STRATEGY FOR THE FIGHT AGAINST HIV & AIDS IN THE PUBLIC SECTOR 2009 -2013

REPUBLIC OF MOZAMBIQUEMINISTRY OF PUBLIC SERVICE

MAPUTO, APRIL 2009

PUBLIC SERVANTSPUBLIC SERVANTS SERVING CITIZENS BETTERSERVING CITIZENS BETTER

MAPUTO, APRIL 2009

STRATEGY FOR THE FIGHT STRATEGY FOR THE FIGHTAGAINST HIV & AIDS

IN THE PUBLIC SECTORAGAINST HIV & AIDS

IN THE PUBLIC SECTOR

2009 -20132009 -2013

Developed with the support of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Photo credit: UNAIDS/Eliane Beeson (except where indicated)

Public Servants Serving Citizens Better 3

Table of ConTenTs

List of AbbreviAtions ...............................................................................................................................4

resoLution .................................................................................................................................................5

PrefAce ........................................................................................................................................................6

executive summAry...................................................................................................................................7

i.introduction .........................................................................................................................................10

ii. brief descriPtion of the PubLic sector in mozAmbique .........................................................11

iii. summAry of the situAtionAL AnALysis of hiv And Aids in the PubLic sector ...............13

iii.1. evoLution And stAte of the resPonse ...............................................................................13

iii.2. the imPAct of hiv And Aids in the PubLic sector .......................................................13

iii.3. KnowLedge, Attitudes And PrActices on hiv And Aids in the PubLic sector .....15

iii.4. hiv And Aids vuLnerAbiLity fActors And situAtions in the PubLic sector ...........16

iii.5. Lessons LeArned And chALLenges to the hiv And Aids resPonse in

the PubLic sector ................................................................................................................17

iv. demogrAPhic And economic imPAct of hiv And Aids in the PubLic sector ...................18

iv.1. estimAtion of PubLic sector worKers infected by hiv ...............................................19

iv.2. estimAtion of deAths due to Aids in the PubLic sector ............................................19

iv.3. estimAtion of PubLic servAnts in need of Art in 2008 ................................................20

iv.4. estimAtion of PersonneL costs ............................................................................................20

iv.5. economicAL imPAct ...................................................................................................................22

v. strAtegy for the fight AgAinst hiv And Aids in the PubLic sector ................................23

1. vision, mission, And objectives .................................................................................................23

2. resPonse APProAch ........................................................................................................................23

3. guiding PrinciPLes ........................................................................................................................24

4. strAtegic AreAs in the scoPe of hiv And Aids resPonse 2009-2013 .............................24

4.1. minimum PAcKAge of services ............................................................................................24 5. mAinstreAming of hiv And Aids in institutions ................................................................316. estAbLishing PArtnershiPs for Provision of services ...........................................................327. normAtive AsPects ........................................................................................................................338. trAnsversAL AsPects .....................................................................................................................34 8.1. coordinAtion And mAnAgement of the resPonse to hiv And Aids in the PubLic service ......................................................................................................................34 8.2. communicAtion ......................................................................................................................40 8.3. monitoring And evALuAtion ..............................................................................................419. finAnce And sustAinAbiLity mechAnisms ..................................................................................42

Anexo 1: Priority AreAs of intervention in the imPLementAtion of the strAtegy ..........44

Anexo 2: PreLiminAry costs of hiv And Aids resPonse for the PubLic sector ...............46

4 Public Servants Serving Citizens Better

LIST OF ABBREVIATIONS

ART Anti-Retroviral TherapyCNCS National Council for the Fight against AIDSEGFAE General Statue for Public ServantsFADM Armed Forces of MozambiqueFP Focal PointHIV HumanImmunodeficiencyVirusIEC Information, Education and Communication ILO International Labour OrganisationKAP Knowledge, Attitudes and PracticesSTDs Sexually Transmitted DiseasesM&E Monitoring and EvaluationMAE Ministry of State AdministrationME Ministry of EnergyMEC Ministry of Education and CultureMFP Ministry of Public ServiceMIMAS Ministry of Women and Social CareMINAG Ministry of AgricultureMINT Ministry of InteriorMISAU Ministry of HealthMITRAB Ministry of LabourMOPH Ministry of Housing and Public WorksMPF Ministry of Planning and FinanceMTC Ministry of Transport and CommunicationsNPCS Provincial Centre for the Fight against HIV/AIDS OGE General State Budget POA Annual Operational PlanPES Economic and Social PlanPEN National Strategic PlanPLHA People Living with HIV and AIDSSIDA AcquiredImmunodeficiencySyndromeTDM Telecommunications of MozambiqueUEM University of Eduardo Mondlane

REPÚBLICA DE MOÇAMBIQUEMINISTÉRIO DA FUNÇÃO PÚBLICA

ESTRATÉGIA DO HIV E SIDA NA FUNÇÃO PÚBLICA

RESOLUTION N.º 44/200919 AUGUST

InresponsetotheneedtodefineaPublicSectorHIVandAIDSResponseStrategy,underpointf) of n.º 1 of article 204 of the Republic’s Constitution, the Council of Ministers determines:Once. The Public Sector HIV and AIDS Response Strategy 2009 – 2013 is approved, the strategy forms part of the Resolution presented in annex.Approved by the Council of Ministers on 23rd June 2009.

Published.

Prime Minister, Luísa Dias Diogo



REPUBLIC OF MOZAMBIQUE

MINISTERY OF PUBLIC SERVICEPUBLIC SECTOR HIV AND AIDS STRATEGY

PREFACE

TheGovernmentof MozambiqueindevelopingaStrategyforthefightagainstHIVandAIDSinthePublicSector2009-2013invitesustoreflectandworktoreversethetrendof thispandemic.According to the demographic impact of HIV and AIDS in the Public Sector for the year of 2008, from around 167,000 public servants and State agents, 32,000 are infected with HIV at national level and of whom 10,000 need Antiretroviral treatment. On the other hand, it is estimated that there is a register of around 1,600 annual deaths of public servants and State employees infected with HIV and AIDS.As a way to impede this happening, and so that we the public servants and State agents continue to behealthyandproductive,thecurrentPublicSectorStrategyforthefightagainstHIVandAIDSwas designed, with interventions necessary to achieve the principle objectives structured into pri-ority areas namely: Prevention; Care and Treatment; Impact Mitigation; Stigma and Discrimina-tion; Mainstreaming of HIV and AIDS into the State institutions; Establishment of partnerships for service delivery; Normative Aspects, Multi-sector coordination; Communication; Monitoring and Evaluation and Financial and sustainability mechanisms.Experiences from countries relatively successful in controlling the rising rates of the spread of HIV and AIDS, indicate that the countries that have adopted a “multi-sectoral” approach have managed to gather their efforts in the same direction, indicating that programmes implemented jointly have had the best results. For this reason, there is always a bigger necessity for us to act togetherusingallourenergyandcreativenesstofindthebestresponsesinawaythatwehalttheadvance of this pandemic and always have fewer public servants in the situation where they are infected and affected by HIV and AIDS.It is our commitment to make the Public Strategy for the Fight against HIV and AIDS 2009-2013 into an instrument that will allow a greatest commitment in the implementation of the programmes in the priority areas framework reinforcing the multi-sectoral coordination, operationalising the monitoring and evaluation mechanism for the improvement of quality and our performance as public servants and State agents, in our noble mission, to serve the citizen better every time.

Maputo, August 2009

The Minister

Vitória Dias Diogo


The Government of Mozambique through the Ministries of Public Service (MFP), Health (MI-SAU) and the National Council for the Fight against HIV and AIDS launched a process to develop a HIV and AIDS Strategy for the Pub-lic Service. According to an analysis of the de-mographic impact of HIV and AIDS in Public Service for the of year 2008, from about a total of 167,000 national public servants 32,000 are infected with the HIV virus, of which 10,000 need anti-retroviral treatment. On the other hand, 1,600 registered deaths are estimated for public servants infected by HIV and AIDS.The HIV and AIDS pandemic is one of the Government’s main concerns as it affects Pub-lic Service absenteeism, prolonged leave due to illness, social duties related to illness and death, and also the additional necessary costs to re-place work force. Utilizing the demographic projections available for 2008, it is estimated that the economical impact of HIV and AIDS in the Public Sector may, in the same year, rise to more than US$ 22 million, representing more than 3%of the foreseen staffing costs in thebudget. These costs could exceed US$ 26 mil-lion in the year of 2008 if the costs relative to administration of anti-retroviral therapy and nutritional support (food basket) are added.The Strategy is a guiding document to enhance and harmonize interventions that have been re-alized by the different Government institutions. The strategy has the scope of application to the Public Administration institutions, performing State administrative services, namely, (i) the lo-cal and central bodies of the State and subordi-nated or dependent institutions; (ii) public insti-tutions and (iii) the institutions and bodies of the local government. It has direct and indirect beneficiaries of approximately 167,420 publicservants and their families.The following strategic approach is orientated on the following basis:

Alignment to the PEN II multisectoral ☑response;Decentralization of activities, at provin ☑cial, district and municipal levels;Gender sensitization: ☑Results based orientation; ☑Efficientuseof availableresources. ☑

This strategy takes into consideration the HIV and AIDS demographic impact projections

available in the country. In relation to the Pub-lic Service if we allow that the levels of HIV infection in the general population in each re-gion is similar to the public servants, we may estimate that from the approximately 167,000 existing public servants in the country, 32,000 are HIV infected. On the other side, approxi-mately 10,000 public servants need to receive antiretroviral treatment. In the year of 2008, the number of HIV/AIDS deaths among pub-lic servants may reach 1,600 people.The necessary interventions to achieve the main objectives of the HIV and AIDS strategy in the Public Sector are structured in priority areas, namely: prevention; care and treatment: impact mitigation; stigma and discrimination; mainstreaming of HIV and AIDS into the State institutions; establishment of partnerships in order to provide services; normative aspects; multisectoral coordination: communication; monitoringandevaluation;mechanismsforfi-nancing and sustainability.Priority Actions in the area of prevention

Develop and implement prevention pro- ☑grams and control HIV infection risks resulting from the occupational duties of each sectoral area;Produce and distribute Information, ☑Education and Communication (IEC) materials appropriate for public servants illustrating new trends of the pandemic, evidencing that these constitute new risk groups and sources of new HIV infec-tions in the country.Promote voluntary testing and counselling ☑activities to public servants and encourage their adherence to available health servic-es related to HIV and AIDS;

Priority Actions in the area of care and treat-ment

Develop and implement a legal mecha- ☑nism that helps public servants and their families to access anti-retroviral treatment under the expansion and coverage regula-tions established by health services:Provide mechanisms for medical and ☑pharmaceutical assistance to public ser-vants established by law and present regu-lations;Make available education and information ☑on the importance of STD treatment and

EXECUTIVE SUMMMARY


its correlation with HIV infection;Establishment of partnerships and in- ☑volvement inhomecarebeneficiarynet-works in public servants’ community.

Priority actions in the area of impact miti-gation

Promote access and use of available psy- ☑cho-social support in health services and/or in the public servants socio-profession-al community. Promote and disseminate the application ☑of the Law and other normative mecha-nisms that protect the public servant liv-ing with HIV and AID in the work place.Ensure knowledge and delivery of basic ☑packets of HIV and AIDS mitigation ser-vices in the work place through training technicians and human resource manag-ers.

Priority Actions in the area of stigma and discrimination

Promote and disseminate the application ☑of the Law and other normative mecha-nisms that protect the public servant liv-ing with HIV and AID in the work place.Develop, disseminate and ensure the ☑implementation of codes of conduct on HIV and AIDS in the public institution work place;Ensure the involvement of active leader- ☑shipinfightingstigmaanddiscriminationin the work place;

Priority Actions in area of mainstreaming HIV and AIDS in Institutions

Develop and implement mechanisms that ☑oblige the institutions of the State Ap-paratus to implement HIV and AIDS re-sponse activities in the work place;Guarantee the active and proactive in- ☑volvement of leaders in the planning, implementation and monitoring of HIV and AIDS activities;Integrate HIV and AIDS prevention, care ☑and impact mitigation activities in the Economic and Social Plans (PESS) and local government and sectoral Annual Operation Plans (POAs).Ensure that HIV and AIDS is part of the ☑agenda of the technical institutional and leadership forums held at several levels (E.g. Consultative Councils, Coordinators’

Council, Technical Councils, Collective to the Executive and National Meetings);To define effective functioning mecha- ☑nisms for the implementation structure of the HIV and AIDS response in all public institutions, highlighting the area of Human Resources.

Priority actions in the areas of partnership establishment

Identify the main HIV and AIDS relat- ☑ed service providers in partnership with CNCS and MISAU facilitating their ac-cess to public servants; Establish a memorandum of understand- ☑ing with relevant sectors, governmental and non governmental organization net-workstodeliverspecificHIVandAIDSservices;Promote the exchange of experiences with ☑other sectors and partners that respond to HIV and AIDS in the work place with a view to replicating innovative approaches in respect to HIV and AIDS;

Priority Actions in the area of normative as-pects and socio-professional rights

Elaborate a conduct of code on HIV and ☑AIDS in the work place, establishing the rights and responsibilities of public ser-vants living with HIV and AIDS;Review within the scope of the imple- ☑mentation of EGFAE, the pharmaceuti-cal and medical assistance foreseen within the extent of the social system reform bringing the principle of Health Insur-ance to Public Servants;

Priority Actions in the coordination and multisectoral management

Ensure participation at the highest level ☑of MFP leadership in the CNCS Manage-ment Board, and strength coordination with the CNCS Executive Secretariat;Expand and institutionalize competencies ☑in the area of human resources manage-ment to guide and co-ordinate the imple-mentation of HIV and AIDS activities in each one of the State institutions;Capitalize on the human resources man- ☑agers’ forum at national level to facilitate the HIV and AIDS response in each one of the sectoral areas;

Priority Actions in communication areas


Develop communication programs for ☑the behaviour change of public servants based on a participative approach and multiple communication channels;Accommodate messages to the occupa- ☑tional reality of public institutions includ-ing communication according to the level of education, gender sensitive and rights based approachesAddress communication to those behav- ☑ioural patterns that fuel the epidemic in each sectoral area;Include the public servants/ beneficia- ☑ries in the process of the development of messages or specific products (e.g.pre-testing material or consultations with beneficiaries);Facilitate dialogue and discussion on spe- ☑cific topics (e.g. condoms, fidelity, treat-ment or others) considering the demand and interest of public servants and/ or otherbeneficiaries

Priority actions in the area of monitoring and evaluation

Develop and disseminate the monitoring ☑and evaluation framework of activities undertaken by public sector institutions;Develop and standardize instruments, ☑collections methods, processes, sharing and use of M&E data;Integrate the oversight component of ☑HIV and AIDS activities in the routine agenda of general and sectoral inspec-tions and in the existing monitoring, su-pervision and evaluation of sectoral ac-tivities; Strengthen the technical capacities of ☑public institutions in the analysis of data and the production of strategic informa-tion on HIV and AIDS undertaking train-ing courses on data collection, analysis and use of data at all levels;Promote inter sectoral annual evaluations ☑on the progress and performance of HIV and AIDS activities.

Priority Actions in the area of financing and sustainability

EnsurethefinancialmechanismsforHIV ☑and AIDS activities through the OGE in-cluding the respective budget lines in the annual plans;

Strengthen partnership and coordina- ☑tion with the CNCS and other partners to guarantee access to resources for the implementation of HIV and AIDS ac-tivities in the public sector;Promote continuous and consistent in- ☑tegration of HIV and AIDS activities in the normal planning and budgeting cycle of the activities of the State institutions.

Based on the priority actions and without prej-udice to the budgeting of the annual operation-al plans, a preliminary estimation of the costs of the implementation of the strategy suggests anything from a minimum of about US$ 48 million to a maximum of US$ 290 million for fiveyears.Thesixpresentedoptions,outlinedin Annex 2, result from different combinations of coverage of activities related to impact miti-gation for public servants and their families. The total cost of implementation of the strat-egy is very sensitive to the costing elements on sickness subsidy and the food basket.


to help public servants but also their families, clients and service users.Thepresentstrategyisorganizedintofivemainthematic sections including the introduction section. In the second section a brief summary on the results of the situational analysis on HIV and AIDS in the Public Service is made. The third section explores aspects referring to the description of the Public Service where aspects are included on the mandate of the Ministry of Public Service (MFP), the sectoral areas of which it is composed and the distribution of the work force. The following section presents the mission, the objective and the vision of this strategy, and lastlythefifthsectionpresentsthesevenareaswhere the actions for the HIV and AIDS re-sponse in the public sector should be concen-trated.

The Government of Mozambique through the Ministries of Public Service (MFP), Health (MI-SAU) and the National Council for the Fight against HIV and AIDS launched a process to develop a HIV and AIDS Strategy for the Pub-lic Service. The Strategy is a guiding document to enhance the sectoral response and harmon-ise efforts that have been made in a fragmented form by the different Public service institutions. Its elaboration is a result of the statement and recognition that the planned and implemented activities in the Public Service still have a re-duced impact and visibility and do not suffi-ciently cover provincial and local levels.In the context of the fight against HIV andAIDS, the Government has been concerned with the pandemic and its implications in the degradation of human resources which may undermine the possibility of achieving the planned strategic objectives of the country. The growing interest in the integration of HIV and AIDS response activities in the public services institutions is directly related to the fact that the Public Service assumes a vital role in the development process and because a large pro-portion of people with technical abilities and professionalqualificationsareemployedthere.Besides,itisconsideredthatanefficientPublicService is a condition for development and this potential is increasingly threatened by the HIV pandemic that undermines not only the levels of humancapital,butalsotheflowof availableresources. AlthoughtherearenospecificdataontheHIVand AIDS prevalence in the Mozambican Public Service as a whole, the interpretation of limited sources, above all, impact studies undertaken by some sectoral areas indicate that public servants in the areas of health, agriculture, education, police, customs, and defence are considered the most vulnerable to HIV infection due to their occupational functions. These areas not only employ the largest number of public servants but occupational functions also expose them to the highest probability of HIV infection, mainly due to mobility required from their profession.The involvement of the public service in the HIV and AIDS response in the country fitswithin the scope of the multi-sectoral response elaborated by the National Strategic Plan for the Fight against HIV and AIDS 2005-2009 (PEN II). At the governmental level, the insti-tutions have been encouraged to develop sec-toral response plans to the pandemic not only

I. INTRODUCTION


Inregardtothelevelof education,ananalysisof theprofileof the167,420employeesof theStateapparatus indicates that the majority of them possess or attended secondary education represent-ing 55,761 employees (33.31%), this is followed by upper primary education with 24,845 employ-ees (14.84%), medium technical and professional education with 24,242 employees (14.48%), basic technical and professional education with 18,040 employees and lower primary education with 16,907 employees.

ThePublicSectorismadeupof agroupof institutionsandentitiesdirectlyorindirectlyfinancedby the State for the provision of goods and services. Its scope is limited to the bodies and institu-tions of Public Administration, carrying out administrative functions of the State, namely, (i) the central bodies of the State apparatus and subordinate or dependant institutions; (ii) the public institutes and (iii) the bodies and institutes of the local councils (Decree number 30/2001, of 15 October).The management of the public sector is undertaken by the Government through the Ministry of the Public Sector (MPF) created in October 2007, which is the central body of the State apparatus responsible for the management of the strategy and inspection of the public administration and public sector. This leadership is shared with all the bodies of the state (Decree number 60/2007, of 17 December).The data on the entire workforce indicates that, in Mozambique, the total number of employees engaged in the public sector is approximately 167,420 distributed throughout the national territory in different sectoral areas of activities, in accordance with the Annual Statistics of public servants andStateAgentspublishedintheyear2008.Theanalysisof thespecificproportionand/orthecontribution of each province to the public sector workforce shows that, with approximately 15.30% (25,610) of employees the central level possesses the largest number of employees fol-lowed by the provinces of Nampula and Zambeze with 11.90% and 10.83% respectively (MPF, 2008: 17). The provinces of Maputo-City, Manica and Tete have a relatively low proportion of employees in comparison to the others.

II. BRIEF DESCRIPTION OF THE PUBLIC SECTOR IN MOZAMBIQUE

TABLE 1: DISTRIBUTION OF WORKERS BY PROVINCE

SOURCE: ANNUAL STATISTICS OF PUBLIC SERVANTS AND AGENTS, 2008

PROVINCE/LEVEL MEN WOMAN TOTAL(M + W)

%(M+W)

Central Services 16202 9408 25610 15.30

Cabo Delgado 7570 2497 10067 6.01Niassa 8045 2070 10115 6.04Nampula 15344 4572 19916 11.90Zambeze 13323 4815 18138 10.83Tete 7531 3242 10773 6.43Manica 7457 2662 10119 6.04Sofala 9640 4465 14105 8.42Inhambane 7495 5189 12684 7.58Gaza 6744 5444 12188 7.28Maputo Province 6824 5477 12301 7.35Maputo City 5557 5847 11404 6.81General Total 111732 55688 167420 100.00


TABLE 2: EMPLOYEES DISTRIBUTED BY LEVEL OF EDUCATION

SOURCE: ANNUAL STATISTICS OF PUBLIC SERVANTS AND AGENTS, 2008

FIGURE 1: PUBLIC SERVANTS BY REGION

SOURCE: ANNUAL STATISTICS ON PUBLIC SERVANTS AND STATE AGENTS, 2008

In regard to the regional distribution of public workers observes the existence of a varied concen-tration of workers between the three regions of the country, namely the south, centre and north. The majority of the workers are concentrated in the southern zone of the country representing 44% of the total, followed by the central zone with 31% and last the northern zone with 24% of the total.

PROVINCE/LEVEL MEN WOMAN TOTAL(M + W)

%(M+W)

Lower primary level education 12903 4004 16907 10.10Upper primary level education 16791 8054 24845 14.84Secondary education 36393 19368 55761 33.31Elementary technical and professional education

8522 5749 14271 8.52

Basic technical and professional education 11559 6481 18040 10.78Medium technical and professional education 15954 8288 24242 14.48Bachelors degree education 2482 811 3293 1.97Honours degree education 6005 2560 8565 5.12Masters degree education 865 310 1175 0.70Doctorate degree education 258 63 321 0.19General Total 111732 55688 167420 100.00


Despite the recognised effort made in involv-ing the different sectors in the HIV and AIDS response, the situational analysis concluded that the activities planned and implemented by the public sector, as a whole, continue to have a minimal impact which could be the result of various causes such as: no prioritisation of HIV and AIDS response activities in the institutions; limited commitment towards prevention pro-grams; weak coordination and capacity of some of the sectoral entities to design programs that are functional, efficient and make an impact;weakness of monitoring and evaluation tools; and, incapacity of the subordinate institutions at provincial, district and local level to develop programs, which results in a weak decentraliza-tion of the process to implement the response and the important fact that the public sector operates with procedures and regulations that have to be standardized.III.2. THE IMPACT OF HIV AND AIDS IN THE PUBLIC SECTORThepublicsectorfulfilsavitalroleinthedevel-opment process of the country and the major-ity of personnel with technical skills and pro-fessionalqualificationsareemployeddependingon the quality and the coverage of the public service in its diversity of the number of public servants and State employees with knowledge andqualificationsrequiredfortheefficientex-ecution of activities. Anefficientpublicserviceisapre-requisitefordevelopment. However, in our country, this sec-tor is increasingly threatened by the HIV pan-demic which not only affects human capital but alsotheflowof resourcesavailable tofinancedevelopment. The propagation of HIV and AIDS has a negative impact on diverse elements of the system, being accentuated in the work place, at the level of service delivery and at the level of communities and families of public ser-vants.The HIV and AIDS situational analysis in the public service showed that some institutions, namely, Agriculture, Customs, Education, Wa-ter and Health invested in the realisation of HIV and AIDS impact studies. The research notonlyidentifiedthenatureof theimpactbutalso sought to estimate it, taking into account that the presented results had to be analysed with caution, due to the inherent methodologi-cal limitations. In what concerns the nature of the impact, the studies until now are unanimous in considering that the work place, where many

III.1. EVOLUTION AND STATE OF THE RESPONSE The development of the response to HIV and AIDS in the Public Sector started during the period of PENI when some Ministry’s created structures and elaborated sectoral operational plans and started implementing programs. In an initial phase, the adopted actions in the scope of the national response were coordinated by the Ministry of Health, being transferred at a later stage to the National Council for the Fight against AIDS (CNCS) as a means to making the response broader and more integrated and where the involvement of the Public Sector in-stitutions constitute added value, by favouring thedefinitionof interventionapproaches thatfocusonspecifictargetgroups.Since 2005, the PEN II process has brought about more involvement of the Public Sector institutions by carrying out the HIV and AIDS response activities. With the implementation of PEN II we notice the beginning of a structured integration of effective actions in response to HIV and AIDS in the sector. The different sectoral areas and respective institutions were encouraged to develop plans aimed at covering not only their employees but also their families, clients and users of provided.Until the time of the elaboration of this strate-gy, the main activities implemented were aimed at prevention, with emphasis on the availability and marketing the use of condoms and cam-paigns to raise awareness in behaviour change. In the same way, there are also mitigation ac-tions by accompanying employees infected with HIV and living with AIDS to health units as wellasofferingfinancialassistancebypurchas-ing the medication and food supplements.The evaluation of the response has shown that up until now, the implementation of the multi-sectoral response has lacked the necessary co-ordination and articulated planning of inter-ventions. Each sectoral area tried to respond to HIV and AIDS in an isolated way, which limited the development of consistent and harmonious interventions in context to the HIV and AIDS approach in the workplace, even assuming that the institutions of the Public Sector possess a mandate and different institutional missions. Beyond this realization it was observed that an institutional environment favourable to an ef-fective response to a pandemic was not yet ef-fectively created.

III. SUMMARY OF THE SITUATIONAL ANALYSIS OF HIV AND AIDS IN THE PUBLIC SECTOR


public servants are infected by HIV, the impact of HIV and AIDS can be felt in various forms, as is detailed in table 3:

TABLE 3: IMPACT OF HIV AND AIDS

SOURCE: DATA EXTRACTED FROM THE REPORT OF SITUATIONAL ANALYSIS ON HIV AND AIDS IN THE PUBLIC SECTOR (MFP, 2008))

Field Nature oF impact

iN the Work place Mortality and Absenteeism involved in the increase in indirect costs.

Loss or decrease in morale.

Increase in direct costs for the State/Employer.

at the level oF Service delivery

Reduction in the capacity of service coverage.

Non fulfillment of planned targets due to absenteeism and low capacity to undertake work.

Increase in unit labour costs to the State due to the increase in the costs relative to social and medical assistance.Increase in the costs to replacing labour for the State.

Increase in the running costs (transports and communications).

at the level oF commuNitieS aNd FamilieS

Distortion of social capital: this can translate as the loss of economically active people due to illness and/or the death of one or more family members.Reduction of the Financial Capacity of Families: the loss of a public servant potentially means a reduction in income or even a loss of financial support to the family.Debilitation of human capital: illness and death in the aggregate family can contribute to the weakness or even rupture the links between this aggregate and other families and/or social networks in the community.


SOURCE: DATA EXTRACTED FROM THE SITUATIONAL ANALYSIS ON HIV AND AIDS IN THE PUBLIC SECTOR (MFP, 2008)

III.3. KNOWLEDGE, ATTITUDES AND PRACTICES ON HIV AND AIDS IN THE PUBLIC SECTORTo measure the knowledge, attitudes and practices of public servants and State employees the situational analysis resorted to the common indicators used in studies made by some of the sec-toral areas such as the Armed Forces, Water, Transport and Communication, Police and Higher Education..It is important however to mention that an information baseline does not exist on these Public sector data, besides the fact that the studies analysed have been developed with the use of varied methodological approaches and equally differentiated analyses, which limits the viability of com-paringthedata.So,anoverallsituationalprofileonknowledge,attitudesandpracticescannotberigorouslydefined,onlythetrendsbasedonsomefavouredindictorsintheavailablestudiesandillustrated in table 4.

TABLE 4: LEVELS OF KNOWLEDGE. ATTITUDES AND PRACTICE OF PUBLIC SERVANTS

compoNeNtS iNdicatorS

kNoWledge

Important knowledge on the existence of HIV and AIDS: in all the studies 100% of the public servants had heard about the illness.More than 95% of those researched besides having heard about the illness believe in its existence.A small number believe that AIDS has a cure.Statement of some erroneous concepts: e.g. some public servants affirmed that HIV can be transmitted by a mosquito bite.

attitudeS

Around a half of those researched in the various studies had a test (varying from 38.4% in the MTC to 66% of teachers in the UEM) for various reasons but rarely motivated by the need to know serological status.The majority of public servants do not consider themselves to be at risk of HIV infection, expressing trust in their regular partner.Accepting a non discriminatory position towards PLHA in the family or with work colleagues (a minimum of 95.8% said they would share space and mix with PLHA).

practiceS

Weak use or inconsistent use of condoms: more than a half of those researched said that they had not used a condom in their last sexual relations.Frequent practice of multiple partners amongst public servants, where 31.6% to 62.7% revealed that they had one sexual partner in the last 12 months.


III.4. HIV AND AIDS VULNERABILITY FACTORS AND SITUATIONS IN THE PUBLIC SECTORThe analysis revealed that there is a joint collection of economic, cultural, social and institutional factorsthatinfluenceand/orplayaconsiderableroleintheevolutionof theHIVandAIDSepi-demic in Mozambique. In what refers to public servants and State employees further to the range of vulnerability to infection factors, in line with the occupational functions in each sectoral area, thecommonfactorsareidentifiedinthetablebelow:

TABLE 5: HIV AND AIDS OCCUPATIONAL RISKS IN THE PUBLIC SECTOR


Nature vulNerability Factor

overall

Gender disparities: limits in the means of prevention for women, low access to education for girls and to basic health care information, as well as biological vulnerability.Work mobility: makes people more vulnerable to occasional unprotected sexual relations and multiple partners.The stigma and discrimination of PLHA and the lack of universal access to care and treatment: undermines the possibilities to promote combined prevention approaches to the epidemic.Cultural resistance to condom use: stereotypes and preconceits on masculinity induce men to have unprotected sexual relations.High levels of illiteracy: restricted access to information on the epidemic and forms of prevention.Limited technical and financial capacity of government and non government institutions to promote and implement HIV and AIDS prevention and impact mitigation strategies in a consistent and systematic way.Simultaneous and concurrent sexual partners: is a factor for the rapid expansion of HIV.

public Sector SpeciFicS

Geographic location: is associated to the concentration of greatest percentage of public servants and State Apparatus in the provinces with the highest rates of HIV prevalence in adults.Professional mobility: constant territorial dislocations and transfers to isolated locations with no conditions to accommodate the family.Sexual harassment: involves the exchange of professional favours for sex. Work accidents/Lack of Biosecurity: associated with those that work in unsafe environments, with a lack of everyday use disposable equipment, lack of sterilization facilities and no protective equipment against HIV infection, involvement in emergency situations in the case of accidents.Practices and routines specific to occupational duties: specific professional routines like night patrols that favour risk and vulnerability to HIV infection.Night school: exposure to the risk of rape for girls at a high risk of HIV infection.Preconceits, Attitudes and Misunderstandings relating to HIV: high risk attitudes and practices.


III.5. LESSONS LEARNED AND CHALLENGES TO THE HIV AND AIDS RE-SPONSE IN THE PUBLIC SECTORThe analysis of the stage at which the HIV and AIDS response is in the public sector allowed us to observe that there are still existing fragilities in the response actioned by the sector. These fragilities pose several important challenges to the re-dimensioning of the sector’s response, as illustrated in the following table:


TABLE 6: LESSONS LEARNED AND CHALLENGES TO THE AIDS AND HIV RESPONSE IN THE PUBLIC SECTOR

compoNeNt leSSoN learNed

geNeral The lack of a more inclusive sector strategy that directs interventions is a limitation to the implementation of the policies and national strategies with the coverage and expected results.

maNagemeNt oF humaN reSourceS&proFeSSioNal rightS

HIV and AIDS is confronted with structural changes to the system on the access of social and professional benefits for public servants. The pandemic generates a new type of demand which is incompatible with the current functioning system.The overall fragility of institutional capacity can compromise the implementation of the HIV and AIDS sector strategy:

Low availability of the focal points High levels of rotation and transfersOverload of structures and functions

kNoWledge, attitudeS aNd practiceS related to hiv aNd aidS

Prevention is still a fundamental pillar in the response: many doubts and misconceptions highlight the difficulties to turn knowledge into practice (inconsistent use of condoms and involvement with multiple partners). The formal methods of bringing awareness about HIV and AIDS (lectures, debates, etc) are not mobilizing the public; this situation highlights the need for new, innovative and attractive approaches.The conception of response initiatives should take into account contextual, geographical, cultural and institutional factors that contribute to exposure to the risk of HIV and AIDS infection on the side of the public servants.

available StructureS Structures were created and financed to boost the response but this favourable environment is not replicated in the majority of subordinated institutions and at provincial and local levels making the decentralization of the response a priority.The creation of structures has the potential to ensure that HIV and AIDS will be a priority in the actions of the sector areas and to guarantee the appropriation of actions; nevertheless making it work is still a challenge.

plaNNiNg, FiNaNciNg aNd iNtegratioN oF hiv aNd aidS iN the iNStitutioNal practice

To turn political and verbal commitment into proactive actions that will change HIV and AIDS no longer as parallel matter or a non priority compared to the occupational actions of each sector area.Each sector area has responded in a separate manner limiting the coordination and development of consistent and harmonious interventions There are persisting financing difficulties manifested by the resistance to include budget items for HIV and AIDS activities in the institutional plans (PES/POA) associated with planning difficulties


The present study was done with recourse to twosourcesof information.Thefirstoneistheresult of the general census on public servants and State employees. This census provides in-formation on public servants and State em-ployees by age, sex and education levels in each province.The second source of data is the result of the HIV democratic impact study in 2008, pro-duced by the National Statistics Institute. This report contains the following indicators: the prevalence rate, the HIV incidence rate, the number of people living with HIV, the number of deaths due to AIDS, the number of orphans, the number of people needing treatment. At national level, the prevalence rate is deter-mined from a biennial and permanent epidemi-ological surveillance of pregnant women called surveillance rounds. The last surveillance round was done in 2007 and its results were used to estimate the demographic impact of HIV in the general population or in other words, the number of infected people, number of deaths, number of orphans, number of people eligible for treatment, etc. For the calculation of the same indicators for the public sector the same prevalence rate was applied in each of the regions, in a presupposi-tion that public servants are subject to the same prevalence rates as the region they live in. Even so, the typical HIV and AIDS impact indicators for the public sector are clearly distinct from the national ones because the geographical distribu-tion as well as the sex and age of public servants is different from the general population in the countrya sub população constituída pelos funcionários e agentes do Estado, estima-se que cerca de 31 mil dos 167 mil funcionários apurados pelo censo em 2008, estão infectados com o vírus de HIV. A região Sul apresenta o maior número de casos de funcionários infectados (17 mil), por causa do elevado número de funcionários exis-tentes nesta província. Por outro lado, a região Sul é a segunda depois do Centro com elevada taxa de prevalência de HIV a nível nacional.

Since 1999, the National Institute of Statistics has been coordinating the elaboration and pub-lication of a national report on the demograph-ic impact of HIV and AIDS with the purpose of ensuring that planning actions in the fightagainst the epidemic in the country are based on the most reliable as possible quantitative data.The most important information that serves as guidance in the HIV and AIDS response and that is mentioned in the national report on the demographic impact of HIV and AIDS, in-cludes the prevalence rate, the HIV incident rate, the number of people living with HIV, the number of deaths due to AIDS, the number of people with treatment needs, among others. At the level of ministries, including the Ministry of Public Service, there is a scarcity of quantita-tive informationreflectingthe impactof HIVand AIDS and that could serve as a basis to guide the strategies against the disease. Based on this the present analysis of this component intends to visualise, in a quantitative way, the demographic impact of HIV and AIDS in the public sector.The results coming from the general census of public servants and State employees in 2008 al-low us to generate information of critical im-portance for the planning of different activities. In what concerns the AIDS response activities, the census allows its results to be combined with data from other available sources in the country in order to estimate the demographic impact of HIV and AIDS in the Mozambican public sector.In this chapter we want to present the HIV and AIDS demographic impact indicators of the general population mirrored on to the sub-pop-ulation made up of public servants and State employees. This is a study which is based on an initiative from UNAIDS trying to respond to the information needs for developing, planning and guiding the HIV and AIDS response in the work place and among public servants.We wish to understand the dimension and specificsof theimpactof theepidemicinthepublic sector in what concerns the geographi-cal areas of the country and the demographic characteristics of this sub-population as a way of identifying with precision the different re-sponse needs that should be taken into account inthefightagainstHIV.

IV. DEMOGRAPHIC AND ECONOMIC IMPACT OF HIV & AIDS IN THE PUBLIC SECTOR


TABLE 7: PUBLIC SECTOR WORKERS INFECTED BY HIV, 2008

Source: MFP 2008 - Public Sector Census, 2008 and INE 2008 – HIV/AIDS Demographic Impact 2008

IV.2. ESTIMATION OF DEATHS DUE TO AIDS IN THE PUBLIC SECTOR Previous Studies have demonstrated that the average time between the need for ART and death by AIDS, if not treated, is approximately 3 years in African populations. Based on the projection of new infections and the coverage of anti-retroviral treatment the number of expected deaths due to AIDS in each of the country’s regions was estimated.This mortality is very different for each region. From about 101,000 deaths due to AIDS estimated for the general population in 2008, the largest number of deaths due to AIDS happens in the Cen-tral region, about 67%, followed by the Southern region with about 22%. This situation has impact on the estimation of deaths in the public sector. Table 8, shows the estimation of deaths due to AIDS for the public sector in 2008. The calcula-tions were based on the regional numbers of deaths in the general population by age group and number of infected public servants. As a result of the pattern of deaths in the general population, one can observe that although the majority of infected public servants are found in the Southern region, the Central region (720) has the greatest number of deaths due to AIDS, because the Cen-tral region has an elevated number of deaths amongst the general population.TABLE 8: DEATHS DUE TO AIDS AMONG PUBLIC SERVANTS, 2008

Source: MFP 2008 – Public Sector Census, 2008 and INE 2008 – HIV/SIDA Demographic Impact 2008

IV.1. ESTIMATION OF PUBLIC SECTOR WORKERS INFECTED BY HIVThe “peaks” of the HIV prevalence rates occur in ages between 30-39 years. Besides that, the prevalence rate of the male population between 20-24 years is quite low when compared with the females (4.3 e 11.4). This means that the probability of a given person being infected depends on his/her age and sex. Infection among women occurs sooner that among men of the same age, such as happens in the general population of the country.Applying the same national prevalence rates to the sub-population of public servants, we estimate that about 31,000 of the 167,000 employees mentioned in the 2008 census are infected by the HIV virus. The Southern region has the bigger number of cases of infected employees (17,000) due to the higher number of employees living on the region. On the other hand, the Southern region comes second after the Central region with the highest HIV prevalence rates at national level.

Age Group

Southern Region Central Region Nothern Region Country TotalT M F T M F T M F T M F

15-19 2 1 1 1 1 1 0 0 0 4 2 220-24 316 100 216 108 49 59 46 15 31 470 164 30625-29 2,641 1,166 1,475 1,752 894 859 440 225 216 4,834 2,285 2,54930-34 4,571 2,657 1,914 2,807 1,820 987 890 619 271 8,268 5,096 3,17235-39 3,383 1,852 1,531 1,867 1,152 715 777 543 234 6,027 3,547 2,48040-44 2,694 1,639 1,056 1,575 1,143 431 615 480 135 4,884 3,262 1,62245-49 2,480 1,866 614 1,463 1,268 195 474 428 47 4,418 3,562 85650-54 1,101 802 299 572 485 88 206 187 19 1,879 1,473 40655-59 359 267 91 215 186 29 82 75 7 656 529 12860-64 135 108 26 64 58 6 35 33 2 234 199 3565+ 158 140 18 72 68 4 34 33 1 264 241 23Total 17,842 10,600 7,242 10,496 7,122 3,373 3,600 2,637 963 31,937 20,360 11,578

Age Group

Southern Region Central Region Nothern Region Country TotalT M F T M F T M F T M F

15-19 0 0 0 0 0 0 0 0 0 0 0 0 20-24 6 3 3 6 3 3 1 1 1 12 6 6 25-29 63 25 35 71 29 33 18 8 8 150 59 76 30-34 135 64 68 136 64 60 41 23 14 310 148 144 35-39 154 102 63 150 100 52 52 42 13 362 241 131 40-44 143 90 58 164 126 43 48 40 9 359 255 112 45-49 109 86 34 109 92 21 28 29 4 240 196 61 50-54 53 53 12 48 55 6 14 17 1 113 119 20 55-59 20 19 5 22 25 3 6 7 0 48 51 8 60-64 7 7 2 7 7 1 3 3 0 17 17 2 65+ 2 6 1 6 7 0 2 2 0 14 15 1 Total 692 454 280 720 508 221 213 172 51 1,626 1,108 560


IV.3. ESTIMATION OF PUBLIC SERVANTS IN NEED OF ART IN 2008The most important lesson that marked the life of all of us is that we can prevent new infections and improve the quality of care and treat people living with the HIV, the virus causing AIDS. People infected with HIV do not need immediate treatment. The time between infection with HIV virus and the need of ART is different in each individual, but studies have shown the average time between infection and death by AIDS to be approximately 11 years in African populations. Otherstudiesshowthatif aninfectedindividualneedingtreatmentdoesnotfindit,thatindividualwill die an average 3 years later. Subtracting the 3 years from the 11 years, we have 8 years on aver-age which is the time between the infection and the need for treatment. These intervals are differ-ent by sex, UNAIDS recommends the use of a value of 7.5 years between infection and the need for ART for men, and 8.5 years for women. A person’s age at the time of infection does not matter, or in other words, a 25 year old person infected by HIV will take the same time to need ART as a 39 years old person will. On the other hand, the older the person is, there is a bigger probability of an older infection when compared to a younger person. The number of people needing ART depends on the evolution of the illness since infection. To make an estimation of the number of people needing ART in the public sector, the time since infection has to be taken into consideration; in turn this time depends on the age distribution of the infected population and the probability of an infected person of a given age needing ART.

T H M T H M T H M T H M15-19 0 0 0 0 0 0 0 0 0 0 0 020-24 39 18 21 14 8 5 7 3 3 59 30 2925-29 426 175 250 294 136 158 82 40 41 801 352 44930-34 932 450 482 594 306 288 194 119 75 1,719 875 84435-39 1,159 717 442 727 478 249 285 215 70 2,171 1,410 76140-44 1,041 631 410 806 599 207 255 206 50 2,102 1,436 66645-49 846 603 243 543 440 103 165 147 18 1,555 1,190 36450-54 456 370 86 291 261 30 92 86 6 839 717 12255-59 166 134 33 133 121 12 40 38 3 340 292 4760-64 63 52 11 36 33 3 16 15 1 115 100 1565+ 128 117 11 69 65 3 25 24 1 222 207 15

Total 5,256 3,268 1,988 3,507 1,058 1,058 1,161 893 268 9,923 4,161 3,314

Grupos de idade

Região SUL Região CENTRO Região NORTE Total País

TABLE 9: ART NEEDS AMONG PUBLIC SERVANTS, 2008

Source: MFP 2008 – Public Sector Census, 2008 and INE 2008 – HIV/SIDA Demographic Impact 2008

Even considering that these are indirect estimations, the results warn of the need to reinforce ac-tionsinthefightagainstthediseaseintheStateinstitutions,mainly,thereinforcementof preven-tion, testing and treatment at all levels.

IV.4. ESTIMATION OF PERSONNEL COSTS ThepersonnelcostsrelatedtotheHIVandAIDSpandemiccanbeclassifiedas:

Absenteeism;•Extended sickness leave;•Social allowance costs related to sickness or funeral and; •Additionalcoststorefillthepositionsleftbydeceasedpublicservantsbecauseof HIVand•AIDS

When, as a result of HIV and AIDS, the health condition of infected people gets worse or the need to care for a sick family member grows, the result is always an increase in absenteeism, char-acterizedbyinformalabsencesrangingfromafewhourstolongerperiods,alwaysbeingdifficultto measure. Some studies done in neighbouring countries (UNDP/Malawi)1 suggest a patient severely affected by AIDS will be absent from work for about 65 days per year while those in the


initial phase infection will be absent for an aver-age of 15 days. In accordance with the demographic analysis of 2008, there will be 31,937 workers living with HIV, of which 9,923 need ART due to the ad-vanced stage of the disease. In absence of ART, the absenteeism of these workers from their re-spective work places due to HIV and AIDS will represent a total of 975,233 days corresponding to about 2.7% of the total working days calcu-lated on the basis of 220 working days per year. Considering an average estimated monthly sal-ary for the public sector of USD 343 (8,334.9 meticals) this would correspond to a total ex-pense of USD 13 million (320.000.000 metical) in 2008.2

Generally when a public servant gets very sick and can not work sick leave is requested, if the employee is HIV positive there is a special sup-port regimen, by which the employee is released from service, maintaining status rights and even benefiting from a 30% salary subsidy aswell as travel costs to the place of treatment if necessary. This regimen ends at the end of two years and the public servant retires. Allowing that there will be at least the same number of workers with these conditions as the number of deaths happening each year and for periods of one year the resultingfinancial costwouldbeabout USD 2 million (48.600.000 metical) with this subsidy. Besides the absenteeism due to sick leave of infected public servants, we must add another main cause, funeral attendance for deceased employees and family members as a result of HIV and AIDS. Admitting that the deaths of employees correspond to the number of funer-als (without including the cases of direct fam-ily members) and that on average about 20 col-leagues will attend the funeral being absent for that day, we will conclude that funeral services due to HIV and AIDS will contribute to exac-erbate the absenteeism index by a minimum of 0.1%. The combined effect of absenteeism and sick leave suggests an enormous impact on public service productivity, reaching 2.8% of the to-tal of public servants working time. In both cases, mainly with absenteeism, this reality does not translate as new contracts (admissions) for short periods, but results in less productivity and a lower volume of services provided by the Public Sector. In accordance with the present legislation, the public servant and his dependant family is enti-

tled to medical and pharmaceutical support and to a funeral subsidy, for which they regularly contribute to a percentage deduction from their salaries. Additionally, in the case of the worker’s death,thefamilybenefitsfromadeathsubsidycorresponding to a minimum of 6 months sal-ary, and to a monthly survival pension, paid at the rate of 50% of the income of the deceased public servant. The application of these regu-lations in the case of the estimated deaths of public servants for 2008 would result in about USD 3.3 million (82,000,000 metical) for the death subsidy and USD 3.3 millions (82,000,000 metical) for the survival pension. Referring to medical and pharmaceutical sup-port, the public servant with HIV and AIDS has free access to health care in the same way as any other citizen, in the framework of universal access to ART. The costs related to the treat-ment of public servants, with 100% coverage, can be estimated at around USD 2.3 Millions (55,890,000 meticais).3 In what concerns the funeral subsidy and assum-ing 1,626 public servant funerals in 2008 which in reality will be a larger number if dependant family is included, would represent an estimated cost of USD 169,000 (4,106,700 meticais).As public sector workers with HIV get sick and die from AIDS they must be replaced, HIV and AIDS has implications in the cost of the training of public servants, which obviously will vary ac-cordingtothelevelof qualificationsof thepro-fessional to be replaced. These costs can vary from small amounts to do on the job training to high amounts when training goes on for several years and includes specialization, sometimes done abroad. At this time there is not enough information on this issue to enable us to make a precise evaluation of the costs involved. The direct annual costs estimated for 2008 among public servants due to HIV and AIDS are summarized in the following table:

1 The impact of HIV/AIDS on Government Finance and Public Services, Markus Haacher, in The Macroeconomics of AIDS, IMF 2 Os valores monetários em dólares foram convertidos com base na taxa de câmbio oficial de 1 USD = 24.30 meticais em vigor no dia 24 de Novembro de 2008. 3. Custo unitário anual de USD 234 para TARV estimado na ME GAS 2004 – 2006


Table 10: Summary of public servant expenses in 2008 due to HIV and AIDSDESCRIPTION COST ESTIMATION IN

DOLLARS (USD)COST ESTIMATION IN METICAIS

(MZN)Absenteeism and prolonged leave 12,865,567.39 321.633.287,58Sickness Subsidy (30%) 2,007,547.18 48.783.396,47Absence for funerals 428,963.07 10.423.802,60Funeral Subsidy 169,083.99 4.108.740,96Death Subsidy 3,345,911.97 81.305.660,87Survival Pension 3,345,911.97 81.305.660,87Personnel Costs 22,162,985.56 538.560.549,11% of expenses with personnel 2008 3.1% 3.1%ART 2,322,090.21 56.426.792,10Food Basket (6 months) 1,718,415.53 41.757.497,38Total direct Cost 26,203,491.30 636.744.838.59

There is another additional item which is not usually accounted for when analyzing the costs of trainingandreplacement,whichisthefactthatanadequatelyqualifiedandinformedworkforceisscarce/limited.Thisrestrictionincreaseswhenhigherqualificationrequirementsareneeded.

IV.5. ECONOMICAL IMPACTIt is universally accepted that HIV and AIDS is a serious challenge to the economical development of any country, specially the ones most affected by the pandemic, as we have tried to illustrate in the previous sections. In this process, individuals and their families face growing risks of contract-ing the virus and the disease, as much by the erosion of the capacity of the formal and informal systems of social protection. Businesses and institutions are affected by the loss of productivity and increasing expenses directly related to HIV and AIDS. At the macroeconomic level, the eco-nomical growth rate goes down due to a slower growth in population and to smaller investment as a consequence of smaller national savings, added costs and reduction of economical expectations. PARPA II states that estimations suggest HIV and AIDS will be responsible for a reduction in the economical growth per capita of 0.3% that could reach 1% in the coming years.

stock photo


1. VISION, MISSION AND OBJECTIVESA) VISIONA more engaged public sector with appropriate conditionstoboostanefficientHIVandAIDSresponse in the work place.B) MISSIONTo guide and safeguard the expansion, inten-sification and consolidation of the nationalHIV and AIDS response through prevention, care and impact mitigation activities as part of the public sector reform strategy in order to achieve productivity and socio-economical de-velopment through an efficient public sectorfree from HIV and AIDS. C) GENERAL OBJECTIVESThis strategy has the following objectives:

To create favourable conditions for ef- ☑fective actions for the HIV and AIDS re-sponse in the Public Sector;

Specifically, thePublic Sector strategy has thefollowing objectives:

Establish parameters to integrate and pri- ☑oritize HIV and AIDS in the program-matic instruments of the institutions of the State Apparatus at all levels; Institutionalize the basis that allows the ☑creation of necessary conditions to pre-vent HIV and AIDS infections among public servants of the State Apparatus, subordinate institutions and their fami-lies; Todefineaminimumpackageof neces- ☑saryservicesforanefficientandeffectiveresponse in the State Apparatus, to HIV and AIDS; To regulate/facilitate access to services ☑and rights associated with public servants with HIV and AIDS and their direct fami-lies in such way as to minimize the nega-tive impact of the disease in the provision of public services; Mitigate the impact of HIV and AIDS in ☑the work place; Establish parameters for the improvement ☑of the coordination of HIV and AIDS response in the Public Sector, to mobi-lize resources for the implementation of actions and to establish mechanisms for the implementation of a Monitoring and

Evaluationsystemof theactionsof fightagainst HIV and AIDS undertaken by the institutions of the State Apparatus.

The objectives of this strategy will be pursued mainly through the implementation of preven-tion, impact mitigation and institutional sup-port activities for an effective coordination and implementation of the actions designed by each one of the sectors according to their institu-tional specificities.The specific thematic areasof the strategy for intervention are presented later in the text. The strategy has as direct ben-eficiaries’ thepublicservantsof theStateAp-paratus and their families at central, provincial and district levels.2. RESPONSE APPROACHAlignment to the PEN II and Multisector Response: the strategy considers the pandemic as a national emergency, to which a response in the public sector requires a multisector integrat-ed and comprehensive approach. This means, on one hand that the social, economical politi-cal and cultural realities are taken into account in the strengthening of the response; and on the other hand that each subsector and public sector institution uses its’ abilities, competence, organizational structures and internal commu-nication processes, prioritising and planning ac-cordingtotheirspecificrolesandresponsibilitiesto contribute to the response without prejudice toitsoccupationalspecificitiesof publicsectorservice provision. The response focuses on the priorityareasdefinedbythePENII.Decentralization: the decentralization of ac-tivities and structures of coordination and im-plementation of the HIV and AIDS response at provincial, district and municipal levels is essential to achieve the expected results. Sub-ordinated institutions and local bodies should be empowered in terms of capacity, planning resources, implementing and coordinating HIV and AIDS response in their places of work. Gender Sensitivity: Woman and Men are differently affected and exposed to HIV and AIDS. The actions of the response will have to consider gender aspects in their programs and intervention approaches. The strategy recog-nizes the vulnerable position of women and its incisive socioeconomic impact. In parallel, it is noted that there is differentiated access to many of the available HIV and AIDS services that register low adherence by men. This situation stimulates the prioritizing of interventions in

V. STRATEGY FOR THE FIGHT AGAINST HIV AND AIDS IN THE PUBLIC SECTOR


view of this double focus and sensitivity.Driven by Results: for the strategy to achieve the expected results it has to focus on processes that allow progressive analysis of the impact and effectiveness of interventions; the same analysis will be a guide to the conception and re-dimensioning of subsequent interventions.Better use of Resources: the mobilization of resourcesorfinancing ismainlyfromexternalsources, good use of the resources in terms of allocation,useandefficiency,accountabilityandtransparency have to be considered as a master line of implementation of HIV and AIDS re-sponse in the Public Sector. 3. GUIDING PRINCIPLESIn order to reduce the propagation of HIV and AIDS among public servants, the present strat-egy guides itself by the following principles:

Working Conditions: 1. to create working conditions suitable for the public servant tofulfiltasksinsuchawayastosatisfytheindividual and collective needs; Information, Education and Commu-2. nication: Dissemination of information about HIV and AIDS, among public ser-vants, using a gender and rights based ap-proach;No stigma and discrimination: 3. in the spiritof dignifiedworkandrespectforhu-man rights and for the dignity of people infected by HIV or degenerative diseases including AIDS, public servants should not be victims of discrimination based on their infection status, be it real or suspect-ed, because discrimination and stigma are an obstacle to prevention efforts; Social Dialogue: 4. cooperation and trust between public servants of the State Ap-paratus (support personnel, administrative, technical and leadership) are necessary so that the application of policies and pro-grams related to HIV and AIDS in the work place are successful. In this perspec-tive the involvement of union groups in the actions of lobbying and advocacy in favour of public servants living with AIDS is vital; Confidentiality: 5. nothing justifies de-manding information on serological status from a public servant, no worker should be under the obligation of revealing infor-mation of this kind, except in situations wherethisdemandwillbenefitthepublicservant. Access to personal data relating

to the serological status of public servants shouldbesubjectedtorulesof confiden-tiality according to the ILO practice guide-lines and the SADC code of conduct that states Governments should support and enforce anti-discrimination laws and other laws protecting workers living with HIV and AIDS both in the public and private sectors and, above all, to assure privacy andconfidentiality;Protection of Employment: 6. infection by HIV can not justify lay off. In the same manner as for other kinds of pathologies, people infected by HIV should continue workingaslongastheyareclinicallyfittofillavailableandappropriateemployment;Prevention: 7. infection by HIV can be pre-vented and this should constitute one of the main pillars when the strategy becomes operational. Prevention of all forms of transmission can be done using different strategies adapted to the national situa-tion and sector securities. Prevention can be reinforced through behaviour changes, through increasing knowledge, during treat-ment and through creating a non discrimi-natory environment in the work place; Respect for the Legislation: 8. the imple-mentation of sector legislation on HIV and AIDS should be in accordance with the national legislation cantered on the re-sponse to stigma and discrimination and the promotion of human rights of people living with HIV and AIDS in the work place; Right to Treatment: 9. health care related with HIV and AIDS, especially access to antiretroviral treatment, should be a prior-ity for the public servant.

4. STRATEGIC AREAS IN THE SCOPE OF HIV AND AIDS RESPONSE 2009-20134.1. MINIMUM PACKAGE OF SERVICESWith the adoption of the multisector approach, the minimal actions for awareness raising of public servants of the State Apparatus have tak-en a stronger dynamic. Nevertheless, to achieve the stated objectives, expanding the activities to district level is essential because it is conducive to acceleration in prevention at all levels. Mak-ing the HIV and AIDS response more inclusive and integrated depends on the level of acces-sibility to basic HIV and AIDS related services (prevention and treatment).


4.1.1.PREVENTIONThe area of prevention is a fundamental pillar of the present strategy in consonance with the re-dimensioning of the HIV and AIDS response that is currently happening in the country. The objectives and strategic actions in this component are essentially focused on the reduction of vul-nerability to infections for the public servant, promotion of behaviour to access information and care, adoption of safe sex practices and increase of responsibility in the prevention of HIV in all areas in the Public Sector.

FACTUAL INFORMATION: o Weak and/or no use of condoms, due to disagreement between partners, cultural and religious barriers and

the dominating situation of men in face of women; o Fragility of the management and distribution systems for male condoms and IEC materials in the public

sector; o Weak knowledge of and access to the female condom. o Persisting barriers in the access to information and to the health services in the State Apparatus;


objectiveTo expand and consolidate prevention actions, to all subsectors and their respective subordinate institutions, as a way of reducing, in a sustainable way, the infection rates among public servants and State employees.

Strategic actioNS iNdicatortarget

baSeliNei N F o r m at i o N 2008

reSpoNSible eNtitieS iNvolved eNtitieS

4.1.1.1. Develop and implement prevention programs and HIV infection risk control of in accordance with the occupational function of each of the sectors areas;

mohr ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.2. Mobilize and involve the institutional leadership, mainly the Permanent Secretaries, National Directors and Human Resource Managers, in the component on HIV and AIDS information dissemination;

moh/mFp ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.3. Produce and distribute appropriate Information, Educational and Communication material appropriate for public servants which illustrate the new trends of the pandemic and show that these are the new risk groups and sources of new HIV infections in the country;

miSau ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.4. Guarantee the involvement of women in all prevention activities in the different sector areas;

mimaS/mFp ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.5. Establish channels and mechanisms for reporting, resolution and sanction of sexual harassment situations in public institutions;

mFp ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.6. Make available educational information about the importance of reducing multiple partners with a major focus on concurrent and/or simultaneous partners;

moh ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.1.7. Increase knowledge on HIV and AIDS prevention methods among public servants in order to dissipate doubts and misunderstandings based on the replication of innovative, participative, attractive and effective methodologies with the most potential of driving behaviour change;


4.1.1.8. Ensure that public servants and their families have basic information about STDs, HIV and AIDS through including these themes in the on going training packages (school curriculum) and professional training of short and medium length.

mohmFp iSapiFapaS

4.1.1.9. Promote Counselling and Voluntary Testing activities for their serological status knowledge of public servants and promote their adherence to available health services related to HIV and AIDS;


4.1.1.10. Improve logistical and distribution capacities to deliver condoms in the work place especially for public servants who have the most professional mobility;


4.1.1.11. Promote the use of male and female condoms, through the reinforcement of partnerships with civil society organizations with experience of promoting and distributing condoms at national level;


4.1.1.12 Guarantee more involvement of infected and affected public servants in diverse prevention actions



4.1.2. CARE AND TREATMENT

FACTUAL INFORMATION: o Many public servants ill from AIDS do not approach health units or they approach them with an advanced stage

of illness; o Expansion of ART to all districts and medication freely available; o Poor connection between the different health services, with the consequence of insufficiencies in registration,

notification, and the monitoring and evaluation of activities in the treatment component; o Delays in seeking treatment by public servants suffering from STDs, due to ignorance and/or lack of attention to

the signs and symptoms of these infections.

objectiveS Reduce mortality among public servants, by promoting and facilitating access to HIV and AIDS care and treatment servicesStrategic actioNS iNdicator/

targetb a S e l i N e iNFormatioN 2008


4.1.2.1. Develop and implement a legal mechanism that facilitates access to anti-retroviral treatment for public servants and their families within the expansion and coverage criteria established by the health service;

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4.1.2.2. Operationalise the mechanisms of medical and pharmaceutical support for public servants as established in the current legislation and regulations;

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4.1.2.3. Make educational information available on the importance of the treatment of STDs and their correlation with HIV infection;


4.1.2.4. Establish partnerships with government and non-governmental networks and agents of traditional medicine, that provide specialized care and treatment for opportunistic deceases;


4.1.2.5. Training for the Focal Points for a better response in supporting HIV and AIDS infected and/or affected colleagues;

SectorS ceNtral, proviNcial aNd diStrict goverNmeNt

4.1.2.6. Make available specialized human resources and/or capacitate human resources in counselling and oversight of public servants affected by HIV and AIDS;


4.1.2.7. Establish partnerships and involvement in home based care beneficiary networks in the communities where the public servants are integrated;


4.1.2.8. Establish memorandums of understanding with the MoH to define clinical protocols for public servants’ priority access to ART. mFp moh


4.1.3 IMPACT MITIGATIONIn the area of impact mitigation efforts will be focused on the creation of conditions that mini-mize the negative effects of HIV and AIDS in the public sector and in the socio-professional life of publicservants.Thebenefitswhichshouldbefavouredarecompliancewiththelawandtheadoption of ethical and functional mechanisms for the reallocation of infected public servants, andthespeedingupof theprocessestoaccesspensionsandbenefits.

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FACTUAL INFORMATION: o Limited technical and financial capacity of institutions to promote and implement HIV and AIDS

prevention and impact mitigation policies, in a consistent and systematic way; o Some of the State institutions have invested in disseminating appropriate messages for the promotion

of impact mitigation initiatives.


objectiveReduce the impact of HIV and AIDS on HIV positive public servants and their families facilitating them to conduct a healthy and productive life.Strategic actioNS iNdicator/

targetbaSeliNei N F o r m a t i o N 2008


beNeFitS For public ServaNtS

4.1.3.1. Promote the use and access to available psychosocial support services at health service premises and/or at the local of the public servants socio-professional insertion;

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4.1.3.2. Assure the continuity of the professional life of the HIV positive public servant;


4.1.3.3. Assure training and professional reorientation of public servants with AIDS who are on ART;


4.1.3.4. Allocate sufficient time to public servants on ART to follow medical recommendations and prescriptions;


4.1.3.5. Promote the knowledge and compliance of the law that protects the HIV positive public servant in the work place;


4.1.3.6.Promote actions that prioritize and guarantee the conditions of lodgings for HIV positive public servants who are being transferred;


4.1.3.7. Promote nutritional educational campaigns and other conditions that prolong the life of public servants living with HIV in coordination with the occupational institutions;


4.1.3.8. Assure knowledge and provision of basic HIV and AIDS impact mitigation services in the work place by capacitating human resource technicians and managers.


beNeFitS For their FamilieS

4.1.3.9. Work in partnership with the Ministry of Woman and Social Action (MMAS), National Institute of Social Action (INAS) and other relevant actors for the integration of public servants’ families in mechanisms of nutritional and psychosocial support provided by these institutions in consonance with the basic services package previewed in the area’s operational plan.

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4.1.4. STIGMA AND DISCRIMINATIONTheactionsdefinedintheareaof thefightagainststigmaanddiscriminationaimmainlyatassur-ing the rights of people Living with HIV and AIDS in the Public Service, promoting an environ-ment respectful of professional ethical values and through the promotion of a culture of solidarity guided by the code of practice of ILO which postulates non discrimination and the protection of the rights of Public Servants including the guarantee of employment.

FACTUAL INFORMATION: o The majority of Public Servants are aware of the necessity to fight stigma and discrimination of PLHA, in

the work place and in the family environment; o In 2002 a specific law protecting the HIV positive worker in his place of work was promulgated, but many of

these aspects are not implemented by most institutions mainly due to organizational and financial reasons.

objectiveTo fight against stigma and discrimination related to HIV and AIDS in the work placeStrategic actioNS iNdicatorS/target baSe liNe

iNFormatioN 2008


4.1.4.1. Promote and disseminate the Law and other norms that protect the Public Servant infected by HIV and living with AIDS in his work place;

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4.1.4.2. Widely disseminate the rights and duties of public servants infected and/or affected by HIV and AIDS;


4.1.4.4. Elaborate, disseminate and guarantee the implementation of codes of conduct on HIV and AIDS in the work place of public institutions; To define, integrate and regulate on aspects related to care of HIV and AIDS with wider information on medical and pharmaceutical assistance in the work place;

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4.1.4.5. Ensure a proactive involvement of leadership in the fight against stigma and discrimination in the work place;


4.1.4.6. Stimulate the creation of PLHA solidarity groups in the work place and encourage the participation of Public servants living with HIV and AIDS.

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5. MAINSTREAMING OF HIV AND AIDS IN INSTITUTIONS

Actions developed aiming at the mainstreaming HIV and AIDS into the routine and program-ming of institutions depends on the capacity of and/or establishment of mechanisms and tools that favour an effective integration of HIV and AIDS into the planning cycle of public service institutions.

FACTUAL INFORMATION: o There are a lack of methodological and planning resources that include HIV and AIDS related activities into the

routine of occupational activities specific to the sector; o Weak participation of leaders at all levels tends to lead to the weak integration of HIV and AIDS in the work

place. o A lack of support and follow up of HIV and AIDS activities by chiefs, managers and leaders at several levels

contributes to a lack of interest and commitment from public servants; o At this moment the concept of Focal Point is not institutionalized, it was created as an institutional arrangement

to facilitate the implementation of the multisectoral response to HIV and AIDS in the framework of PEN II

objectiveTo establish an environment where all public servants feel free to contribute to the best methodologies and approaches concerning HIV and AIDS in the public service and include these actions in the routine sectoral planning cycles.Strategic actioNS iNdicatorS/

targetbaSe liNe iNFormatioN 2008

reSpoNSible eNtitieS

iNvolved eNtitieS

5.1. Develop and implement mechanisms that oblige Government institutions to implement activities responding to HIV and AIDS in its own work place;

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5.2. Guarantee active and proactive collaboration of leaders in the planning, implementation and monitoring of HIV and AIDS activities;

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5.3. Define effective functioning mechanisms of the HIV and AIDS response implementation structures in all public institutions, specifically in the area of Human Resources;

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5.4. Integrate HIV and AIDS prevention, care and impact mitigation activities in the Financial and Social Plans (PES) and in the sectoral and local government operational plans;

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5.5. Ensure HIV and AIDS is included in the agenda of technical institutional and leadership forums that take place at several levels (E.g. Advisory Councils, Coordination Councils, Technical Councils, Directorship Collective and National Meetings);


5.6. Institutionalize the role of the Focal Point in the areas of Human Resources and include it in the professional post description;


5.7. Make the central, provincial and district Permanent Secretariats responsible for the implementation, management and growth of the HIV and AIDS response in the Public Service;


5.8. Capacitate Human Resources, Planning, Administration, Finance and other relevant Sectors in the development and implementation of HIV and AIDS programmes in the work place;


5.9. Introduce the response to HIV and AIDS in curriculums of the national public servant educational and professional system and enable its leaders and managers to develop plans in institutional development which include matters related to HIV and AIDS



6. ESTABLISHING PARTNERSHIPS FOR PROVISION OF SERVICESThe levels of the response to HIV and AIDS between partners are different. Some factors such asinstitutionaloccupation,material,humanandfinancialcapacities,partnershipsoracquiredin-stitutionalexperienceinfluencethedifferentiatedstatesof theHIVandAIDSresponsebetweenpartners. As a way of harmonizing the efforts of different partners, it is necessary to establish partnerships either with private sector institutions, with other public sector institutions or with Public Society institutions, as a way of assuring institutional complementarities with a view to providing better service provision for all.

FACTUAL INFORMATION:

o There is no record of synergetic actions in the HIV and AIDS response in the Public Sector; o The partnerships between the public, private and civil society sectors are not being sufficiently capitalised in

what concerns the sharing and/or provision of specialized services.

objectiveTo assure the improvement of provision of services, through partnerships with institutions with a wider experience in the implementation of activities as a way of reinforcing the activities implemented by the sectoral areas. Strategic actioNS iNdicatorS/



iNvolved eNtitieS

6. 1. Identify the main service providers in the area of HIV and AIDS together with CNCS and the MISAU to facilitate public servants’ access;

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ceNtral, proviNcial aNd diStrict level goverNmeNt

6.2. Strengthen partnerships with national and international civil society organizations supplying home care and support to orphan children for the benefit of public servants and their families;

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6.3. Establish a memorandum of understanding with relevant sectors, networks of government organizations and non government organizations for providing specific HIV and AIDS related services;


6.4. Set up service provision contracts specific to the area of HIV and AIDS (testing and counselling IEC, training etc.), based on a clear definition of terms of reference, tasks, expected results and monitoring and evaluation mechanisms;


6.5. Establish partnerships with institutions that produce information for communications in the area of health and/or HIV and AIDS so that it will be possible to influence the production of messages best suited to change behaviours in the work place taking into account the sectoral or institutional specifics in which the public servant is inserted;


6.6. Promote the exchange of experiences with other sectors and partners responding to HIV and AIDS in the work place aiming to follow and replicate innovative ways of addressing HIV and AIDS;


6.7. Prioritize partnerships with the education sector to potentiate prevention activities, mainly in the information, education and communication components for HIV and AIDS;

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7. NORMATIVE ASPECTSThe strategic actions in this area aim at, fundamentally, assuring the observance of the rights of public servants suffering with chronic and degenerative diseases in particular HIV and AIDS, as established in the EGFAE and other legal documents. The enforcement of the legislation is con-ducive to the promotion of an environment respectful and observant of with ethical professional principles and promotion of a culture of solidarity in the work place.

FACTUAL INFORMATION:

o The present regimen of medical and pharmaceutical support has functional deficiencies, in what applies to the provision of pharmaceutical support, it is necessary to approve mechanisms that the complementarities of 21/96 Decree make possible;

o There is no Legal Document that regulates on Health Insurance and the respective Health Plan for public servants

vulnerable to infection of HIV in the course of their occupational duties; o The law on EGFAE, in what relates to the Special Regimen of Support (30%) authorises the allowance benefit on

appearance at the National Health Committee and then grants the beneficiary two (2) years, at the conclusion of this period the public servant will be given a pension.

objectiveSTo assure the dissemination of existing normative and legal framework about HIV and AIDS in the work place; Guarantee the implementation of policies and codes of conduct about HIV and AIDS in the work place.Strategic actioNS iNdicatorS/



iNvolved eNtitieS

7.1. Develop a code of conduct on HIV and AIDS in the work place which establishes the rights and duties of public servants living with HIV and AIDS;

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7.2. Propose and approve a special regimen for the public servant suffering from prolonged sickness that could affect their physical and productive capacity.

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7.3. Guarantee the implementation of the special regimen applicable to public servants (Art. 42, EGFAE);


7.4. Review under the rules of EGFAE the system of medical and pharmaceutical support in the scope of the social security system reform establishing the principle of Health Insurance for public servants;

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7.5. Assure a higher level of confidentiality by altering the procedures on dealing with HIV and AIDS in order to protect medical information confidentiality and above all information on the serological status of the public servant;

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7.6. Promote and disseminate the law that protects the worker living with HIV and AIDS;


Ongoing Actions7.7. Assure that the sectoral areas effectively integrate activities and financing for the HIV and AIDS response into their routine planning cycles;

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7.8. Promote actions of advocacy with the bodies responsible for global planning and financial disbursement (Ministry of Planning and Development, Ministry of Health) destined to medical and pharmaceutical support so that funds arrive on time;

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8. TRANSVERSAL ASPECTS 8.1. COORDINATION AND MANAGEMENT OF THE RESPONSE TO HIV AND AIDS IN THE PUBLIC SERVICE

The response to HIV and AIDS in the public service requires on one side, an effective and co-ordinated administration in the framework of human resources management procedures and on the other side, the multiple and continuous involvement of the sectoral areas at the various levels. Thisinvolvementrequires,initsturn,sufficientspace,coordinationmechanismsandmanagementof theactivitiestakingplaceinsuchawayastoavoidduplicationof efforts,theinefficientuseof available resources and to guarantee the strengthening of the quality and effectiveness of the interventions, through sharing of documentations and disseminating good practices.

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FACTUAL INFORMATION: o The implementation of the multi-sector response does not favour an articulated and coordinated planning of

interventions, because each sectoral area responds to HIV and AIDS in an isolated manner, which limits the development of consistent and harmonious interventions, even taking into account the specific missions and occupational mandates;

o At provincial level both the multisector provincial nucleus and the Provincial Nucleus for the Fight against HIV

and AIDS have the mandate to coordinate the sectoral and provincial response, nevertheless there is a weakness in the inter-institutional coordination component of this area;

o At provincial and district level there are no forums for discussion, sharing of information and intervention

experiences or opportunities to share good practices between the public sector institutions.


objectiveTo assure an effective coordination, articulation, management and harmony of the HIV and AIDS prevention and mitigation plans from the different various public service institutions with the perspective of capitalizing and reinforcing the capacity of the existing institutional structures.Strategic actioNS iNdicatorS/



iNvolved eNtitieS

coordiNatioN at ceNtral level

8.1.1. Capitalize on the Committee/CNCS Management Board, assigning and/or extending responsibilities and authority to lead and coordinate at central and multisectoral levels the response to HIV and AIIDS in the public service;

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8.1.2. Capitalize on the Interministerial Committee for the Public Sector Reform (CIRESP) to include the monitoring of the sectoral implementation of HIV and AIDS activities in order to facilitate the articulation and harmonization of different programming instruments in the sectoral areas;

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8.1.3.Assign and institutionalize competencies in the areas of management of human resources so they can manage and coordinate the implementation of HIV and AIDS activities in each of the State institutions;


8.1.4. Define a common framework of training as a way of guaranteeing a uniform and harmonized intervention;

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8.1.5. Promote semestral meetings on sharing information and good practices in the framework of the HIV and AIDS pubic sector response;


8.1.6. Capitalize on the use of the existing human resource management forums to facilitate the coordination of the HIV and AIDS response for each of the sectors;


8.1.7. Create provincial and district HIV and AIDS coordination committees;

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8.1.8. Strengthen the coordination between NDCS/NPCS together with all district management including socio-professional organisations, etc.;

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8.1.9. Establish partnerships with NGOs and other intervening entities at provincial and district level aiming for a better implementation of HIV and AIDS activities in the work place;

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8.1.10. Capacitate the general semestral meetings for public servants in order to facilitate monitoring and feedback in relation to achieved activities;


8.1.11. Assign management and coordination competencies to the permanent secretaries at provincial and district levels and the human resource managers;



COORDINATION AND MANAGEMENT OF THE RESPONSE: TASKS AND RE-SPONSIBILITIESThedefinitionof rolesandresponsibilitiesaimsat assuring dissemination, effective and constant implementation of plans, policies and strategies bythepeopleorsectorstowhomspecificrespon-sibilities will be stipulated.I. MANAGEMENT AND LEADERSHIP OF THE RESPONSE TO HIV AND AIDS IN THE PUBLIC SERVICEI.1. CENTRAL LEVEL MANAGEMENT: COMMITTEE/CNCS MANAGEMENT BOARDThe management and coordination system of the HIV and AIDS response in the public ser-vice should be distinguished by how it capitalizes on existing institutional structures at all levels, as much as possible and avoid duplications or cre-ation of new structures.The CNCS has a Directive Council established on the framework of the implementation of the op-erations of the CNCS and other instruments that rule the institutional partnerships between the CNCS and partners of the national HIV/AIDS response, guided by the National Strategic Plan. The MFP should capitalize on the functioning of this body, including the representation of the MFP at the highest level. Furthermore, CNCS as a coordinating body, could be assigned or extended responsibilities and com-petencies for the Coordination and Multisectoral Management of the HIV and AIDS response in the public service in close partnership with MoH and MFP The committee/management board is a working group under the leadership of the CNCS which convenes the Executive Secretariat of the CNCS and the leadership of the Ministry of Public Ser-vice through the National Directive of the Strate-gic Management of the State Human Resources (DNGERH). This body could include agencies and/or partners’ forums from the government in the area of HIV and AIDS. The committee/board meets on a semestral basis and has the function to guarantee and safeguard effective support to the diverse needs and aspects that require decision-making and oversight in the implementation of the Public Service HIV and AIDS Strategy. This body is under the CNCS Management Board.

MANDATE AND TASKS OF THE MAN-AGEMENT COMMITTEE:

Responsible for the Management of ☑the Strategy and institutional Plans of the

HIV and AIDS response;Coordination and stimulation of the HIV ☑and AIDS strategic planning processes in the public service;Definition of sectoral policies for the ☑HIV and AIDS response;Advice and programme guidance about ☑specificstrategiesof theHIVandAIDSresponse to public service institutions;Global evaluation of the actions devel- ☑oped by thePublic Service and identifi-cation of needs for the implementation of the Strategy of the HIV and AIDS response;Promotion, approval and incorporation ☑of the results of M&E reports of the activities to improve the performance of sectoral programmes.

I.2. COORDINATION AND MANAGE-MENT AT SECTOR LEVEL: DNGERHThe National Directive for the Strategic Man-agement of the State Human Resources (DNGERH) is a structure within the system of the MFP that amongst other roles is responsible for the monitoring and management of human resources, control of implementation of poli-cies related to the social welfare of public ser-vice employees; monitoring the compliance of the rights and duties of public service workers and State employees and; proposing policies and strategies for the management of public service and public institutes human resources (Decree 60/2007 of 17 December). These tasks are giv-en to public servants who are the direct ben-eficiariesof theproposedstrategy,being theirresponsibility to implement the tasks in order to harmonize the HIV and AIDS response in collaboration with leaders and implementers of interventions in the different institutions of the State Apparatus. It is subordinate to and acts under the leadership of the committee/CNCS management Board in what concerns HIV and AIDS in the public service.ADDED SPECIFIC RESPONSIBILITES FOR DNGERH:

Responsible for the implementation of ☑all activities in the area of the HIV and AIDS response in the Public Service; Harmonize Public service interventions; ☑ Provide technical assistance to the human ☑resource managers and to the planning areas of the different State institutions in coordination with the MoH in the integra-


tion of the HIV and AIDS component in their routine and planning cycles;Advocacy through the human resources ☑managers for a bigger involvement and integration of the HIV and AIDS com-ponent in sector annual budgets;Facilitate the process of submission of ☑projects, programs and annual plans of activity of the Public Service as well as the disbursement of funds together with potentialfinancers;Supervision and monitoring of the pro- ☑cess of the implementation of the strat-egy in terms of intervention approaches, scope, accountability and report making;To disseminate the main deliberations of ☑the Committee/management boards of the public institutions;To report on the progress achieved by ☑developingasinglereportwhichreflectsthe main activities implemented in the dif-ferent sectoral areas and its submission to the committee /management board under the leadership of the CNCS;To promote forums of inter-institutional ☑discussion on HIV and AIDS and spread relevant information;To develop the annual report basing it on ☑the indicators of the plan of action to be developed.

I.3. MANAGEMENT, COORDINATION AND LEADERSHIP AT INSTITUTION-AL LEVELI.3.1. MINISTERIAL PERMANENT SEC-RETARY The Permanent Secretary at the level of each sector area is an entity responsible for the ex-ecution, management and technical administra-tive supervision of the activities of each sectoral area including human resources. By way of this entity the institutional leadership will have the overall responsibility for the execution, integra-tion and management of the implementation of the response to HIV and AIDS in each sectoral area. The Permanent Secretary will have the overall responsibility to assure the process of development, implementation and monitoring of the actions of the HIV and AIDS response in the work place, as well as, to guide the process of the revision of policies and plans and assure that these processes for the implementation of benefitsprescribedbylawarecompliedwithinthe sector. The assignment of these responsi-bilities to the Permanent Secretary aims also at

assuring a proactive and effective involvement and commitment of the leadership of all sec-toral areas in the implementation of HIV and AIDS related activities. This structure should be replicated at provincial and district levels.DUTIES OF THE PERMANENT SECRE-TARY:

Advocacy at all levels for the implemen- ☑tation of the actions to fight HIV andAIDS;Coordination of the elaboration of the ☑Sector Annual Plan of Activities;Leadership on the management and im- ☑plementation of the HIV and AIDS Strat-egy, Policy or Plan in its sectoral area;Promotion of the mobilization of resources; ☑Monitoring and follow up of the imple- ☑mentation of activities;Overall evaluation of the progress of plans ☑and actions implemented by an institution; To guarantee that the semestral general ☑meetings are carried with public servants toreflectontherecordedprogressreportson the HIV and AIDS response activities in the different sectoral areas.

I.3.2. MANAGEMENT OF THE IMPLE-MENTATION AT INSTITUTIONAL LEV-EL: DIRECTORATE/DEPARTMENT/ HU-MAN RESOURCES The bodies managing human resources are en-tities already established at the level of State Institutions and include essential functions for the development of public servants and State employees in the Ministries, National Direc-torates, Subordinated Institutions and Provin-cial Directorates and district administration/government. At central level and in each one of the public institutions, the Human Resource DirectoratesandDepartmentare thefirst lineof contact in all questions pertaining to the pro-grammes related with HIV and AIDS, in this sense being the principle sources that dialogue, in a double subordination, with the Permanent Secretary and the DNGERH. These bodies represent the more permanent and executive institutional structures in the implementation of the activities assuring the continuity of the programs related to the HIV and AIDS in the public service.The human resource managers at provincial and district levels in coordination with the manager at central level and the Provincial and District Secretariat should put emphasis on their partici-


pation in the coordination of the activities of their institution at district and provincial level. The manager at provincial level should be in permanent coordination with the district and provincial Nucleus and/or the District HIV and AIDS Response Coordination Forum (i.e. NPCS, NDCS, Forums and/or networks of lo-cal organisations, etc.). THE HUMAN RESOURCE MANAGERS ARE RESPONSIBLE TO:

Inform all public servants in the respec- ☑tive sectoral area about the existence of the strategic plan, Action Plan and Poli-cies of HIV and AIDS in the work place;Ensure the implementation of the actions ☑previewed in the Plans and guarantee their update;Monitor the progress of implementation ☑of activities at sector level and supply feedback to managers and leadership;Propose to the institutional Permanent ☑Secretarytheorder,floworhierarchyof implementation of programmed actions without sacrificing the priorities previ-ouslydefined;Recommend changes or updates of the ☑programmed activities and submit them for approval to the leadership;Prepare and compile progress reports ☑about the activities in that sector area;To gather relevant data for M&E on the ☑HIV and AIDS response activitiesTo Participate in intra-ministerial and ☑multisector HIV and AIDS forums;

I.3.3. COORDINATION OF THE RESPONSE AT PROVINCIAL AND DISTRICT LEVELSFor an all encompassing and integrated re-sponse to HIV and AIDS, the decentralization of the actions of the HIV and AIDS response should be extended to district and provincial levels, making each of the interveners respon-sible in the different levels. The responsibilities for the coordination at this level rest with the Permanent Secretary.DISTRICT AND PROVINCIAL PERMA-NENT SECRETARYThe Permanent Secretary at provincial and district level has the role of overall coordina-tion of HIV and AIDS activities in the Public Service and guarantees the process of develop-ment, implementation of activities in the area and the level of political-administrative man-

agement. This entity should be responsible for the decentralization of funds and execution of activities up to district and local levels of ad-ministration and public service. The duty of the entity to replicate the duties and tasks of the central Permanent Secretary at local level, in as much as this is suitable. DUTIES OF THE PROVINCIAL AND DIS-TRICT PERMANENT SECRETARY:

Advocacy at district and provincial levels ☑on the implementation of actions for the HIV and AIDS response;Coordination of the development and ☑implementation of the Sector Local Plans of activities (both provincial and district); Lead the management and implementa- ☑tion of the Strategy at that level;Promotionof themobilizationof finan- ☑cial resources for implementation of the strategy;Monitoring and follow up on the imple- ☑mentation of activities;Overall evaluation of the progress of the ☑plans and actions implemented in that in-stitution;Ensure that the semestral meetings with ☑public service employees at provincial and district levels are followed through to evaluate the implementation of the ac-tions of the HIV and AIDS response;Ensure the compilation of data and its ☑sending to the competent authorities.Strengthen the coordination between the ☑NDCS/NPCS together with all the dis-trict directorates including social and pro-fessional organizations, etc;Establish partnerships with NGOs and ☑other entities who intervene at provincial and district level for a better implementa-tion of HIV and AIDS activities of HIV in the work place;Formulate proposals that can make the ☑HIV and AIDS response more effective.


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8.2.COMMUNICATIONAllof theactivitiesdefinedinthisplanwill/mustbecommunicatedthroughthemeansof amul-tifaceted combined approach using various channels and diverse means of communication.

FACTUAL INFORMATION: o The messages used for the education of Public Servants are the same as those used for other social

groups, not including specific situations directly related to the functions being performed; o Overall, the target group for the sensitisation campaigns in the institutions is constituted of the public

servants without including the hierarchical leadership;

objectiveEnsure effective communication on HIV and AIDS in the Public ServiceStrategic actioNS iNdicator/

targetiNFormatioN baSe 2008


iNvolved eNtitieS

8.2.1. Develop behaviour change communication programmes for Public Servants using a participative approach and using various means of communication;


8.2.2. Develop communication campaigns with the aim to promote Counselling and Testing to know serological status;

miSau, mFp ceNtral, proviNcial aNd diStrict level goverNmeNt

8.2.3. Adapt messages to the vocational reality of public institutions, including the segmenting of communication in accordance with level of education and sensitivity to gender and rights;

mFp, mmaS e miSau


8.2.4. Direct communication to address the behaviour patterns that galvanise the epidemic in each sector area;

miSau ceNtral, proviNcial aNd diStrict level goverNmeNt

8.2.5. Involve public servants/beneficiaries in the process of the development of messages and specific products (i.e. pre testing of materials or consultation with beneficiaries);


8.2.6. Facilitate dialogue and discussion on specific topics (e.g. condoms, fidelity, treatment and others) meeting the demand and interest of public servants and/or other beneficiaries;


8.2.7. Guarantee the dissemination of HIV and AIDS tools at all levels of the work place (ILO Code of Conduct, SADC);


8.2.8. Maximise the use of information and data coming from mass media communication bodies to feed communication activities developed in the work place.



8.3. MONITORING AND EVALUATIONThe organisation of the single M&E system is reconciliated through various mechanisms, respec-tive collection tools and compilation of information.OBJECTIVEGuaranteeaneffectiveandefficientoversightof actions,improvingthequalityandquantityof theinformation compiled, for an effective assessment of reach, relevance, sustainability and impact of HIV and AIDS interventions in the public service.

FACTUAL INFORMATION: o The existence of different monitoring and evaluation instruments that are used in an isolated manner in each

of the public institutions that implement HIV and AIDS activities; o Lack of a body/entity and/or functioning coordination mechanisms between the various public sector areas

and the respective institutions; o Inexistence of standardised M&E instruments and clear information system flows and previously defined for

public institutions; o Weak sharing of information between sectoral areas in respect to HIV and AIDS interventions in the work

place

objectiveGuarantee an effective and efficient oversight of actions, improving the quality and quantity of the information compiled, for an effective assessment of reach, relevance, sustainability and impact of HIV and AIDS interventions in the public service and guaranteeing the sustainability and continuity of actions in the medium and long termStrategic actioNS iNdicator/

targetSiNFormatioN baSeliNe iN 2008


iNvolved eNtitieS

8.3.1. Develop and disseminate the monitoring and evaluation framework to all public service institutions;

cNcS, miSau, mFp

diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.2. Develop and standardise instruments and data collection methods, procedures, sharing and the use of M&E data;

cNcS, miSau, mFp


8.3.3. Promote the practice of the compilation of annual and trimestral reports;

mFp diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.4. Integrate a component on the oversight of HIV and AIDS activities in the daily routine of general and sectoral inspections and in the monitoring, supervision and evaluation mechanisms of already existing activities of the sectoral areas;


8.3.5. Promote meetings on the exchange of experiences and good practices on the implementation and coordination of intra and inter sectoral HIV and AIDS response programmes;

mFp aNd SectorS


8.3.6. Create a database of qualitative and quantative information;

cNcS, miSau, mFp


8.3.7.Capacitate relevant actors (Focal points, human resource managers, inspectors) in the strategic sectoral implementation of M&E at central and provincial level;

cNcS, mFp diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.9. Guarantee the flow and sharing of information with partners and relevant entities as relevant;

miSau, mFp aNd cNcS



9. FINANCE AND SUSTAINABILITY MECHANISMSThesustainabilityandcontinuityof actionsinthemediumandlongtermalsodependsonfinancialresources.Theflowof financialresourcesfollowsmechanismsalreadyinplace;themainsourcebeingtheOGEandbeingtheuseof otherfundscomingfromdonationsandspecificfinancingapplications.

8.3.10. Strengthen the technical capacity of public institutions in data analysis and the production of strategic information on HIV and AIDS, running training courses on data collection, analysis and use of data at all levels;

cNcS aNd mFp diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.11. Develop and implement mechanisms that oblige all public institutions implementing HIV and AIDS activities to provide programmatic information to MFP, MISAU, CNCS and other coordinating bodies;

miSau diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.12. Promote annual inter-sectoral evaluations on progress and performance of HIV and AIDS activities;

miSau aNd mFp diStrict, ceNtral aNd proviNcial goverNmeNt

8.3.13. Institutionalise the Focal Points in the sectoral constitutional statues in order to guarantee the coordination and reliable follow up of HIV and AIDS activities in public institutions;


8.3.14. Undertake periodic evaluation research on behaviour change in order to evaluate the efficiency and impact of activities undertaken and their capacity for behaviour change in public servants.

miSau, cNcS aNd mFp


FACTUAL INFORMATION: o Lack of regular financing, timing, planning shortfall and not making use of partnering opportunities and available

resources; o No inclusion of budgeted items for HIV and AIDS activities in institutional plans;

o Late availability and/or disbursement of funds to finance HIV and AIDS in State institutions.

objectiveGuarantee the sustainability and continuity of implemented actions in the medium and long termStrategic actioNS iNdicator/

targetiNFormatioN baSeliNe iN 2008


iNvolved eNtitieS

9.1. Ensure the financing mechanisms for HIV and AIDS activities through the OGE include the respective items in the annual budget plan;

mF, mpd aNd mFp

diStrict, proviNicial aNd ceNtral goverNmeNt

9.2. Improve the partnership and coordination with CNCS and other partners in order to guarantee access to resources for the implementation of HIV and AIDS activities in the public service;

mpd, mF diStrict, proviNicial aNd ceNtral goverNmeNt

9.3. Promote the ongoing and consistent integration of HIV and AIDS activities into the normal planning cycle and the activity budget for State institutions;

mpd, mF, mFp diStrict,

proviNicial aNd ceNtral goverNmeNt


PUBLIC SERVANTSPUBLIC SERVANTS

SERVING CITIZENS BETTERSERVING CITIZENS BETTER

ANNEX 1

Priority Areas of Intervention in the Implementation of the Strategy


1. PREVENTION Objective: To expand and consolidate prevention actions, for all the sub-sectors and the respective institutions under their charge, as a way of reducing the numbers of public servants infected by HIV in a sustainable manner. Reasoning: prevention continues to be considered as a priority area in the framework of the national HIV and AIDS response. Main Activities o To hold sensitisation workshops to promote behavioural change; o To educate peers based on innovative methodologies; o To acquire and make available condoms (male and female); o To reproduce and distribute IEC materials (brochures, pamphlets, boards); o To reproduce and put up posters in the work place (bathrooms, refectories, libraries/resource centers); o To hold cultural and educative joint events (Theater, video, singing and dancing, painting etc.) in the framework of the 1st of December; 2. MAINSTREAMING OF HIV AND AIDS IN THE INSTITUTIONS Reasoning: the ongoing Public Sector Reform is strongly orientated by a results philosophy. From that comes the necessity of re-dimensioning the HIV and AIDS response so a favourable environment is created facilitating an effective response to the epidemic. Objective: To create an environment where all public servants find space to give their contribution on the best methodologies and policies to the HIV and AIDS response for the public sector and include these actions in the regular sectoral planning cycles. Main Activities o To budget HIV and AIDS activities in each of the sectoral areas; o Guarantee the participation of the Focal Point in the discussion forums in each of the sectors; 3. COORDINATION, MONITORING AND EVALUATION Reasoning: the coordination between the different sectoral areas is one of the mechanisms that are conducive to a successful HIV and AIDS response in the Public Sector. Joint efforts are the basis for achieving an effective harmonization of interventions. Besides, joint planning and the harmonization of the M&E component are important for the evaluation of the degree of implementation and results of the response. Objective: Assure an effective coordination, management and harmony of HIV and AIDS prevention and mitigation plans in the different institutions of the Public Sector with the perspective of capitalizing on and reinforcing the response capacities of the existing institutional structures. Main Activities: o To hold planning and evaluation meetings; o To adopt a data compilation model (reports); o To hold discussion sessions on areas relevant to research; o To produce and disseminate progress reports and evaluations; o Bi-annual administration of KAP studies on the Public Sector; o To continuously capacitate and train the main intervening actors in the response dynamics.


ANNEX 2

Preliminary Costs of HIV & AIDS Response for the Public Sector

MAPUTO, DECEMBER 2008

PUBLIC SERVANTSPUBLIC SERVANTS

SERVING CITIZENS BETTERSERVING CITIZENS BETTER


I.INTRODUCTION

Having completed the blueprint of actions that make up the draft HIV and AIDS response strat-egy in the Public Sector and aiming to re-dimension the response in public sector institutions and in the broader framework of the Strategic Plan of the Fight against HIV/AIDS in the country, it is important to calculate, even if only in an approximate manner, the costs as a result of its imple-mentation.The estimation of costs will facilitate an evaluation of the best combination of scarce resources, to achieve the intended objectives of the different Strategic Areas of the Response.

The basic demographic data used to make the projections results from an information analysis of public servants in 2008.Thefinancialanalysisisbasedonthepremisethatthepopulationof publicservantswillhaveanannual growth rate of 2% (an estimate based on the population growth rate), that the proportion of public servants infected by HIV/AIDS would remain constant and that deaths from HIV/AIDS would grow 1% per year in the period under analysis.Theestimationof costswasbasedonthesimplifiedadoptionof thenationalresponsescostingmodel so that it is adjusted to the limited demographic information as well as to the concrete ac-tions to be undertake (plan of action). For this reason, the logic of the costing model was applied to the series of proposed Strategic Actions, using the available information on unit costs for the different overall activities. In order to eliminate as much as possible the double counting of planning costs, the structure of theStrategicActionsweremaintainedandwhereverariskof duplicationwasidentifiedacrossreference was created.

II. METHODOLOGY

III. RESULTSThefinancialcostprojectionsaredetailedbyStrategicArea.Thecalculations includethemostrepresentative costs, except for cost of home based care which was not determined.In the area of Impact Mitigation, the available information allowed for the determination of costs forthedifferentoptionsof applyingfinancialassistanceof 30%andfortheFoodBasket.The total cost of implementation of the Strategic Areas thereby varies between a minimum of $US 48 million to a maximum of $US 290 million for the period 2008 – 2012. These variations are duetothecostof thefoodbasketandthecoverageof thebeneficiaries:publicservantsonlyorincludingtheirfamilies;aswellastothecoverageof financialassistance(30%):Allpeopleinfectedby HIV, those on treatment or only those most serious during the year (deaths).The different combinations from the least expensive to the most expensive are presented in order for the period 2008-12.


Option 1 Sickness Subsidy given only in the event of Death occurring during the year, supposing the de-ceased was not in condition to work, and the Food Basket given to all public servants on treatment, excluding their respective families.

Strategic Areas Total 2008-12Prevention 9,006,382.17Care and Treatment 12,415,740.72Impact Mitigation 21,824,833.59Stigma & Discrimination 0.00HIV & AIDS Mainstreaming 0.00Partnerships in Services 375,760.00Normative Aspects 0.00Multisector Coordination 0.00Communication 0.00

Monitoring and Evaluation 4,362,271.65Financing Mechanisms 0.00 Total 47,984,988.13

Options used for Mitigation:1: ART; 2: Deaths; 3: Infected 2Families (Y/N): N

Option 2Sickness Subsidy given only in the event of Death occurring during the year, supposing the deceased was not in condition to work, and the Food Basket given to Public Servants on treatment including their respective families.

Strategic Areas Total 2008-12Prevention 9,006,382.17Care and Treatment 12,415,740.72Impact Mitigation 54,585,197.95Stigma and Discrimination 0.00HIV & AIDS Mainstreaming 0.00Partnerships in Services 375,760.00Normative Aspects 0.00Multisector Coordination 0.00Communication 0.00Monitoring and Evaluation 4,362,271.65Financing Mechanisms 0.00 Total 80,745,352.49

Options used for Mitigation:1: ART; 2: Deaths; 3: Infected 2Families (Y/N): Y

The change in the coverage of the Food Basket doubles the estimated costs.


Option 3Sickness Subsidy given to Public Servants on treatment during the course of a year and the Food Basket given to public servants on treatment, excluding their respective families.

Strategic Areas Total 2008-12Prevention 9,006,382.17Care and Treatment 12,415,740.72Impact Mitigation 79,252,766.80Stigma and Discrimination 0.00HIV and AIDS Mainstreaming 0.00Partnerships in Services 375,760.00Normative Aspects 0.00Multisector Coordination 0.00Communication 0.00Monitoring and Evaluation 4,362,271.65Financing Mechanisms 0.00 Total 105,412,921.34

Options in use for Mitigation:1: ART; 2: Deaths; 3: Infected 1Families (Y/N): N

Theincreaseinthenumberof beneficiariesexplainstheincreaseintheforeseencosts.

Option 4Sickness Subsidy given to Public Servants on treatment and the Food Basket given to Public Servants on treatment, including their respective families.


Options in use for Mitigation:1: ART; 2: Deaths; 3: Infected 1Families (Y/N): Y


Option 5Sickness Subsidy given to Public Servants infected with HIV and the Food Basket only given to Public Servants on treatment.


Options in use for Mitigation:1: ART; 2: Deaths; 3: Infected 3Families (Y/N): N

Option 6Sickness Subsidy given to Public Servants infected with HIV and the Food Basket given to Workers on treatment and their respective families.


Options in use for Mitigation:1: ART; 2: Deaths; 3: Infected 3Families (Y/N): Y

The different options presented clearly indicate that the total cost for implementation of the Strategy proposal is extremely sensitive to two elements of the costing, Sickness Subsidy (30%) and the Food Basket, so this should be considered with the utmost attention.


IV. STRATEGIC AREAS OF THE HIV AND AIDS RESPONSE-COST DETAILS

4.1. MINIMUM PACKAGE OF SERVICES The details of the calculated costs in accordance with the Strategic Areas are presented as fol-lows.The same numbering is maintained as in the draft of the Strategic Plan so as to facilitate analysis and comparisons.


4.1.

1. P

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4.1.

2.C

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4.1.

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1


Opt

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2


Opt

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3


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4


Opt

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5


Opt

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6


4.1.

4.ST

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5. M

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7. N

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8. T

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8.1.

MU

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N


8.2.

CO

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ICA

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N


8.3.

MO

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OR

ING

& E

VALU

AT

ION


9. C

OST

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NA

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ING

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Government & Nonprofit

STRATEGY FOR THE FIGHT AGAINST HIV & AIDS IN THE PUBLIC SECTOR 2009 -2013