CCA: HIV/AIDS Initiative: In-Country Work: Report from Senegal March 2006

March 24 – April 8, 2006

The HIV/AIDS Prevelance Rate in Senegal

Today, Senegal has succeeded in stemming the AIDS epidemic within its borders due in part to a high level of political engagement. In the 2005 Demographic and Health Study, Senegal announced that the adult prevalence rate was 0.7%, one of the lowest infection rates in subSaharan Africa. At the end of 2003, the number of Senegalese living with HIV/AIDS was estimated at 83,430 people. The average prevelence rate for pregnant women was maintained at 1.5%. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.) Among sex workers, the prevalence rate remained at the same high level as in previous years (21% in Dakar and 30% in Ziguinchor) at the end of the decade (Gomes and others, 2005). (UNAIDS AIDS epidemic update: December 2005 Sub-Saharan Africa)

Several factors could explain the weak HIV/AIDS prevalence rate within the Senegalese population: conservative cultural norms regarding sexuality ; a high level of blood safety around blood provision and transfusions; national registeration and regular medical visits for sex workers; promotion and use of condoms; support and advocacy from religious and community leaders around HIV/AIDS ; a large network of projects initiated by collectives or NGOs.

However, there are factors that increase the spread of the epidemic, notably ones related to poverty, prostitution, illiteracy (A large part of the Senegalese population is illiterate : the illiteracy rate is nearly 56.1% among women and 28.5% among men (DPS, 2000)); conflict and movement of people. The national socio-economic situation also contributes to increased taboos around sex. Poverty and urbanization have pushed back the age of marriage for young women as well as an increased rate of sex before marriage. (“Plan Strategique 2002-2006 de Lutte contre le SIDA au Senegal”)

Notable regional disparities in HIV prevalence exist in the general population (around 3% in Ziguinchor and Kolda), and nationally, the number of women infected is twice as high than the number of men. Lastly, the high rates among sex workers (20 to 22%), tuberculousis patients (15%) and men having sex with men (21%) demonstrates that the epidemic in Senegal is concentrated in these high risk groups, which means that the an effective national reponse must target these most vulnerable groups with their activities. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.)

The National Reponse to HIV/AIDS in Senegal

The creation of a National Multisectoral HIV/AIDS Council, under the authority of the Prime Minister, clearly shows how the Senegalese government has prioritized the fight against HIV/AIDS and believes in a multisectoral approach. It also demonstrates a new governmental approach that favors a community-based, decentalized approach involving associations, NGOs and the private sector. Close to 50% of the project resources are allocated to regional, departmental and community structures.

In order to implement this approach, the project needs to put in place key institutional reforms suggested by donors to faciliate the execution of a multisectoral HIV/AIDS response. The reforms suggested apply to the implementation and activities of the SEN, regional and departemental committees, as well as structures within the ministries that focus on HIV/AIDS. Another major reform consists of delegating financial management and provision to private entities and to outsource monitoring and evaluation tasks to specialized institutions. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.)

The MAP in Senegal

The overall objective of the MAP in Senegal is to assist the government to : i) prevent the increase of HIV/AIDS by reducing transmission in high-risk groups ; ii) increase access to treatment and care and provide assistance to people infected by HIV in Senegal within the framework of a pilot ARV treatment project in subSaharan Africa ; iii) support civil society and community HIV/AIDS prevention and treatment initiatives.

The project supports the execution of the National Strategic Plan for HIV/AIDS (PNLS) developed by Senegal for 2002-2006. The specific objectives of the plan are to :i) maintain infection prevalence below 3% from 2002 – 2006 ; reduce the health and socio-economic impact of HIV/AIDS at the individual, household and community level ; iii) create a conducive environment for the execution of the national plan favoring a more solid partnership between the public and private sectors. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.)

Results to Date

There is a postive progression of results which bodes well for the attainment of certain performance indicators by September 2007 : i) 8 regions out of 11 have 12 counseling and testing centers and 76 sites for voluntary testing serivces are functional in 11 regions, which permited 59,667 people to be tested between 2003 and 2005 (compared to 7195 in 2002) ; ii) 91% of the regions have PMTCT sites and 20371 women benefited from an HIV test as part of PMTCT services between 2003 and 2005 out of 58044 targeted in the project evaluation report ; iii) 85% of the hospitals and 48% of health centers offer treatment services and psychosocial support to people living with HIV/AIDS (PLWHA), with 3622 PLWHA actually on ARV treatment. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.)

The Private Sector in Senegal

The agricultural sector contributes one-fifth of GDP and supports 75% of the working population. The marine fishing industry is the leading exporter, followed by groundnuts and phosphate products. Tourism is also a major foreign exchange earner. (UNECA country profile)

The Senegalese private sector includes the formal and informal sectors, employer federations and trade unions, parastatals, private institutions and professional associations. Several large associations regroup the private sector by size. The Conseil National du Patronat (CNP), the principle private sector body with whom the government interacts, regroups multinational and large national companies (defined as businesses with more than 100 employees or bringing in 500 million CFA in start-up capital). Federations such as le Mouvement des Entreprises du Sénégal (MEDES) and le Conseil National des Entreprises de Sénégal (CNES) regroup legally recognized small and medium size companies (defined as businesses with 20 – 100 employees and less than 500 million CFA in annual revenue). The informal sector, a sector dominated by micro-enterprises with less than 10 active employees, is represented by l’Union nationale des. commerçants et industriels du Sénégal (UNACOI). The private sector is the principle source of creation and accumulation of wealth in Senegal and accounts for 90% of GDP (80% of which comes from the informal sector). However, due to a very competitive environment, there is a very little dialogue between these groups.

The Senegalese National Strategy for HIV/AIDS 2002-2006: Implementation of the plan to integrate HIV/AIDS in the workplace (“Plan Strategique 2002-2006 de Lutte contre le SIDA au Senegal”)

Integration of a response to HIV/AIDS and STIs in private sector development plans
Definintion of a legal framework regarding HIV/AIDS in the workplace
Mobilization of workers in the formal and informal sectors around the prevention of HIV/AIDS

At the private sector level, the National Employers Council implemented HIV/AIDS awareness raising and sensitization activities in 65 companies. A framework for a dialogue among private sector representatives was also put in place to reinforce the partnership between the SEN and the private sector companies, with the Caisse de Sécurité Sociale as coordinating body, which has the capacity to mobilize 12000 companies in the formal and informal sectors, and to integrate HIV/AIDS into the companies’ employee social protection policies. Other private sector actors are also encouraged to integrate the fight against HIV/AIDS into their business plans and develop a partnership with SEN to access a private sector-specific manual, which serves as a base for elaboration and selection of HIV/AIDS projects. (République du Sénégal. Projet Mulrisectoriel de Lutte contre le VIH/SIDA: Mission de Revue à Mi-Parcours, Octobre 2005. Aide Memoire Final 8 December, 2005.)

Although a study highlighting some of the high-risk sectors in Senegal (“Rapport relative aux interventions du secteur privé dans la Lutte Contre le SIDA”) has been conducted, very little research has been presented to create a solid argument for the private sector to join the fight against HIV/AIDS at the national level. The study conclude that the fishing, tourism, and transport industries should be targeted as they present the highest risks, and presents a solid base for the creation of a national private sector strategy.

Mission Objectives:

The objective of this private sector HIV/AIDS mission was to begin a dialogue with the CNLS (Comite National de Lutte contre le SIDA) and private sector stakeholders, including other donors and NGOs, on how to develop the role of the private sector in support of the Senegal national agenda against HIV/AIDS. The discussion included an evaluation of the private sector component of the MAP housed within the CNLS; an assessment of private sector involvement in the national HIV/AIDS strategy; the development of basic mechanisms for private sector engagement through the CNLS, including a private sector manual, criteria, and M&E tools; the role of the private sector in the national strategy against HIV/AIDS; the role of the CNLS in coordinating the national strategy.

The mission looked at:

Current private sector initiatives to address HIV/AIDS and financial support available from donors/NGOs;
The status of the private sector component of the MAP housed within the CNLS;
Information on the current legal framework relating to employer social responsibility and discrimination (and planned legislation);
Mechanisms to enhance private sector engagement, including application forms, eligibility criteria, eligible expenditures, review process, monitoring and evaluation (M&E);
Strategies for scaling up private sector involvement in the national response to HIV/AIDS; and
Development of a 2006 CNLS private sector action plan to enable effective development of a private sector strategy.

In addition, we were asked to:

Review the “Rapport relative aux interventions du secteur privé dans la Lutte Contre le SIDA,” a study on the private sector response to HIV/AIDS in Senegal conducted by Maty Ndiaye Sy, a consultant to the CNLS, as well as the draft private sector manual, and make recommendations to advance the development of a national private sector strategy; and
Review the existing CNLS communications plan and offer suggestions for private sector communications plan.

Results:

The Private Sector Response to HIV/AIDS in Senegal

The private sector response to HIV/AIDS in Senegal is disparate and uncoordinated. The principle private sector actors addressing HIV/AIDS in the workplace are the multinational corporations and a small number of national companies, including la Société Nationale des Eaux du Sénégal (SDE) and Compagnie sucrière sénégalaise (CSS). However these actions are taken on an individual company level and there is no motivation to engage within the context of the national response.
The mission determined that no business coalition regrouping representatives from all private sector actors in the fight against HIV/AIDS exists in Senegal. SIDA Entreprises has convened several of its members interested in developing a business coalition, however this initiative is in its early stages. The CNP has established an internal HIV/AIDS committee to develop and implement a program reaching out to its members, principally MNCs and large national companies. However, small and medium size companies, the informal sector and other professional associations are not represented within the CNP and no strategy to reach out to these entities exists to date.
Although the national prevalence rate is low (0.7%), HIV/AIDS rates by region and by industry vary greatly. The mission recommends approaching the private sector according to rate of vulnerability by industry. The mission noted a serious lack of research and consequently, knowledge, regarding the most vulnerable industries that should be targeted in Senegal’s national strategy.
The mission and the CNLS discussed the development of a 1) private sector advisory group, consisting of five to seven motivated private sector actors that would assist the CNLS in drafting a private sector strategy to include in the 2007 – 2011 national strategy; 2) a short and long-term communications plan to better engage and coordinate the private sector around HIV/AIDS; and 3) a business coalition that would support a more diverse representation of the private sector in the development and implementation of activities and act as intermediary between the private sector and the public sector (including the CNLS) to advocate for private sector needs and interests on a national level.

MAP Proposal Process and Funding

Currently, there is one focal point at the CNLS and one basket of MAP funds allotted to both the private sector and civil society. Although any private sector entity legally registered, in existence for a minimum of two years, and currently employing at least ten people, is eligible to receive funding, most of the MAP funding has gone to civil society organizations. However, the CNLS was receptive to the idea of separating the two sectors in the 2007-2011 national HIV/AIDS strategy.
The CNLS solicits projects using a bidding process. The first round of the bidding process was held in 2004 and project financing was completed in 2005. A national commission is charged with reviewing and approving submissions and an independent financial body is charged with disbursement of funds. In the first round of bids, the submission, review and funding processes were identical for the private sector and civil society.
It was difficult to evaluate the MAP funding process as only one project pertaining to the private sector was funded in the first round of the bids (2005 – 2004). (However, several projects submitted by organizations representing the private sector were financed under the umbrella of civil society. The only private sector project submitted and consequently financed by the MAP was a project submitted by the CNP in coordination with ILO. The CNP project focused on sensitizing and training the directors and focal points within 65 member companies about HIV/AIDS in the workplace.
The CNLS plans to launch the second and final round of bids for civil society and the public sector in April 2006. The MAP has specified that for the second round of bids for the private sector, procedural mechanisms must be in place for the private sector component of the MAP (including private sector manual, submission form, eligibility criteria, and M&E indicators). The CCA mission, in coordination with CNLS, reviewed a draft of a private sector manual and made suggestions, including revised submission criteria specific to the private sector. (The mission suggested using the private sector manual developed by the Democratic Republic of Congo as a model) The Senegalese manual must be reviewed and approved by the CNLS, AGF and the World Bank before it can be implemented.
The mission also developed a plan of action and communication strategy to assist the CNLS in reaching out to the private sector.

Communications Strategy

Currently, the CNLS communications plan is in draft form and there is no strategy for approaching the private sector.
The mission highlighted the importance of a communications strategy in the short and long-term and has made recommendations for the development of such a strategy.

Next steps:

A follow-up mission will be conducted.