US embassy cable - 05GABORONE405

UNCLAS  GABORONE 000405 
 
SIPDIS 
 
 
STATE FOR S/GAC, AF/S, EAP, WHA AND OES; DEPARTMENT PLEASE 
PASS TO PEACE CORPS WASHINGTON; DEPT ALSO FOR AID; HHS FOR 
WSTEIGER 
 
E.O. 12958: N/A 
TAGS: KHIV, SOCI, TBIO, EAID, KPAO, BC, HIV and AIDS 
SUBJECT: BUILDING THE PRESIDENT'S EMERGENCY PLAN FOR AIDS 
RELIEF IN BOTSWANA 
 
REFS:  A) STATE 28801; (B) 04 BOTSWANA 1572; (C) 04 BOTSWANA 
1170 AND PREVIOUS 
 
1.  Summary:  Botswana is one of 15 focus countries assisted 
by the President's Emergency Plan for AIDS Relief.  In FY- 
2004, the U.S. Mission in Botswana expended more than $18 
million for Emergency Plan HIV/AIDS prevention, treatment, 
and care.  More than $35 million has been programmed in FY- 
2005.  From August through October 2004, a USG interagency 
team engaged in a broadly participatory process with the 
Government of Botswana (including the Country Coordinating 
Mechanism of the Global Fund), civil society, the United 
Nations, and other partners to prepare a Five-Year Emergency 
Plan Strategic Plan and a FY-2005 Emergency Plan Country 
Operational Plan.  Both plans were reviewed and approved in 
Washington, with the exception of two small projects that 
were reprogrammed.  This report describes the process 
utilized, which was described by local partners and UN staff 
in Botswana and Geneva as a best practice.  End summary. 
 
2.  The USG has been working hand-in-hand with local 
partners in Botswana on HIV/AIDS and tuberculosis since 
1995.  However, in 2000 the HIV/AIDS program began to 
rapidly scale up with the advent of the DHHS/CDC Global AIDS 
Program.  Further significant increases occurred in 2003 
with the commencement of the President's Initiative for 
PMTCT.  In FY-2004, USG HIV/AIDS funding in Botswana doubled 
under the Emergency Plan to more than $20 million, and 
nearly doubled again to about $40 million in FY-2005. 
 
3.  In developing the FY-2004 Country Operational Plan (COP) 
-- the first year of the five-year Emergency Plan -- the 
U.S. Mission Emergency Plan team (comprised of State, 
DHHS/CDC, the USAID Regional Program, Peace Corps and the 
DOD Office of Defense Cooperation) formed an advisory 
Steering Committee, chaired by the Coordinator of Botswana's 
National AIDS Coordinating Agency (NACA) (which is charged 
by the Office of the President with coordinating all 
national HIV/AIDS interventions).  The Steering Committee 
included the Ministries of Education, Finance & Development 
Planning (which oversees all international development 
assistance), Health, and Local Government (which oversees 
palliative care and assistance to orphans), along with 
UNAIDS, UNDP, UNFPA, UNICEF, and WHO.  The Steering 
Committee endorsed the FY-2004 COP, which was approved in 
full by the Office of the Global AIDS Coordinator. 
 
4. In 2004, the preparation of the Emergency Plan Five-Year 
Strategic Plan and the substantial increase in funds 
available for the FY-2005 Emergency Plan COP provided the 
U.S. Mission with the opportunity to undertake a more 
extensive participatory strategic planning process.  The 
Steering Committee was brought under the purview of the 
HIV/AIDS Subcommittee of the Country Coordinating Mechanism 
(CCM) of the Global Fund in order to ensure broad 
participation and coordination with other HIV/AIDS response 
initiatives.  The Steering Committee was also further 
expanded to include the Ministry of Labor and Home Affairs 
(which oversees AIDS in the workplace and youth issues).  An 
all-day CCM workshop, led by the CCM Chair (the Secretary 
for Economic Affairs in the Ministry of Finance and 
Development Planning), was held on August 26, 2004 to 
initiate the Botswana Emergency Plan planning process. 
Participants included the U.S. Mission (led by the DCM, 
visiting Emergency Plan Core Team members, representatives 
from six relevant Ministries, five UN agencies and key civil 
society organizations, and the African Comprehensive 
HIV/AIDS Partnership (ACHAP - the Gates and Merck 
Foundations). 
 
5.  The CCM endorsed the formation of five Technical Working 
Groups (TWGs): 1) behavior change communication for 
prevention, youth, and gender issues; 2) care and treatment 
(including PMTCT, blood safety, injection safety, ARVs, 
laboratory strengthening, sexually transmitted infections, 
 
 
palliative care, tuberculosis and other opportunistic 
infections); 3) HIV counseling and testing; 4) orphans and 
vulnerable children; and 5) strategic information and 
capacity building (including monitoring and evaluation, 
human capacity development, informatics, policy analysis, 
and system strengthening including program management 
training).  Each TWG was composed of technical experts drawn 
from the Government of Botswana, the U.S. Mission, the UN, 
and civil society. 
 
6.  The USG Mission became the secretariat for all TWGs, 
providing technical, administrative and logistical support. 
This proved to be important in maintaining the momentum of 
the effort and relieving other partners, particularly 
government officials, of the cumbersome burden of such 
matters.  Participants were only asked to express their 
ideas, not to manage the process. 
 
7.  Guided by the Botswana HIV/AIDS National Strategic 
Framework (2003-2009) and National Operational Plan (2003- 
2009), nearly 100 TWG participants spent many hours in 
August, September, and October 2004 providing input for the 
Five-Year Strategy and FY-2005 COP, often meeting on a 
weekly basis.  A senior technical USG representative 
provided linkage to each group, and a U.S. consultant with 
skills in participatory program planning provided day-to-day 
coordination and edited the input from the groups.  On 
October 13, the Steering Committee endorsed both documents. 
The CCM Chair added his endorsement on October 22, clearing 
the way for final approval by the Ambassador and submission 
to Global AIDS Coordinator Randall Tobias by the October 29 
deadline.  Both plans were reviewed and fully approved in 
Washington, with the exception of two small projects 
(representing less than half of one percent of the total 
budget) that were reprogrammed. 
 
8.  As a reference for interested posts, the Terms of 
Reference for the Steering Committee and TWGs are included 
in paras 13 and 14. 
 
The Emergency Plan Process in Botswana - A Success Story 
--------------------------------------------- ----------- 
 
9.  The U.S. Mission is very pleased with how well the 
consultative process engaged key HIV/AIDS intervention 
partners in the nation, building on Botswana's outstanding 
political will and leadership -- most notably that of 
President Festus G. Mogae.  Our five-year strategy and FY- 
2005 COP not only reflect widespread consensus on Botswana's 
most critical needs for HIV/AIDS intervention, they have 
also been formally adopted by the Government of Botswana and 
other key institutions, paving the way for rapid and 
effective project implementation.  Employing the already 
existing Global Fund Country Coordination Mechanism (CCM) 
and utilizing multi-agency TWGs has ensured that there is no 
duplication of effort among key partners, has allowed a 
broad range of technical experts and decision-makers to be 
instrumental in developing the Emergency Plan, has assured 
that the objectives of Botswana's national strategic 
framework are recognized and fully incorporated, and has 
contributed to the overall sustainability of the many new 
and existing initiatives under the Emergency Plan. 
 
10.  It is worth noting the importance of the Mission's 
seamless internal USG interagency process, led by the 
Ambassador, which enabled the USG in Botswana to always be 
on the same page and speak with one voice.  Team Botswana 
(State Department, DHHS/CDC, USAID, Peace Corps and DOD/ODC) 
truly left their uniforms at the door and collaborated to 
create a unified Five-Year Strategy and FY-2005 COP.  The 
DCM, as the interagency head of the Emergency Plan process, 
routinely gathered Team Botswana together to resolve 
questions and issues that arose. 
 
11.  It is also important to single out the work of civil 
 
 
society organizations.  Their involvement in the Emergency 
Plan process is a key to success as they are in the 
forefront of identifying and responding to the challenges 
and issues of implementing HIV/AIDS intervention at the 
community level. 
 
12.  Comment: The U.S. Mission feels the process involved 
has been well worth the effort.  Commenting on the process 
employed in putting together the Emergency Plan, the 
Botswana WHO Representative commented: "This is a best 
practice for being inclusive.  We commend the management 
style of the Emergency Plan team in Botswana.  Indeed they 
are a team to emulate."  During the Ambassador and CDC 
Director's recent visit to Geneva, UNAIDS Deputy Director 
Michele Sidibe commented, "Botswana represents a model that 
other countries should emulate in fighting the HIV/AIDS 
pandemic."  We trust this description of how we built the 
Emergency Plan in Botswana will provide ideas for other 
focus countries and for other USG HIV/AIDS intervention 
programs in the future. 
 
13.  Terms of Reference - Steering Committee 
     --------------------------------------- 
 
In order to maximize the benefit from and coordinate the 
implementation of PEPFAR, a Steering Committee with 
representation from the Government of Botswana, relevant UN 
agencies, and the U.S. Embassy country team, including the 
BOTUSA Project, was constituted in 2003.  With the need to 
develop a five-year strategic plan and plan for the doubling 
of funding available in FY-2005, this steering committee is 
being reactivated with these terms of reference. 
 
Composition of Steering Committee: 
 
-- The Permanent Secretaries, or their representatives, from 
five Ministries from the Government of Botswana (Education, 
Finance & Development Planning, Health, Labor and Home 
Affairs, & Local Government). 
 
-- National AIDS Coordinating Agency (NACA) 
 
-- The Agency Heads, or their representatives, from five 
United Nations Agencies (UNAIDS, UNDP, UNFPA, UNICEF and 
WHO) 
 
-- U.S. Mission (State Department, DHHS/CDC (BOTUSA), 
USAID/RCSA). 
 
Goal of Steering Committee:  To guide the U.S. Mission in 
developing a PEPFAR program that most effectively combats 
the HIV/AIDS epidemic in Botswana through the Government of 
Botswana's 2003-2009 HIV/AIDS Response National Strategic 
Framework and National Operational Plan and the U.S. 
Government's PEPFAR objectives. 
 
Specific Objectives: 
 
-- To provide policy guidance, advise on, review, and 
approve a five-year PEPFAR Botswana Strategic Plan - 2004- 
2008, and an FY-2005 Country Operational Plan (COP), which 
will be drafted by five Technical Working Groups (TWGs). 
The TWGs are being formed working under the auspices of the 
Botswana Global Fund Country Coordinating Mechanism (CCM). 
 
-- Critical policy guidance is needed on: (a) Distribution 
of funding by priority area - prevention, treatment, and 
care and support, and (b) 
 
Distribution of funding by partner type - Government of 
Botswana funding, international contractor, university, 
international NGO, UN agency, local NGO, etc. 
 
 
-- To provide oversight as needed at the policy level for 
future needs in planning, implementation, monitoring, and 
evaluation of PEPFAR Botswana. 
 
 
Steering Committee Operations: 
 
-- The Chairperson of the Steering Committee will be the 
NACA Coordinator or her designee. 
 
-- The TWGs will report to the Steering Committee, which in 
turn will report to the Chairman of the CCM. 
 
-- The CCM will provide the above-named documents to U.S. 
Ambassador to Botswana Joseph Huggins for his approval and 
submission to Ambassador Randall Tobias, U.S. Global AIDS 
Coordinator. 
 
-- The U.S. Embassy country team will provide administrative 
and technical support to the Steering Committee. 
 
14.  Terms of Reference - TWGs 
     ------------------------- 
 
A steering committee with representation from the Government 
of Botswana, relevant UN agencies, and the U.S. Embassy 
country team, including the BOTUSA Project, was constituted 
in 2003 to maximize the benefit from and coordinate the 
implementation of PEPFAR.  With the need to develop a five- 
year strategy and plan for the doubling of funding available 
in FY-2005, PEPFAR technical working groups (TWGs) are being 
formed working under the auspices of the Botswana Global 
Fund Country Coordinating Mechanism (CCM). 
 
Technical Working Groups:  There will be a total of five 
TWGs in the following areas: 
 
-- Behavior Change Communication for Prevention, Youth, and 
Gender (BCC) 
 
-- Care and Treatment, including PMTCT, blood safety, 
injection safety, ARVs, sexually transmitted infections, 
palliative care, tuberculosis and other opportunistic 
infections (Care) 
 
-- HIV Counseling and Testing (HCT) 
 
-- Orphans and Vulnerable Children (OVC) 
 
-- Strategic Information and Capacity Building, including 
monitoring and evaluation, human capacity development, 
laboratory infrastructure, informatics, policy analysis, and 
system strengthening including program management training 
(SI/CB) 
 
Composition:  Each TWG will have a chairperson, a secretary, 
and members drawn from the Government of Botswana, the UN, 
the U.S. Embassy country team, and civil society. 
 
Reporting:  The TWGs will report to the PEPFAR Steering 
Committee, which reports to the Chairperson of the CCM, 
representing the Permanent Secretary of the Ministry of 
Finance and Development Planning. 
 
Purpose:  The TWGs will have the following objectives: 
 
-- To provide technical input into the PEPFAR Botswana five- 
year strategic plan using the guidelines provided by the 
U.S. Office of the Global AIDS Coordinator. 
 
-- To provide technical input into the PEPFAR Botswana FY- 
2005 Country Operation Plan using the template provided by 
the U.S. Office of the Global AIDS Coordinator. 
 
 
-- To provide technical input as requested by the PEPFAR 
Steering Committee for future needs in planning, 
implementation, monitoring, and evaluation of PEPFAR 
Botswana. 
 
Rationale:  Working through TWGs under the PEPFAR Steering 
Committee in the CCM will help ensure that PEPFAR Botswana 
is effective; coordinated with initiatives of the Government 
of Botswana, the UN, other development partners, and civil 
society; and aligned with the Botswana 2003-2009 HIV/AIDS 
Response National Strategic Framework and National 
Operational Plan. 
 
Support:  The U.S. Embassy country team will serve as the 
secretariat to the TWGs providing administrative and 
 
SIPDIS 
technical support. 
 
HUGGINS 
 
 
NNNN