The HIV/AIDS Strategy The HIV/AIDS Strategy ProcessProcess

Glenn Post, MD, MPHGlenn Post, MD, MPH

Office of HIV/AIDSOffice of HIV/AIDS

ContextContext Great increase in resourcesGreat increase in resources

• from minor component to dominatingfrom minor component to dominating More scrutiny, reporting & interestMore scrutiny, reporting & interest

• 12 reports to congress in FY 03 (draft leg)12 reports to congress in FY 03 (draft leg) about half on HIV/AIDSabout half on HIV/AIDS

• auditsaudits• administratoradministrator

Operational plan -- missions prepare HIV/AIDS strategy Operational plan -- missions prepare HIV/AIDS strategy for tech approval (GH with regional bureau and PPC)for tech approval (GH with regional bureau and PPC)

Targets, directives & strategic Targets, directives & strategic directionsdirections

Expanded Response targets Expanded Response targets • prevalence prevalence • PMTCTPMTCT• community support for OVCcommunity support for OVC• care & support for PLWHA care & support for PLWHA

Scale/national-level impactScale/national-level impact Prevention-to-care continuumPrevention-to-care continuum

Why you need a strategyWhy you need a strategy

Not enough resourcesNot enough resources Tough strategic choicesTough strategic choices

• no blueprint no blueprint • epidemic statusepidemic status• other-partner activitiesother-partner activities• direct impact/optimal use of fundsdirect impact/optimal use of funds

Roadmap when resources changeRoadmap when resources change• funding increase/decreasefunding increase/decrease• Global Fund or other-donor programGlobal Fund or other-donor program

At stakeAt stake

Who needs an HIV/AIDS Who needs an HIV/AIDS strategy?strategy?

Missions proposing/receiving $1 million or Missions proposing/receiving $1 million or more per year for HIV/AIDS more per year for HIV/AIDS

• Rapid scale-up countriesRapid scale-up countries

• Intensive-focus countriesIntensive-focus countries

• Regional officesRegional offices

• Basic countries Basic countries

What is a USAID HIV/AIDS What is a USAID HIV/AIDS strategy? strategy?

Stand-alone documentStand-alone document• what is the situation?what is the situation?

• what is the mission’s approach or strategy?what is the mission’s approach or strategy?

• what will be the result?what will be the result?

• what are the resources?what are the resources?

<Tell your story><Tell your story>

Note: Current approach may well be valid.Note: Current approach may well be valid.

What is the situation?What is the situation?•Background & problem analysisBackground & problem analysis

status of the epidemicstatus of the epidemic critical populations & locationcritical populations & location supports/constraintssupports/constraints prior USAID assistance/lessons learnedprior USAID assistance/lessons learned national strategynational strategy other donors/Global Fundother donors/Global Fund

‹‹What is going on?›What is going on?›

Experience: SituationExperience: Situation Target populations -- specify Target populations -- specify

• prevalence, size & locationprevalence, size & location Assess epidemic potential Assess epidemic potential

• comparative datacomparative data ContextContext

• USAID activities, results & lessons learnedUSAID activities, results & lessons learned• private sectorprivate sector• national plannational plan• other donorsother donors

•

What is the mission’s What is the mission’s strategy?strategy?

• ObjectiveObjective• Rationale/targetingRationale/targeting• Results frameworkResults framework• Interventions Interventions • Special concerns to consider -- Special concerns to consider --

stigma, youth, PLWHA, gender, etc.stigma, youth, PLWHA, gender, etc.• Other programs & partnersOther programs & partners

Experience: StrategyExperience: Strategy Critical populations not targeted or Critical populations not targeted or

targeted too broadlytargeted too broadly

Resources spread too thinResources spread too thin

Results frameworkResults framework• not causally hierarchicalnot causally hierarchical• key program components missingkey program components missing

Experience: Strategy Experience: Strategy (cont’d)(cont’d)

How USAID complements partnersHow USAID complements partners• strategicstrategic• geographicgeographic

InterventionsInterventions• details, e.g., how plan to develop & details, e.g., how plan to develop &

wherewhere• defining behavior change defining behavior change

What will be the result?What will be the result? Nature & magnitude of expected Nature & magnitude of expected

changechange• critical group can have national impact critical group can have national impact

Key indicators and targetsKey indicators and targets Contribution to global E. R. targetsContribution to global E. R. targets

• prevalence, PMTCT, OVC, PLWHA prevalence, PMTCT, OVC, PLWHA Surveillance, behavior surveys, other Surveillance, behavior surveys, other

M&EM&E Agency reportingAgency reporting

Experience: Results & Experience: Results & ReportingReporting

Nature & magnitude of expected change Nature & magnitude of expected change unclearunclear• need to put results -- prevalence, need to put results -- prevalence,

coverage -- in national contextcoverage -- in national context Weak surveillance systemsWeak surveillance systems Indicators don’t match resultsIndicators don’t match results USAID standard indicators not used (when USAID standard indicators not used (when

should be)should be) Behavior change indicators limited to Behavior change indicators limited to

condom usecondom use

What are the resources?What are the resources? Actual or planned program fundingActual or planned program funding

<Where are the funds going?><Where are the funds going?>

StaffingStaffing

OE -- constraintsOE -- constraints

Experience: ResourcesExperience: Resources Present the current or straight-line Present the current or straight-line

budget firstbudget first

Resource discussion too vague -- as Resource discussion too vague -- as appropriate, give a rough breakdownappropriate, give a rough breakdown• directed to at-risk groups vs. general directed to at-risk groups vs. general

populationpopulation• prevention vs. care/treatmentprevention vs. care/treatment

When to submitWhen to submit…….Submit with new country strategic plan .Submit with new country strategic plan

(CSP) -- (CSP) -- ifif by March 04by March 04

Otherwise: Otherwise: due by the end of FY 03due by the end of FY 03::

Rapid scale-up Jan 03Rapid scale-up Jan 03 Intensive-focus June 03Intensive-focus June 03 Regional office Sept 03Regional office Sept 03 Basic ($1m/yr or more) Sept 03 Basic ($1m/yr or more) Sept 03

USAID/W reviewUSAID/W review

OHA sets up review meeting with regional OHA sets up review meeting with regional bureau and PPC.bureau and PPC.• solicit commentssolicit comments• prepare discussion paperprepare discussion paper• inform mission of progressinform mission of progress• share discussion papershare discussion paper

Mission participation welcomeMission participation welcome• discussion paper comments/correctionsdiscussion paper comments/corrections• at the meetingat the meeting

What can be the result What can be the result of the technical review?of the technical review?

Draft strategy or concept paper (not subject to Draft strategy or concept paper (not subject to approval):approval):

• issues identifiedissues identified• comments and recommendations sent to missioncomments and recommendations sent to mission

Final strategy:Final strategy:

• approved/no significant issuesapproved/no significant issues• approved pending mission responseapproved pending mission response• unresolved issues/mission to revise and resubmitunresolved issues/mission to revise and resubmit

How long will it take?How long will it take? First major submission – preliminary First major submission – preliminary

draft or finaldraft or final• allow 4-5 weeksallow 4-5 weeks

Subsequent submissionSubsequent submission• allow about 3 weeksallow about 3 weeks

How USAID/W can helpHow USAID/W can help Provide in-country TA -- OHA or CA -- for Provide in-country TA -- OHA or CA -- for

strategy development & -- as appropriate strategy development & -- as appropriate -- M&E, PMTCT, OVC, care, treatment, -- M&E, PMTCT, OVC, care, treatment, support, behavior change, youth, etc. support, behavior change, youth, etc.

<Priority countries have . . . priority><Priority countries have . . . priority>

Identify mechanisms for CA supportIdentify mechanisms for CA support Provide virtual support/answer technical Provide virtual support/answer technical

questionsquestions

How USAID/W can help How USAID/W can help (cont’d(cont’d))

Provide relevant materials/examplesProvide relevant materials/examples Practical Field GuidePractical Field Guide

Carry out technical review of a Carry out technical review of a concept paper or draft strategy --> concept paper or draft strategy --> recommendations for strategy recommendations for strategy developmentdevelopment

<The earlier the better><The earlier the better>

We’re prepared to go to We’re prepared to go to some lengths . . . .some lengths . . . .