The HIV, TB and STIs Burden in KwaZulu-Natal Province
KwaZulu-Natal’s HIV, TB and STIs burden and response continues to have a significant bearing on the national burden and response. The latest Thembisa Model estimates that there are 2 million people living with HIV (PLHIV) in KwaZulu-Natal (KZN) province, and thus represent 27% of the national burden of the disease. Focus for impact approach data shows seven districts in the province are part of the 27 national high burden districts for HIV. These are eThekwini, uMkhanyakude, uMgungundlovu, Ugu, uThukela, King Cetshwayo and Zululand (See NSP 2017-2022 page 12).
HIV prevalence in the general population was estimated at about 18.3% compared to the national average of 13%. 2017 Districts estimates showed all districts in the province with HIV prevalence rates in the general population that were higher than 16% and therefore higher than the national average. Districts with relatively high prevalence rates were Zululand (19.2%), Ugu (18.5%), King Cetshwayo (17.8%) and uMgungundlovu (20.6%).
The estimates from the Thembisa Model (Version 4.2) further showed total new HIV infections to be 41952, accounting for 21% of the country’s total new HIV infections. eThekwini had the highest number of new HIV infections. Other districts with high new HIV infection estimates were uMgungundlovu, King Cetshwayo and Zululand. These four districts accounted for 61% of estimated total new HIV infections in the province.
The incidence of TB in the province was 642.5 per 100 000 population (year) and remains well above the World Health Organisation threshold of 200 000 per 100 000 population. The province is one of the most affected in the country. 4 districts namely eThekwini uMgungundlovu, King Cetshwayo and Ugu accounted for 70% of the TB disease burden in the province.
The KwaZulu-Natal Provincial Multi-Sectoral Response Plan for HIV, TB and STIs 2017-2022 (PIP)
The province’s response to HIV, TB and STIs is guided by the PIP, whose implementation period commenced in 2017 and ends in 2022. The PIP is aligned to the national response efforts as defined in the NSP 2017-2022. This ensures that PIP interventions feed into achieving the nationally set goals and objectives. The PIP is further operationalised by the District Multi-Sectoral Implementation Plans for the HIV,TB and STIs reponse (MDIPs). All the provinces 11 districts have an MDIP.
The goals and objectives of the PIP are as follows:
Goal 1: Accelerate prevention to reduce new HIV, TB and STI infections
- Reduce new HIV infections to less than 27 000 by 2022 through combination prevention Interventions
- Reduce TB incidence by at least 50%, from 642/100 000 population to 321/100 000 by 2022
- Reduce the incidence of sexually transmitted infections (STIs) Incidence to 50 per 100 000 or less by 2022
Goal 2: Reduce morbidity and mortality by providing treatment, care and adherence support for all
- To have 100% of people living with HIV are and remain on treatment by 2022
- To have 100% of people diagnosed with TB are TB negative by 2022
Goal 3: Reach all key and vulnerable populations with customised and targeted interventions
- Increase engagement, collaboration and advocacy of key and vulnerable populations in the development and implementation of social and HIV, TB and STI support activities
- Provide an enabling environment to increase access to HIV, TB and STI services by key and vulnerable populations
Goal 4: Address the social and structural drivers of HIV, TB and STIs
- Implement social and behaviour change programmes to address key drivers of the epidemics and build social cohesion
- Increase access to and provision of services for all survivors of sexual and gender-based violence
- Scale up access to social protection for people at risk of and those living with HIV and TB
- Implement and scale up a package of harm reduction interventions for alcohol and substance use
- Implement economic strengthening programmes with a focus on youth
Goal 5: Ground the response to HIV, TB and STIs in human rights principles and approaches
- Reduce stigma and discrimination by 50% by 2022 among people living with HIV or TB
- Facilitate access to justice and redress for people living with and vulnerable to HIV and TB
- Promote an environment that enables and protects human and legal rights and prevents stigma and discrimination
Goal 6: Promote leadership and shared accountability for a sustainable response to HIV, TB and STIs
- Strengthen AIDS Councils to provide effective coordination and leadership of all stakeholders for shared accountability in the implementation of the provincial plan
- Improve collaboration and co-operation between government, civil society, development partners and the private sector
Goal 7: Mobilise resources to support the achievement of plan goals and ensure a sustainable response
- Improve efficiency and mobilise sufficient resources to achieve the goals, objective and targets of the provincial plan
Goal 8: Strengthen Strategic Information to drive progress towards achievement of provincial plan goals
- Optimise routinely collected strategic HIV, TB and STIs information for data utilisation in decision making
- Rigorously monitor and evaluate implementation and outcomes of the plan
- Strengthen strategic research activities to create validated evidence for innovation, improved efficiency and enhanced impact
The Focus for Impact Approach
The NSP 2017-2022 states that Focus for Impact (FFI) is a fundamentally new “way of doing business” as the country works to achieve a decisive transition from disease control to eliminating HIV, TB and STIs as public health threats.
The approach brings together data, data integration and analytics, technology and people to support planning, coordination, monitoring and decision-making in the multi-sectoral HIV, TB and STI response. It provides answers to where the HIV and TB high burden areas are (spatial location); provides reasons as to why are areas are high burden (associated risk profile), highlights who is most at increased risk of new infection in these high burden areas (population specific) and points to what high impact interventions should be put in place to reduce the burden (tailored interventions).In 2015, South Africa adopted use of the approach in planning for the response and allocating resources accordingly. The approach identified 27 National high burden districts, 7 of these were in KZN.
The PIP and the MDIPs have all incorporated the focus for impact approach highlighting the areas of high burden. The PIP classifies five districts as high burden of HIV, TB and STIs. These are eThekwini; iLembe; uThukela; uMgungundlovu and Ugu. They account for 53% of the triple HIV, TB and STIs burden in the province. Three of the eleven districts have a dual high burden as follows: King Cetshwayo and Zululand have a high HIV and TB burden; Harry Gwala has a high HIV and STIs burden and uMkhanyakude has a high TB and STI burden. Amajuba, on the other hand, has a high STIs burden.
Local municipalities with a high burden of HIV, TB and STIs are Alfred Duma, KwaDukuza uMhlathuze and Greater Kokstad. AbaQulusi, Big 5 Hlabisa, Okhahlamba, Mpofana and uMdoni have a high burden of HIV and TB and Richmond, uMngeni, and uPhongolo have a high HIV and STIs burden. Dannhauser, Mandeni and Mfolozi has a high TB and STIs burden.
SCOPE OF WORK
Implementation of the PIP is now at mid-point and there is need to conduct a review that will provide information on the achievements, challenges and assess the efficiency and implementation of the PIP.
Goal of the Mid-Term Review
The goal of the mid-term review is to determine progress made towards achieving outcomes of the KwaZulu-Natal PIP 2017-2022 as spelled out by the eight goals and objectives and assess relevance of interventions.
This will be done through conducting an in-depth analysis that will allow for the following questions to be answered
- What progress has been made in the implementation of the PIP 2017-2022 at the mid-point?
- What outcomes have been achieved against the objectives and goals of the PIP 2017-2022 at mid-point implementation?
- Are the key interventions still relevant, are there new interventions that need to be considered to accelerate progress?
- What are successes, gaps and challenges have been experienced at the mid-point implementation of the PIP 2017-2022 including documenting lessons learnt, best practices and innovations?
- What are recommendations that will likely accelerate achievement of goals at end point implementation of the PIP 2017-2022?
- What factors suggest that the focus for impact approach has embedded in the implementation of the PIP 2017-2022?
Objectives of the Mid-Term Review
- Assess the major achievements from 2017/2018 to date in relation to the PIP objectives and intended results [Effectiveness].
- Assess key achievements, the likelihood of meeting targets of key indicators at the end of the PIP implementation period, and the significance/ strategic importance of the achievements,
- Examine implementation processes and interventions including the focus for impact approach to determine extent of their effectiveness
- Identify challenges/barriers to progress of implementation
- Identify best practises and lessons learnt.
- Assess the extent to which the NSP strategies/PIP key activities are being implemented and adapted as necessary by the multi-sectoral stakeholders responding to HIV, TB and STIs in the province [Efficiency]
- Identify the extent to which departmental strategic plans, including municipal integrated development plans are aligned to the PIP 2017-2022 and therefore extent of mainstreaming of response activities in to departmental/IDP plans
- Identify role of civil society sectors in the implementation of the PIP and how this can be strengthened.
- Assess and make recommendations on the key activities/priorities which need updating in the current PIP and update targets. [Relevance].
- Assess the governance, coordination, and management of the PIP.
Process of Review
The mid-term evaluation is to be guided by the Utilisation Focused Evaluation (UFE) approach. It is expected that the consultant(s) will propose a suitable design and rigorous methodology that will adequately address the evaluation questions. The consultant will triangulate data collected via, but not limited to, focus group discussions/meetings, key informant interviews and desktop review of secondary programmatic data, survey data and other relevant epidemiological data. A participatory process will be applied during the review. All relevant stakeholders at governmental, non-governmental and private sector levels will as much as is possible be involved in the review.
Specific Tasks include
- Prepare inception report detailing the methodology, data collection tools and workplan with clear timelines
- Indepth literature review of all relevant documents including policy documents, departmental APPs, reports from departments, donors and implementing partners, private sectors, AIDS Councils
- Conduct Key Informant Interviews
- Conduct programmatic gap analysis through data triangulation, literature review and interviews to assess achievements and gaps
- Stakeholder consultative meetings and workshops at provincial and district level including departmental representatives, civil society, implementing partners and donors.
- Compile detailed review report and prepare presentation for PCA
- A stakeholder review and dissemination workshop
The following are the deliverables to be submitted both in electronic copy and PDF.
- Inception Report
- Best practices and innovations report
- A draft report which will be reviewed and approved by stakeholders for finalisation
- Final review Report including recommendation briefs to all relevant stakeholders to assist acceleration of implementation to ensure that targets are met by end of the PIP implementation period.
- Recommendation briefs to all relevant stakeholders to assist acceleration of implementation to ensure that targets are met by end of the PIP implementation period.
All the above documents should be submitted as follows:
- Electronic copy in Microsoft Word and PDF with appropriate tables, graphs and infographics.
The consultant/consultant firm is anticipated to start work in 13 July 2020 and submit data collection by 30 September 2020.
The consultant will report to the PCA Head of Secretariat
Provincial Technical Committee on HIV, STIs and TB will be established to oversee the process and provide feedback on deliverables.
The team should comprise of a lead consultant with a Bachelor’s degree in health or social sciences and at least 15 years’ experience in HIV and TB programme strategic planning, implementation and monitoring.
The team should also have an M&E Specialist with a Bachelor’s degree in any health or social sciences and at least 10 years’ experience in M&E including conducting similar reviews at provincial or district level.
They should have demonstrated knowledge in the following
- Different empirical paradigms of evaluation
- Design and development of HIV and AIDS Strategic plans
- Project / Programme Management in Sustainable Development
- Research, Monitoring and Evaluation
- Data analysis and interpretation (quantitative and qualitative)
- Excellent report writing, editing, presentation and packaging
They should have proven abilities in the following
- Ability to synthesis large volumes of data and information
- Strategic thinking and ability to synthesis critical strategic issues
- Ability to work under pressure and meet deadlines
- Good communication skills and interpersonal skills
- Good facilitation skills
Submission of Proposals
Prospective applicants must submit their technical proposals and financial quotation including the following:
- A costed project plan, stating the methodology and approach for accomplishing the task, project phases, time frame and outputs
- Two references of similar work done
- Contact numbers, names and CVs of workers/ consultants assigned to the project, including their roles and responsibilities
The submission of applications must be sent by email to the following address: [email protected] . The deadline for submission is 16h00 on 07 July 2020.
The shortlisted applications must do a presentation to the BAC panel before final selection.
Enquiries may be directed to Ms Belinda Van Eck, by email at [email protected]