September 2009 Guide to Producing Campaign to End Pediatric Aids (CEPA) National Advocacy Action Plans (NAAPs)

Remember CEPA’s Long-Term Goal 80% coverage for pediatric HIV/AIDS treatment and PPTCT+ services

Focus on CEPA’s Four Core Objectives Long-term Goal: 80% coverage for pediatric HIV/AIDS treatment and PPTCT+ services Section 3: Early Infant Diagnosis and Treatment Section 4: Access to Medicines Section 2: Comprehensive Family Centered Care Section 5: Full Funding

Structure of a NAAP Document Section 1: Introduction and Overview of Country Context Section 2: Core Objective 1 - Family Centered Care and Nutrition Section 3: Core Objective 2 - Early Infant Diagnosis and Treatment Section 4: Core Objective 3 - Access to Appropriate Medicines Section 5: Core Objective 4 - Full Funding to Eliminate Pediatric Aids Section 6: Review and Identify Synergies and Links Between Sections 2-5 Section 7: Monitoring Plan Section 8: Partner Roles and Accountabilities

For Section 1 of your NAAP Document Follow These Steps : 1. Provide overview of HIV/AIDS and Pediatric HIV/AIDS country context, with HIV/AIDS and Health Statistics (See Section of “On the Road…”) 2. Provide overview of country response to HIV/AIDS and Pediatric HIV/AIDS (See Section of “On the Road…”) 3. Provide environmental scan and assessment of advocacy/political climate (See Sections , , and of “On the Road…”) 4. Provide initial identification of potential advocacy targets (See Section of “On the Road…)

For Sections 2 to 5 of NAAP Document Follow These Steps: FOR EACH OF THE 4 CORE OBJECTIVES: 1. Identify Beneficiary Outcomes tied to each specific core objective which will contribute to achievement of the long-term goal (80% coverage for pediatric HIV/AIDS treatment) 2. Identify Bottlenecks that prevent achievement of beneficiary outcomes 3. Identify Advocacy Outcomes for addressing/removing identified bottlenecks that prevent achievement of beneficiary outcomes 4. Identify Advocacy Outputs that are potential shorter term steps towards the achievement of advocacy outcomes (These will often be linked to changes in advocacy target actors and institutions) 5. Identify Types of Evidence in particular Key Performance Indicators (KPIs), so that progress towards advocacy outcomes and advocacy outputs can be monitored over time 6. Identify Activities and Strategies to achieve advocacy outcomes and advocacy outputs (specifically for year 1 of the campaign)

Core Objective: Family Centered Care and Nutrition Steps to a NAAP – Sections 2 to 5 1. Identify Beneficiary Outcomes for Each Core Objective 80% Coverage Beneficiary Outcome Accessible health facilities offer comprehensive quality prevention, treatment, and family care along with broader reproductive health services

Core Objective: Family Centered Care and Nutrition Steps to a NAAP – Sections 2 to 5 2. Identify Bottlenecks to Beneficiary Outcomes 80% Coverage Bottleneck Stigma Lack of coordinated care Limited number and capacity of trained health care professionals Beneficiary Outcome Accessible health facilities offer comprehensive quality prevention, treatment, and family care along with broader reproductive health services

Steps to a NAAP – Sections 2 to 5 3. Identify Advocacy Outcomes that Address Bottlenecks Advocacy Outcome National policy strengthened to prevent discrimination against HIV positive mothers and children. An accredited set of National Training curricula for task shifting is established. Comprehensive and harmonized pediatric care policies, guidelines, and standard operating procedures are adopted by National Government, donors, and providers. Bottleneck Stigma Lack of coordinated care Limited number and capacity of trained health care professionals

Steps to a NAAP – Sections 2 to 5 4. Identify Advocacy Outputs Towards Advocacy Outcomes Advocacy Output Advocacy Outcome National policy strengthened to prevent discrimination against HIV positive mothers and children. An accredited set of National Training curricula for task shifting is established. Comprehensive and harmonized pediatric care policies, guidelines, and standard operating procedures are adopted by National Government, donors, and providers. Bottleneck Stigma Lack of coordinated care Limited number and capacity of trained health care professionals Pediatric care policy guidelines drafted by Ministry of Health Report on national stigma index is published National Training curricula is drafted by relevant actors

Steps to a NAAP – Sections 2 to 5 5. Identify Evidence/KPIs to Monitor Progress Towards Advocacy Outcomes and Advocacy Outputs Advocacy Outcome National policy strengthened to prevent discrimination against HIV positive mothers and children. Advocacy Outcome An accredited set of National Training curricula for task shifting is established. Advocacy Outcome Comprehensive and harmonized pediatric care policies, guidelines, and standard operating procedures are adopted by National Government, donors, and providers. Bottleneck Stigma Bottleneck Lack of coordinated care Bottleneck Limited number and capacity of trained health care professionals Advocacy Output Pediatric care policy guidelines drafted by Ministry of Health Advocacy Output Report on national stigma index is published Advocacy Output National Training curricula is drafted by relevant actors Evidence/KPIs: Punishments for discrimination in National policy are made more severe Evidence/KPIs: National Training curricula document Evidence/KPIs: Relevant legislation Evidence/KPIs: Draft of Pediatric care policy guidelines Evidence/KPIs: Draft of Training Curricula Evidence/KPIs: Stigma Report

Steps to a NAAP – Sections 2 to 5 6. Identify Activities to Achieve Advocacy Outputs and Outcomes Advocacy Outcome National policy strengthened to prevent discrimination against HIV positive mothers and children. Evidence/KPIs: Punishments for discrimination in National policy are made more severe Advocacy Outcome An accredited set of National Training curricula for task shifting is established. Evidence/KPIs: National Training curricula document Advocacy Outcome Comprehensive and harmonized pediatric care policies, guidelines, and standard operating procedures are adopted by National Government, donors, and providers. Evidence/KPIs: Relevant legislation Bottleneck Stigma Bottleneck Lack of coordinated care Bottleneck Limited number and capacity of trained health care professionals Advocacy Output Pediatric care policy guidelines drafted by Ministry of Health Evidence/KPIs: Draft of Pediatric care policy guidelines Advocacy Output Report on national stigma index is published Evidence/KPIs: Stigma Report Advocacy Output National Training curricula is drafted by relevant actors Evidence/KPIs: Draft of Training Curricula Activities Conduct research for national stigma index Activities Conduct briefing session with MoH, donors, and health care providers on guideline requirements Activities Conduct joint briefing session with MoH, MoL, MoE, PS

For Section 3, Example of Core Objective 2: Early Infant Diagnoses and Treatment Policy briefing sessions with the MOH/PS Activities Meeting with key stakeholders and CSOs to shape PEDs HIV/AIDS agenda coordination and activation Activities Community mobilization with child health advocates Advocacy Output National AIDS plans including specific policies and guidelines supporting pediatric AIDS services drafted Evidence/KPIs: Draft plans Advocacy Output Broad agreement by key stakeholders to adopt early testing and treatment guidelines Evidence/KPIs: Signed MOUs among key parties Advocacy Outcome MOH, MOF, MOL promulgate national Pediatric HIV training curricula Evidence/KPIs: Approved training curricula Advocacy Outcome National health care centers purchase and distribute laboratory equipment Evidence/KPIs: health center inventory lists indicate equipment purchased and received Advocacy Outcome MOH Approve and implement National pediatric EID/EIT standards and quality assurance protocols Evidence/KPIs: Approved standards and quality assurance protocols Bottleneck Lack of access to care Slow test results Bottleneck Lack of trained healthcare workers Bottleneck

For Section 4, Example of Core Objective 3: Access to Appropriate Medicines Dialogues with national drug procurement and supply chain management authorities Activities Briefing sessions with MOH, DRAs, Parliamentary committee(s), & procurement/distribut ion/supply chain mgmt authorities on harmonizing drug registration (PaATH, NEPAD) Advocacy Output Government reviews existing guidelines on procurement, distribution and supply chain management Evidence/KPIs: Report reviewing existing guidelines Advocacy Output MOH, DRA, Procurement authority recommend/call for increased government funding for pediatric ARVs, PPTCT meds and commodities Evidence/KPIs: Press release/announcement Advocacy Outcome Increased funding for PPTMT meds approved Evidence/KPIs National budget, appropriate legislation Advocacy Outcome Procurement, distribution and supply chain management policies and guidelines amended Evidence/KPIs: Amended policies and guidelines Slow drug approval process Bottleneck High cost of pediatric HIV drugs Bottleneck Weak national procurement and supply chain management guidelines Bottleneck Advocacy Outcome PaATH registration process implemented Evidence/KPIs: Appropriate legislation Advocacy Output DRA reviews and tailors PaATH proposal to country needs Evidence/KPIs: PaAth proposal

For Section 5, Example of Core Objective 4: Full Funding National media campaign highlighting need for better utilization of PPTCT funds Activities Briefings with donors on increased funding allocations for PPTCT and pediatric services Activities National demonstrations to pressure governments to increase funding Advocacy Output High level committee formed to consider option for new budget monitoring institution Evidence/KPIs: Committee report and recommendations Advocacy Output Governments commit to allocate more resources to health budgets Evidence/KPIs: Government press release Advocacy Outcome Overall national PPTCT budget increased Evidence/KPIs: 50% increase in funds allocated towards PPTCT Advocacy Outcome Institution for budget monitoring established Evidence/KPIs: Opening announcement Available funds not utilized Bottleneck Lack of national funding for PPTCT Bottleneck Pediatric HIV prevention and treatment not perceived as a priority Bottleneck Advocacy Outcome Line item within health budgets dedicated to PPTCT and pediatric services established Evidence/KPIs: National budget/appropriate legislation Advocacy Output Donors commit to reviewing funding allocations for PPTCT Evidence/KPIs: Decision point of donor organization board Advocacy Outcome Overall donor funding for PPTCT increased Evidence/KPIs: 50% increase in funds allocated towards PPTCT

Section 6 – Review and Identify Synergies and Links Between Sections 2-5 Identify the bottlenecks that cut across more than one core objective. Identify the advocacy outcomes that address more than one bottleneck. Identify the advocacy outputs that link to more than one advocacy outcome. Identify the activities that contribute to more than one advocacy output.

Section 7 Monitoring Plan Establish processes for collecting data for the evidence, especially KPIs: How will evidence be collected? How can current baseline data be collected? How often will data be collected? Who will be responsible for data collection? Can the selected KPIs be incorporated into CEPA score cards? Identify potential opportunities for learning and reflection that could lead to course correction. More guidance on the monitoring plan will be provided once sections 1-6 are further developed and at the advocacy summit.

Section 8 Partner Roles and Responsibilities