T HE M ULTISECTORAL A PPROACH, I NVESTMENT T HINKING AND N ATIONAL AIDS R ESPONSE C OORDINATION M ESFIN G ETAHUN & B ENJAMIN O FOSU -K ORANTENG N OVEMBER 2013 A DDIS ABABA United Nations Development Programme

Background  Rationale for the multisectoral approach  Need for innovative ‘solutions’ beyond the confines of the health sector  Impact of the epidemic on national development  Main aspects of the multisectoral approach  Unprecedented mobilisation of public, private and CS sectors  Inclusion of the HIV and AIDS response in development planning and implementation processes including national development plans

Impact of the multi sectoral approach The multi sectoral approach promoted:  Political will and leadership at all levels  Gender sensitive and human rights based approaches  Establishment of partnerships across sectors  Participatory approach and community mobilisation  Institutional capacity development  Resource mobilization  The establishment of M&E and accountability systems  Decentralised structures and ensured decentralisation of services

Challenges of the multisectoral approach  Major limitations of the multi sectoral approach:  Lack of focus – engaging all sectors at all levels  Limited capacity building interventions for HIV and AIDS mainstreaming  Varied levels of commitment across sectors  Dependence on external funding  Limited cross sectoral accountability  Within the public sector  Between the public sector and CS and private sectors

From multisectoral approach to investment thinking  What is the investment thinking and what is different about it:  Focus on basic programme activities proven to result in averting maximum number of infections averted and lives saved  Identify critical enablers and synergies that improve quality, efficiency and effectiveness of basic programme activities  Promotes country ownership and shared responsibility  Simplifies the country strategy to get better focus – population groups, geographic areas, etc  Systematically prioritizes interventions based on country epidemiology and context  Reduces parallel interventions that spread resources thinly across sectors

Conventional multi sectroal approach

Investment thinking

The Investment Framework SYNERGIES WITH DEVELOPMENT SECTORS Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employer practices. CRITICAL ENABLERS Social enablers Political commitment & advocacy Laws, policies & practices Community mobilization Stigma reduction Mass media Local responses, to change risk environment Programme enablers Community-centered design & delivery Programme communication Management & incentives Production & distribution Research & innovation Care & treatment Male circumcision Keeping people alive BASIC PROGRAMME ACTIVITIES Key populations OBJECTIVES Stopping new infections

Enablers and synergies as key aspects of the investment thinking

Why invest on enablers and synergies  Continued investment on enablers and synergies ensures:  Efficacy, equity efficiency, reach and scale up of basic programme activities  Financial and programmatic sustainability of the response through integration into broader health and non-health sectors  Non health sectors continue to implement programs that directly reduce risk to HIV  Protection and promotion of human rights and human rights principles: participation, accountability, inclusion, non- discrimination and informed consent;  AIDS response contributes to other development and health outcomes across the MDGs

Implications of the investment thinking for national coordination  Successful application of the investment thinking requires strong multisectoral coordination in order to ensure:  Strong ownership and leadership for enablers by different institutions/sectors (e.g. parliaments, justice and interior ministries, local governments)  Continued investment on enablers and synergies in the context of increased domestic financing  Strong technical guidance on national strategies and global principles  Prioritization of relevant sectors based on specific contexts (e.g. concentrated vs generalised epidemic)