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