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HIV/AIDS ProgrammeHIV/Aids Programe UNDP is strategically placed to provide comprehensive support to the Government of Botswana (GoB) in addressing the development impact of HIV and AIDS by developing national capacity to respond to the epidemic effectively. This support enhances the implementation of the 2001 Declaration of Commitment on HIV/AIDS, and supports the achievement of the Millennium Development Goals (MDGs). This is also in accordance with the specific and well-defined role of UNDP as expressed in its corporate strategy on HIV and AIDS, which focuses on:
The GoB has initiated policies and organizational changes to facilitate a multisectoral, human rights-based, gender-sensitive response to HIV and AIDS in the context of increasing epidemic-related capacity erosion. The current circle of engagement with the Government of Botswana assists in accelerating the momentum generated in the previous project. It assists the government to strengthen capacities in the following areas of; leadership for results with a focus on communities; mainstreaming of gender and appropriate responses to HIV and AIDS; and applied research on the socio-economic impact of HIV and AIDS. Situation analysis Since independence, Botswana has made remarkable progress in the areas of health, education, the rule of law, general welfare of the people, and the macro-economic situation. However, the emergence of HIV in the mid-1980s, and its spread country-wide, is undermining post-independence gains, as evidenced by declining life expectancy at birth, and increasing under-five mortality and crude death rates.
Importantly, the AIDS epidemic presents a major threat to the government’s capacity to enhance socio-economic development in Botswana. In addition to its impact on individuals, in Botswana as in other countries AIDS threatens to reduce state capacity to optimally perform in delivery of services to its citizens. Two issues account for this: first, the pressure on state budgets as governments attempt to mitigate the impact of the epidemic on society (through efforts such as treatment programmes and initiatives to mitigate the social and other impacts of the epidemic); and second, the epidemic reduces productivity and quality of services provided by governments, owing to loss of skilled personnel and increased absenteeism. According to the Botswana AIDS Impact Survey (BAIS 2004), it is estimated that 17.1% of Batswana (people of Botswana) are now living with HIV and AIDS, making Botswana one of the worst HIV-affected countries in the world. Some of the identified underlying factors for the spread of HIV in Botswana include: biological determinants; social-cultural determinants including gender inequality and alcohol abuse; migration; and, socio-economic determinants such as poverty. Gender inequality in particular is one of the critical determinants of the continuing spread of HIV in Botswana, given that HIV transmission in the country is predominantly heterosexual. Embedded in heterosexual relationships are the unequal power relations between men and women, which should be taken into account in the design and implementation of responses to the epidemic. The burden of care for the ill and orphans is also disproportionately borne by women. One of the recommendations of the Evaluation of Gender Mainstreaming in UNDP (2005) articulated the need to revitalize gender mainstreaming by setting up and monitoring specific organization-wide and country-specific targets in all thematic areas of work, and incorporating gender analysis into policy and programme design. In addition, targeted initiatives should promote women’s empowerment and gender equality. These recommendations have been taken into account in the development of the present Programme Support Document (PSD). In keeping with this, the PSD contributes to the speedy implementation of Botswana’s plan associated with the Secretary-General’s Task Force on Women, Girls and HIV&AIDS. The PSD’s focus on women’s empowerment and issues related to gender equality is based upon evidence which strongly suggests women’s relative vulnerability to infection. Recent data on HIV in Botswana indicate that girls are more susceptible to HIV infection than their male counterparts. For every HIV-positive boy in the age group 15-19, there are three HIV-positive girls within the same age group; this may be indicative of a trend of intergenerational sex where young girls have sex with relatively older men. Violence against women and abuse of power and money in sexual relationships are also believed to be placing women at increased risk of HIV infection. Despite this grim reality, there may be reason for optimism: according to the latest Sentinel Surveillance Report (2005 Botswana Second Generation HIV/AIDS Surveillance: Technical Report 2005), 33.4% of pregnant women in the age group 15-49 are HIV-positive, which is a decline from 37.4% in 2003. Most of this reduction has occurred in the younger age groups 15-19 and 20-24 years. One of the primary aims of this programme is to support the further reduction of infection in this highly vulnerable group. Since the first case of HIV in Botswana was identified in 1985, a number of organizational and institutional initiatives have been taken to address the challenges related to the epidemic. This includes the creation of the National AIDS Council (NAC) in 1995 chaired by the Honourable Minister of Health. In 1999 AIDS was declared an emergency, and His Excellency the President took over the NAC Chair. He also approved the establishment of the National AIDS Coordinating Agency (NACA) in December 1999, which serves as the NAC Secretariat. At ministerial level, AIDS Coordinators were appointed to facilitate the implementation of AIDS programmes within their respective sectors as called for in the National Strategic Framework. District Multi-Sectoral AIDS Committees (DMSACs) with technical support from the district AIDS Coordinators and the AIDS Coordinating Unit in the Ministry of Local Government, were also created to coordinate district AIDS responses, with clear linkages to both communities and the national response. AIDS and gender management structures have been put in place at national, district and community levels. Government has also introduced the following programmes, which are mutually reinforcing:
Under the previous GoB-UNDP Project (Strengthening Capacity for Gender Sensitive Multi-Sector Response to HIV and AIDS in Botswana, 2003-2006), the Government, with the assistance of UNDP and other United Nations agencies (UNICEF and WHO) and the African Comprehensive HIV and AIDS Partnership (ACHAP), commissioned a series of socio-economic impact studies that have formed the basis for policy dialogue and advocacy. These studies have addressed issues related to the demographic and economic impacts of AIDS in Botswana, and have contributed to policies and initiatives such as the introduction of Antiretroviral (ARVs) and the mainstreaming of gender and AIDS into public sector policies and programmes. The findings of the ongoing AIDS socio-economic impact studies are critical in informing national planning, policies, programmes and interventions in the national response. UNDP has also supported the Government of Botswana in its efforts to prevent the further spread of infection and to curb the impact of the epidemic through support for capacity building in the areas of policy development, institutional strengthening, and the improvement of service delivery systems. Capacity development efforts have focused on both central and district-level interventions. In addition to strengthening institutional capacity through policy development, grassroots-level responses were strengthened using community capacity enhancement approaches such as the Leadership Development Programme (LDP) and the Community Capacity Enhancement-Community Conversations (CCE-CC) methodologies. At the community level, civil society organizations (including community-based organizations, faith-based organizations, and non-governmental organizations) and health workers, assisted by national UNVs recruited under the project, successfully worked together to mobilize communities. According to the Mid-term Review (MTR) of the UNDP/Government of Botswana Country Programme (2003-2007), through the effective use of the CCE-CC methodology, communities have begun to articulate their concerns and priorities with regard to development issues in general, and more specifically with regard to HIV and AIDS. This collective identification of problems and challenges is important for informing policy making, particularly at the local level. The CCE-CC was also recognized as a best practice in the 2006 regional evaluation undertaken by the UNDP Evaluation Office (“Evaluation of UNDP’s Role and Contributions in the HIV/ AIDS Response in Southern Africa and Ethiopia”). The evaluation made a specific recommendation regarding the value of up-scaling this innovative approach to community mobilization for a multisectoral response. Outline of National Strategy Botswana is signatory to all of the major regional and global declarations on HIV and AIDS and gender, including the Abuja and UNGASS Declarations, Beijing, and SADC conventions. The National AIDS and Women in Development policies are currently being revised. The Botswana Government recognizes that an effective response to HIV and AIDS should be multisectoral, gender- sensitive and use human rights approaches as reflected in “Vision 2016” and National Development Plan (NDP) 9. To supplement the significant national resources which Botswana allocates for the national response, much-needed additional resources have been received from the Global Fund on AIDS, TB and Malaria (GFATM), ACHAP, the United States Government’s President’s Emergency Plan for AIDS Relief (PEPFAR) and other development partners. In keeping with the United Nations Development Assistance Framework (UNDAF) for 2003-2006, UNDP will continue to focus on capacity strengthening for community capacity enhancement, leadership development, and addressing the special vulnerability of girls and women through mainstreaming gender and AIDS in sector mandates and selective support to the National Action Plan on Women, Girls and HIV and AIDS. With regard to strengthening capacity at the community level, the lessons learnt from functional DMSACs will be critical to ensuring a district-based approach to HIV and AIDS that take into account the local problems identified. Under the previous PSD, the combination of international and national United Nations Volunteers (UNVs) at national and sub-national levels was found to facilitate the implementation of AIDS initiatives at the district and community levels. National UNV support has therefore been built in to the present PSD extension. Execution modality and implementation arrangements National Execution (NEX) is the preferred execution modality for UNDP-supported programmes and projects. There is consensus that NEX reflects national ownership and ensures sustainability. It is also recognized that there is a need to continue training of implementing agencies in NEX and to strengthen their capacities to manage and coordinate projects effectively. Under this PSD, the Ministry of Finance and Development Planning (MFDP) is the national coordinating authority within the overall framework of GoB/UNDP collaboration, while the National AIDS Coordinating Agency (NACA) will assure the implementation of the project in collaboration with other partners. NACA is responsible for the attainment of the objectives of the project, while implementing agents are responsible for transforming inputs into outputs. In order to ensure integrated implementation of the programme, a Project Executive Board provides policy direction and implementation oversight. The membership of the Project Executive Board is drawn from the Government of Botswana, civil society, the UN system and any other relevant partners; representation is at policy decision-making level (Chief Executives and agency Representatives). The Project Executive Board meets quarterly to review progress towards the attainment of the project outputs. NACA serves as the Project Executive Board Secretariat. UNDP assists the implementing agency in financial reporting as appropriate and necessary and will make direct payments to contractors and suppliers at the request of the executing and implementing agencies. In addition, UNDP may provide the below services, in accordance with the regulations, rules and procedures of UNDP, at the request of the NACA:
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Botswana
