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Cablegate: Pepfar Vietnam's Strategic Information Activity

VZCZCXRO2343
RR RUEHHM
DE RUEHHI #0094/01 0280713
ZNR UUUUU ZZH
R 280713Z JAN 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 7054
INFO RUEHHM/AMCONSUL HO CHI MINH 4186
RUEHBK/AMEMBASSY BANGKOK 6161
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 03 HANOI 000094

SIPDIS

SIPDIS

STATE FOR OGAC (AMBASSADOR DYBUL, JHOLLOWAY, KMARCONI)
HHS/OSSI/DSI PASS TO HHS/OGHA (WSTIEGER, LVALDEZ, CHICKEY, MWYNNE)
AND NIH/FIC (RGLASS) AND SAMHSA (CWESTLY)
USAID FOR ANE (CJENNINGS, MWARD) AND GH (KYAMASHITA, KHILL)
BANGKOK FOR USAID/RDM/A (OCARDUNER, CBOWES)
CDC FOR COGH (SBLOUNT), CCID (MCOHEN), and GAP (DBIRX, RJSIMONDS)

E.O. 12958: N/A
TAGS: PGOV PROP SOCI TBIO EAID SNAR KHIV VM
SUBJECT: PEPFAR VIETNAM'S STRATEGIC INFORMATION ACTIVITY

REF: HANOI 1082 (2007)

1. (U) Summary. The President's Emergency Plan for AIDS Relief
(PEPFAR) plays an important role in U.S.-Vietnam relations and is
the single largest vehicle for U.S. bilateral assistance. As in the
14 other PEPFAR nations, information collection and analysis play an
important role in promoting AIDS prevention efforts here. Our
strategic information (SI) challenges, however, are unlike those in
other PEPFAR nations due to differences in the nature of the
epidemic and the government environment in Vietnam. In this
message, we seek to outline the distinctive problems we face here
and our approaches to addressing them. In particular, we document
how we are reacting to deficiencies in Vietnam's health
establishment through capacity building at the Ministry of Health
(MOH) and other national institutions, which we see as essential for
programmatic success. To better focus efforts, and to help build a
common OGAC-Mission Vietnam vision for the SI activity, we request
headquarters technical support from the OGAC Strategic Information
(SI) Team Leader and the Vietnam SI advisor. End Summary.

3. (U) "Strategic information," or SI, empowers policy makers to
both "know the epidemic" and "know the results" from on-going
efforts. SI is critical in the process of developing efficient
planning of evidence-based implementation approaches and in
optimizing the use of resources. SI is tied to the systems that
produce it. In health, an SI system is a networked, integrated set
of processes to manage information and assist in strategic decision
making. It supports and shapes the strategy of an organization,
often leading to innovation in the way the organization conducts its
work, the creation of new opportunities, and the development of
services.

SI in Vietnam
-------------

4.(U) Intravenous drug use largely drives Vietnam's HIV epidemic, a
situation very different than that in the other 14 PEPFAR nations.
Accordingly, efforts in Vietnam have focused on implementing a
customized SI program focusing on prevention. The in-country PEPFAR
team worked with the Office of Global AIDS Coordinator (OGAC) SI
technical working groups and OGAC assigned technical advisors to
develop the Vietnam-specific SI strategy. Focused on training, data
use, and information exchange, SI efforts to date have promoted the
use of models and tools to increase the availability of accurate and
relevant information forms the basis of planning, implementation,
monitoring, evaluation, and management of HIV programs. The
in-country SI Team provides direct technical assistance to the GVN,
national technical working groups (TWGs), and program implementers
for program monitoring and evaluation, health information systems,
surveillance and surveys, and human capacity development (HCD).
Through national MOH-led TWGs, the team develops training,
guidelines, and implementation plans for national SI activities.
USG technical staff and funded partners review and analyze data for
each PEPFAR program area to assess and improve the quality of
information collected during service delivery. Finally, team
members strengthen HCD by formalizing partnerships among national
training institutions and MOH to develop curricula and applied
learning opportunities to build a qualified public health workforce.


5. (U) Last summer, Mission Vietnam's Front Office undertook a
detailed review and analysis of "strategic challenges" facing the
PEPFAR program in Vietnam (reftel). Their conclusions highlighted
the need to build capacity in the broader health sector and to
improve sustainability of donor supported programs. To maintain
health sector improvements and buttress PEPFAR success, they
determined that Vietnam must improve its capacity to manage and use
information to evaluate and improve program performance. Though
PEPFAR information activities have contributed to continued GVN
progress in developing timely and complete information, Mission
leadership determined that refocusing on-going activities in SI will
allow Vietnam and the PEPFAR program to shift their primary focus
from providing "emergency relief" to building long-term Vietnamese
capacity to sustain its fight against HIV/AIDS. Therefore, as
designed and implemented, PEPFAR Vietnam's SI strategy is tailored
to promote the creation of a set of standardized methods and tools,
staff trained in data use, and an integrated information system
centered in the Ministry of Health (MOH), and including data from
all HIV program activities regardless of funding source or
implementer.

Resources

HANOI 00000094 002 OF 003


---------

6. (U) In line with OGAC guidance, approximately 6.6 percent of the
total COP FY 2008 budget is directly devoted to the SI program area,
supported by a nine-person in-country team, five of which were newly
approved in the FY2008 COP. Currently, the PEPFAR team has filled
five positions and is recruiting for the other four. Additionally,
funding and support from other program areas assists the development
of SI through information collection as part of normal service
delivery operations and by providing expert program-specific input
to data collection and use plans.

Accomplishments
---------------

7. (U) Consistent with the SI mission and strategy, SI-supported
national TWGs, in close cooperation with PEFPAR partners, such as
MOH, UNAIDS, World Health Organization (WHO), World Bank (WB),
Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), have
developed a framework to begin monitoring and evaluation,
established a sentinel surveillance system, conducted special
surveys including the Integrated Biological and Behavioral
Surveillance (IBBS) and AIDS Indicator Survey, and strengthened
components of various health information systems. These TWGs plan
to conduct another round of IBBS and national activities aimed at
estimating the size of most-at-risk populations. Surveillance and
survey activities are being targeted on these populations with
behavioral and population size estimation data prioritized
Information systems have been developed and are being piloted for
routine service delivery of HIV care, treatment, and prevention.

Current Challenges
------------------

8. (U) PEPFAR SI efforts do not lack financing or USG human
resources. However, the inability of central authorities to
implement and manage infrastructure and human capacity, coordinate
national programs through the MOH, or deploy SI tools most relevant
to Vietnam hamper overall HIV prevention efforts. Because all
PEPFAR HIV programs in Vietnam are implemented through the GVN, this
lack of capacity affects PEPFAR's ability to obtain quality
information on supported programs. While reporting systems already
exist and PEPFAR technical staff members continue to work with their
GVN counterparts to improve data quality and use, the capacity to
collect and report quality data remains extremely limited.

9. (U) Vietnam's increasingly decentralized approach to health
sector reform further complicates SI efforts. The GVN needs to
upgrade systems infrastructure while hiring and training its own
staff on relevant SI activities. The current (poorly designed)
reporting system is too cumbersome. In particular, capacity and
appropriate systems are lacking to 1) review and revise across
programs and funding streams; 2) further develop and standardized
tools for collection and dissemination to ensure a nationally
centralized source of information on all HIV program activities; 3)
maintain, organize and systematize existing data to improve data
quality and completeness; 4) continue to prioritize surveillance and
population size estimation to improve reliability for the
hard-to-reach and most at risk populations, which form the focus of
the current epidemic; and, 5)develop, organize and conduct, in
coordination with domestic and foreign experts, trainings and
workshops to promote the strategic use of information derived from
the above programs.

The Way Forward
---------------

9. (U) The establishment of national TWGs and associated cooperative
frameworks provides a mechanism through which to build a functional
system. TWGs must target field level (i.e., provincial or district)
involvement and use customized approaches that work at facility and
community levels. One important goal is to institute the use of
nationally standardized forms, combined with a capable and
affordable software development private sector, which will allow
Vietnam to establish nationally standardized and integrated
information systems centered and coordinated by in the MOH.

Comment: Forging A Common USG Strategy
--------------------------------------

10. (U) Recent discussion of Vietnam's FY2008 COP review has
revealed concerns within OGAC regarding the strategy and focus of

HANOI 00000094 003 OF 003


the SI activity of PEPFAR in Vietnam. From the Mission Vietnam
perspective, some of these concerns might be attributed to the stark
differences in the epidemic and government environment we face here
compared to those in other PEPFAR nations. Regardless of their
origin, Mission Vietnam and its PEPFAR team is committed to
eliminating misunderstandings and forging a common understanding as
we move forward together. With that goal in mind, we request
continued technical support from the OGAC SI team with a concerted
focus on SI-specific technical experts in national strategies for
size estimation, surveillance systems, and information systems. In
addition, the PEPFAR Team requests that the OGAC SI Technical Work
Group leader and the Vietnam SI advisor visit Vietnam to assist team
Vietnam to finalize a concrete strategy to address the data issues
unique to Vietnam.

MICHALAK

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