Country Situation Analysis

UN Support to the National Response

Contacts

UNAIDS Global Report 2006 Data

Country Situation Analysis

The national response is characterized by a multisectoral, multidisciplinary, decentralized and community-based approach. Multiple coordinating bodies have been created in the past three years at national and decentralized levels:

• Government structures: In 2000, the National AIDS Control Commission was created, under the Office of the President to coordinate a multisectoral programme; 2001 - The Treatment and Research AIDS Centre was created, to coordinate monitoring and evaluation of care, treatment and drug stocks and reports to the Commission. Minister of State for major epidemics appointed in 2002, within the Ministry of Health. In 2006 there was the decentralization of the Commission (within government administrative restructures) for representation in 30 District Committees for the Fight against AIDS; and
• Nongovernmental structures: coordinating umbrella organizations represent people living with HIV, youth, faith-based organizations, women, private sector, media and cluster of HIV (Government of Rwanda and Development partners).

To better monitor the effectiveness of these structures, measures to operationalize and harmonize standard operating procedures have been put in place, e.g. mapping of activities of all implementing agencies, who now sign memoranda of understanding  with the National AIDS Control Commission. The Commission is currently finalizing a guiding document on coordination mechanisms in the country.

Assessment of expenditures on HIV shows that financial resources have increased from US$ 7.7 million in 2003, to US$ 40.3 million in 2004 to US$ 78.5 million in 2005. The levels of support will be high until the end of 2009, when the PEPFAR programme comes to an end. The increase in resources has shown clear benefits, with remarkable successes in the numbers of people on antiretroviral drugs (19 058 in Dec 2005; 8355 in Dec 2004; 4189 in Dec 2003) and numbers of clients reached on prevention of mother-to-child transmission. The new Demographic and Health Survey 2005 reports that women are more affected than men. For 15-49-year-olds, women are 1.5 times more infected than men (M: 2.3%, F: 3.6%). Among 15-24-year-olds, there is a five-fold difference (M: 0.5%, F: 2.5%). Comprehensive knowledge among youth on different prevention methods has increased from 22% in 2000 to 52% in 2005, while unprotected sex has increased for both sexes (10% to 15% among females and 42% to 48% among males) and decrease of condom use among males (dropped from 55% to 41%).

Behaviour change remains a barrier and communication messages are conflicting for the youth. Further efforts need to be made for predictable and sustainable financing of the national plan to facilitate universal access. The current national plan proposes to address this issue.

Needs and Challenges

Coordination
From 1 January 2006, Rwanda's geo-administrative structures have been reduced from 106 districts in 12 provinces to 30 districts in four provinces. Government and development partners need to align and harmonize operations in the new structure, whose essence is to strengthen decentralized levels, bringing quality services closer to the people. There is a need to balance prevention, treatment, care and support aspects of the response.

Research
The new strategic framework has placed emphasis on evidence-based programming and the use of research to guide decisions. Support will be needed from partners to assist capacity-building among Rwandans to carry out good quality relevant research, from the planning, implementation and analysis up to publication and presentation stages.

Programme sustainability
It is estimated that the new strategic plan will require US$ 332 million to implement. This is about US$ 66.6 million per annum for the next five years. In 2005, all partners reported expenditures totalling US$ 78.5 million. The government share was 2% of the total. The issue is how government and partners can maintain the momentum for scaled up responses.

Technical support for monitoring and evaluating the national response and for building national capacity needs to be maintained by partners until the national system is fully operational.

• Technical assistance to the National AIDS Control Commission for the revision of the National Strategic Plan 2005-2009.
• HIV integration in Poverty Reduction Strategy Paper.
• Technical support for strategies and monitoring and evaluation plans for civil society and other coordinating organizations (Strategic plans for Pan African Youth Association, Network of People Living with HIV, National Youth Council; monitoring and evaluation plans for orphans and vulnerable children and the National Youth Council).
• Technical assistance for development of workplace policy.
• Technical assistance for the process and product of the mid-term review.
• Technical support for Common Country Assessment.
• Support to civil society coordinating bodies ('umbrellas') for strengthening strategic planning and monitoring and evaluation and reinforcing partnerships (training for nongovernmental organization Umbrella, information, education and communication campaign with APELAS-Private Sector Umbrella, support for home-based care service provision with Network of People Living with HIV, information, education and communication training for religious leaders).
• "Unite for Children, Unite against AIDS" in Rwanda.
• "Treat Every Child As Your Own" Campaign with Organization of African First Ladies Against AIDS.
• World AIDS Day Campaign to Stop AIDS through individual responsibility.
• Support to National AIDS Control Commission to provide UNGASS 2005 report and UNGASS 2006 full report.

Individual agencies provided support in mandated areas e.g. UNICEF provided support to prevention of mother-to-child transmission sites, WHO developed protocols for treatment, UNFPA provided free distribution of condoms along with reproductive health programme support, UNDP provided microeconomic support for vulnerable people, especially women, WFP provided nutritional support for mitigation, and World Bank MAP provided multiple services in a multisectoral approach.

Objectives

• Elaboration of one joint UN programme on HIV and AIDS. In 2006 a pilot joint UN programme will be implemented. In 2007, a joint support plan will be elaborated as a bridging programme prior to the next UNDAF cycle, to be aligned with the new national programme cycle. Emphasis will be on prevention among youth, and on monitoring and evaluation support.
• Integration of HIV and AIDS into national development frameworks (EDPRS) and sector strategies.
• Led by UNDP, the World Bank and UNAIDS, participatory processes to ensure that emerging issues and challenges for universal access to quality service delivery as well as sustainability of programmes will be addressed, with every effort made to link intervention with national development frameworks.
• Technical support to strengthen the national monitoring and evaluation framework.

Expertise within the UNAIDS family and other UN agencies on the ground will be resourced to support the national efforts in finalizing and operationalizing the national monitoring and evaluation plan as well as improving monitoring and evaluation of the joint UN response.

Contacts

Chair, UN Theme Group on HIV/AIDS
Bintou Keita
Tel: +250 590 405 / 573 033
Fax: +250 573 024
Mobilephone: +250 587 717
Postal Address:
UNICEF, BP 381, Kigali, Rwanda
Email: bkeita@unicef.org

UNAIDS Country Coordinator
Kekoura Kourouma
Tel: +250 510 623
Fax: +250 510 622
Postal address:
P.O. Box 445, Kigali, Rwanda
Email: Kekoura.kourouma@undp.org

NAC
Commission Nationale de Lutte Contre le SIDA (CNLS)
Agnes Binagwaho
Secrétaire Executif
B.P. 7162, Kigali, Rwanda
Tel: +250 582 018
Fax: +250 583 325
Email: cnls@rwanda1.com, abinagwaho@yahoo.fr

Networks of organisations working on HIV

NGO Forum
Regis Ruhangwa
Mobile: +250 0830 7775
Email: ruharegis@yahoo.fr

APELAS (private sector)
Juru Rurangwa
Mobile: +250 0830 1690
Email: jruranganwa@bnr.rw

CNF (women’s network)
Diane Gashumba
Mobile: +250 0858 6437
Email: dgashumba@yahoo.fr

CNJ (youth)
Claude Ruk
Mobile: +250 0846 7955
Email: rukclaude@yahoo.com

RCLS (FBO)
Mobile: +250 0853 0335
Email: gbunini@yahoo.fr

HIV donor cluster
Nancy Fitch
Mobile: +250 0830 3036
Email: nfitch@usaid.gov

Network of people living with HIV
Shaquilla Umutoni
Mobile: +250 0830 8191
Email: shakillak@hotmail.com

UNAIDS Global Report 2006 Data

For more information contact Richard Delate at tel. 27 11 517 1524, mobile +27 82 909 2638 or visit www.unaids.org

Country profiles provide key information on the status-quo of the HIV pandemic in the countries of the region. Data is updated by the UNAIDS Country Offices on a yearly basis.