Periodic Review ccm request template

Describe whether the counterpart financing requirements have been met as listed below. If not, provide justification which includes actions planned during the next Phase/Implementation Period to move towards reaching compliance.

1. 
   Minimum threshold for counterpart financing
   

Percentage in Line M of the ‘Financial Gap Analysis and Counterpart Financing’ table must be greater than or equal to the minimum threshold that applies to the applicant’s income level

The minimum threshold for government financing of the national disease programme is 60% for upper middle income countries. The percentage in Line M of the ‘Financial Gap Analysis and Counterpart Financing’ table is 92% for the HIV component. For the TB component, the counterpart percentage is 93%. Increasing government contribution to national disease Programme over the next Phase/Implementation Period  Figures in Line B of the ‘Financial Gap Analysis and Counterpart Financing’ table must increase over time

The figure below is a representation of the figures in Line B of the ‘Financial Gap Analysis and Counterpart Financing’ table in the RSA Financial Renewals Template. The figure clearly shows the increasing contribution to the HIV and TB programme.



Figure 6: Line B of the ‘Financial Gap Analysis and Counterpart Financing

2. 
   Increasing government contribution to the overall health sector over the next Phase/Implementation Period
   

 Figures in Line I of the ‘Financial Gap Analysis and Counterpart Financing’ table must increase over time

The figure below is a representation of the figures in Line I of the ‘Financial Gap Analysis and Counterpart Financing’ table. The figure clearly shows the increasing government contribution to financing the health sector.

Figure 7: Government contribution towards financing the health sector

The figure below shows how the government funding for the national response increases steadily year on year; although the health budget as a percentage of the national budget is largely stable at about 11%.

Figure 8: Consolidated government health and HIV and AIDS allocations

HIV/AIDS accounts for nearly 8% of the total health spending (2011/12), and is expected to increase to 10.4% by 2014/15. The national HIV/AIDS allocation for the health sector increased over 7 times from $250 million in 2006/7 to almost $1.8 billion expected in 2015, and reflects the commitment that the South African government has made to the fight against HIV/AIDS and TB. This is just over 50% of the estimated resources of $3.5 billion required in 2015 to meet national strategic plan targets, notwithstanding budget allocations from other sectors including education and social services sectors.

As a consequence of increased demand for resources, it is estimated that provincial governments are likely to increase their share of allocation from the Provincial health discretionary Equitable Share allocations for HIV and AIDS to supplement the national health HIV and AIDS grant. The provincial discretionary allowance from equitable share is estimated to increase by almost 1.8 times from $49 million in 2012/13 to $89 million in 2014/15, with Gauteng and KwaZulu-Natal – the provinces having the highest HIV burden - taking the leading in allocating additional funds from their own equitable Share budget.

4.2 Progress towards Proposal Goals and Impact/Outcome

Please refer to the results reported by the PR(s) for impact/outcome indicators included in the Performance Framework and provide additional updates if recent information is available (e.g. survey reports, impact assessment studies, etc.)

Table 10: Impact/outcome indicators included in the Performance Framework

Baseline'>Impact/Outcome Indicators	PR	Baseline		2011		2012
		Date	Baseline	Target	Result	Target	Result
Impact: % of young women and men aged 15-24 who are HIV infected (1)	NDOH	2008	8.7%			6.1%	Pending
	NACOSA	2008	19%			N/A
	NRASD	2009	21.7%			TBD	8.7% (2008)
	RTC	2008	8.7%			6.1%
	WCDOH (1.a)	2004	8%	5	8.4%		No target
Impact: % of ART patients alive and on treatment at 12 months (2)	NDOH	2009	72%	76%	Pending
	NACOSA	2008	72%			N/A
	NRASD (2.a)	2008	72%			90%	72.3% (2007)
	RTC	2009	72%	76%	Pending		No target
	WCDOH	2006	85%			83% (2013)	84% (2012)
Impact: % of babies born to HIV positive women who tested HIV positive (PCR) at 6 weeks (3)	NDOH	2010	3.6%	3.3%	2.7%
	NACOSA	2008	7.9%			7.5% (2009)
	NRASD (3.a)	2008	24%			5%	3.5% (2010)
	WCDOH	2005	7.4%			4%	2%( final rpt. pending)
Outcome: % men and women aged 15-24 reporting the use of a condom with their sexual partner at last sex (4)	NDOH	2008	M=87% F=73%			M=95% F=90%
	RTC	2008	M=87% F=73%			M=95% F=90%	No target
Outcome: % of young women and men ( 15-24) who have had sexual intercourse before age of 15 (5)	NDOH	2008 (4)	M=11.3% F=5.9%			M=8.7% F=3.3%	Pending
Outcome: % smear positive TB cases that are successfully treated (cured or completed treatment) (6)	NDOH	2010	74%	77%	Pending
Outcome: TB case registration rate (Notification rate of all forms of TB cases) (7)	NDOH	2010	708 per 100,000	675 per 100 000	Pending
	RTC	2010	708 per 100,000	675 per 100 000	Pending
Outcome: % women and men aged 15-49 years who have had sexual intercourse with more than one partner in the last 12 months (8)	NDOH	2008 (4)	10.6%			5.38%	Pending
Outcome: Current school attendance among orphans and non-orphans (9)	NRASD	2008	81%			N/A	97.9% for orphans, 99.3% for non-orphans (2008)

Comments related to table above

1. 
   DHS/HSRC survey is conducted 3 yearly, with the last survey conducted in 2008. Since 2008, no survey was undertaken due to lack of funds during that period. The survey only commenced beginning of 2012. A target of 7.8 % was estimated for the 2012 Survey. The report for the 2012 Survey is anticipated to be released in June 2013. The final target (6.1%) which is in line with the GF grant period was projected for 2014 of which the report will only be available by June 2015.
   
   1. 
      Results based on the provincial Antenatal HIV Prevalence Survey results. Official Update pending as per NDOH
      
2. 
   Baseline figure used for % of ART patients alive and on treatment at 12 months is for Western Cape Province. The National ART system was not established at that time and Western Cape was thus, the only province to have baseline data. A target of 76% has been set for 2012 of which the report will only be available by June 2013.
   
   1. 
      The actual result of 72.3% is for 2007. The 2006 actual result was 81.5%, the 2005 actual result was 83.1%, and the 2004 actual result was 84.8%. No data was available for 2010
      
3. 
   This result was published by the MRC in June 2012 with a rate of 2.7% for 2011 (vs. 3.5 for 2010 and 8.2% in 2008)
   
4. 
   No calculations / projection of targets for 2012 were made. Final target of (Male 95%; Female 90%) which is in line with the GF grant period was projected for 2014. The report will only be available by June 2015.
   
5. 
   The DHS/HSRC survey is conducted 3 yearly, with the last survey conducted in 2008. No survey was undertaken in 2011 due to lack of funds during that period. The survey only commenced at the beginning of 2012. A target of (Male 10.4%; Female 5.0 %) was estimated for the 2012 survey. Report for the 2012 survey anticipated to be released in April 2013. The final target of (Male 8.7%; Female 3.3%) which is in line with the GF grant period was projected for 2014; the report will only be available by June 2015.
   
6. 
   The April-June 2012 Interim TB Report indicates that 75.3% smear positive TB cases were successfully treated (cured or completed treatment). The reported figure is based on preliminary data and it is less than the previous quarter of 78.7%. The final TB Datasets for April –June 2012 have been received and data are being processed. The findings of the final TB report will be shared with GF when the analysis process is completed. Initial indicator
   
7. 
   The April – June 2012 Interim TB Report indicates a TB case registration rate of 878.5 per 100 000. The reported figure is based on preliminary data. The final TB Datasets for April –June 2012 have been received and data are being processed. Report to be shared as above
   
8. 
   The DHS/HSRC survey is conducted 3 yearly, with the last survey conducted in 2008. No survey was undertaken in 2011 due to lack of funds during that period. The survey only commenced at the beginning of 2012. A target of 7.12% was estimated for the 2012 Survey. Report for 2012 Survey is anticipated to be released in April 2013. The final target (5.38%) which is in line with the GF grant period was projected for 2014, the report will only be available by June 2015.
   
9. 
   NRASD did not verify any of the information contained in this report. The actual result of 97.9% for orphans aged 10-14 and 99.3% for non-orphans aged 10-14 is for 2008. For actual results beyond 2010, an HSRC Survey is planned with fieldwork to finish by June 2013.
   

Please confirm if the method of data collection and data source is consistent with the M&E framework agreed at the time of signing the Grant/SSF Agreement(s).

At the time of signing of the grants, the M&E Plan for the National Strategic Plan for HIV, AIDS, TB and STI was not developed. Hence the collection of indicators at an impact and outcome level was never formalized. However, some data was collected even though not necessarily in a comprehensive format.

Is there a recent report analysing information regarding health impact and outcome available? Yes

1. 
   Rapid Mortality Surveillance Report 2011 (General Annex 5)
   
2. 
   Evaluation of the effectiveness of the national PMTCT Programme until 18 months postpartum in South Africa – 2011 National Cohort Report (2011 National SAPMTCT Survey Results) (General Annex 6)
   
3. 
   2011 Antenatal HIV Prevalence Survey (General Annex 7)
   

If yes, when was it conducted? 2011 and 2012

1. 
   Rapid Mortality Surveillance Report⁶⁷
   

Based on the Rapid Mortality Surveillance Report 2011, the estimates show that South Africa is making progress in improving the health status of the nation. Life expectancy started to increase from about 2005, one year after national ART rollout. It can be seen that there have been sustained improvements in mortality of young adults and child mortality, largely due to the rollout of ART treatment and prevention of mother-to-child transmission of HIV. However, neonatal mortality rates have not improved, and by 2009, maternal mortality was still increasing (also see Section 3 Table 8).

2. 
   2011 National SAPMTCT Survey Results⁶⁸
   

The National South African PMTCT Survey evaluates the impact of the PMTCT programme. This has shown steadily improving results and it is hoped that we will reach the NSP target for 2017 of having a transmission rate of less than 2%. However, as more women live longer on ARVs, the potential for vertical transmission will continue to increase, so we will need to watch this very carefully.

Table 11: 2011 National SAPMTCT Survey Results

Summary of National Findings

Percentage of infants exposed to HIV-(weighted exposure prevalence): 2010: 31.4% (95% CI 30.1-32.6%) ≈ ANC survey 2011: 32.2% (95% CI 30.7-33.6%)

Perinatal mother to child HIV transmission rate measured at 4-8 weeks of infant age (weighted): 2010: 3.5% (95% CI 2.9-4.1%) 2011: 2.7% (95% CI 2.1-3.2%)