PNAC shall serve as the overall coordinator in the execution of the AMTP IV with the support of the PNAC secretariat. Member agencies shal carry out their respective mandates with respect to the AMTP IV. Existing comittee structure will be reviewed and modified given the emerging needs for focused interventions. An organizational cum planning meeting will be held at the start of every year to translate the AMTP IV into an annual operational plan where the focus of responsibility for each major activity will be identified and agreed upon by the whole body. A sub-national coordination task force will be established and equipped to strengthen coordination of efforts at the local level and to facilitate the flow of information, technical assistance and resources.

POLICY

Policies and guidelines that will chart the directions in the implementation of the AMTP IV will be formulated at the national level with due consultation among various stakeholders including those involved in implementing programs at the local level. Each member agency of PNAC has its own policy concerns, and each one is therefore expected to develop their respective policies and guidelines following a consultative process. Issuance and adequate dissemination of these guidelines shall also follow the formal route of the agency concerned. All policies and guidelines developed shall be subject to the review by the Council. The LGUs, on the other hand, are expected to also formulate ordinances that support HIV/AIDS prevention, treatment, cre and support in their respective localities. They are to adopt or loclize national policies and guidelines as appropriate to their respective situations and needs. Both the national government and LGUs are expected to enforce them.

TRAINING AND OTHER FORMS OF TECHNICAL ASSISTANCE

Training and other forms of technical assistance needed at the local level shall be provided by the concerned agencies and partner NGOs. The PNAC secretariat willf acilitate the infusion (NGO to NGO, NGO to LGU, LGU to NGO, LGU to other donors, and NGO to other donors) and wider application of appropriate technology, by coordinating with those who have the expertise and those who need them. It will establish a directory of resource persons at various levels who will be tapped to address the training requirements of stakeholders. PNAC will ensure the quality of training given by developing and disseminating standards and reviewing the training modules of institution-based programs. Should there be a need to mobilize expertise from the international community, the PNAC shall take the lead in mobilizing said experts to help in the implementation.

ADVOCACY

The AMTP IV requires the development of an overall advocacy plan to harmonize advocacy efforts, purpose and messages and to focus these on identified target groups or audiences. It is incumbent on PNAC to take this initiative in consultation with concerned stakeholders at all levels. Stakeholders at the local level have been doing their respective advocacies and shall continue to do so, guided by a national advocacy plan.

INFORMATION, EDUCATION AND COMMUNICATION

The PNAC shall endeavor to make an inventory of IEC efforts with support from the local levels, NGOs, the donor community and other stakeholders and undertake an assessment of their effectiveness. It shall enhance the existing Communication Plan and ensure that each concerned member agency implement and monitor the communication activities as designed and planned. The local level stakeholders shall parlay of this overall plan in developing, expanding and adapting IEC strategies and interventions in their locality. Each member agency of PNAC has been mandated to unedrtake HIV/AIDS related information, education and coomunication activities for the various sector groups they are to reach and serve. These mandates should be articulated to their regional or local counterparts to ensure wider coverage and reach.

TREATMENT, CARE AND SUPPORT

The provision of responsive treatment, care and support for those infected and affected by HIV/AIDS requires the coordinated efforts of all concerned. These include hospitals, LGUs, national agencies, NGOs and other concerned institutions and community groups. The DOh in consultation with the rest shall take the lead in reqviewing and strengthening the referral system to ensure continuity of care. The DSWD, together with their partner NGOs, will be responsible for establishing community and home-base care systems. Policies and guidelines for TCS shall be reviewed and updated at the national level. PNAC shall ensure that these are appropriately disseminated to all concerned.

LOGISTICS

The procurement and acquisition of necessary treatment drugs and other medicines will not be cost-efficient and effetive if these are done by LGUs and NGOs on an individual basis. The DOH is tasked to coordinate said procurement and shall establish a procurement and distribution mechanism to facilitate the easy access and availment of these supplies by those concerned. At the local level, the LGUs shall take the prime responsibility for procuring drugs, supplies and reagents for their SHCs.

SURVEILLANCE AND RESEARCH

The DOH shall be mainly responsible for providing technical assistance to LGUs in establishing their surveillance systems, which the latter shall be responsible for operating and maintaining. Surveillance data will follow the routine flow from the LGU and hospitals to the DOH-Center for Health Development (CHD) and DOH-national level. The DOH shall be responsible for disseminating reports to all concerned. In research, the PNAC shall review and update the research agenda for the next six years which shall server as a guide in the review and approval of research studies to be undertaken. The local level stakeholders are encouraged to undertake their own researches on concerns applicable to their area.

RESOURCE MOBILIZATION

Given the huge amount of resources to implement the AMTP IV, the PNAC Chair with support from the Secretariat shall spearhead the mobilization of resources. The PNAC must also take an active stance in coordinating and mobilizing donor assistance to further increase resources and ensure their appropriate utilization and prioritization. It shall establish a mechanism by which the technical expertise of donor agencies, NGOs and concerned national agencies can be transferred and expanded to toher areas needing technical support. Furthermore, the PNAC shall document various mechanisms and initiatives in order to promote the sustainability of programs and interventions for HIV/AIDS prevention, treatment, care and support. As to the wealth of non-fiscal resources which the country has accumulated in implementing a national response, the need to maximize their value will be addressed by the establishment of a dynamic resource center that willa ct as a central repository of training modules, research studies, IEC templates and materials, and information on agencies, organizations and individuals with expertise in these areas. With the timely matching between needs and the resources present, the mobilization of these resources is facilitated.

Refer to Annex 3 for the detailes delineation of scope and area of responsibility between the national and local levels.

J. MONITORING AND EVALUATION

The implementation of the AMTP IV will be monitored and evaluated using the set of indicators as defined and established by the Ad Hoc Committee on Monitoring and Evaluation. Please see Annex 4. Specific targets for each indicator will be established once the baseline data is a priority activity to be undertaken during the first year of AMTP IV implementation.

As designed, the monitoring and evaluation will be operationalized through the various agencies as part of their mandate. Each database will generate a set of information which will be centrally collected by DOH, particularly through the National Epidemiology Center (NEC). NEC in turn will be responsible for consolidating and disseminating this information on a regular basis. Information from the LGUs will be coursed through the Department of Interior and Local Government (DILG). NGOs both at the local and national levels will be linked to the M and E System through an NGO data clearinghouse.

The M and E system calls for various methodologies in collecting data. These include population-based surveys, program monitoring, surveillance, special surveys and routine reporting.

Monitoring visits to local areas implementing their respective local response against HIV/AIDS will be conducted. The PNAC, with DILG taking the lead will organize monitoring teams to make the necessary visits to the local areas. A mid-term evaluation will be conducted to determine the progress of implementation and the potential result of the activities and other inputs.

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