STRATEGIC PLANNING V.Slobozian Coordinator, Harm Reduction Programs SOROS Foundation Moldova

National Program Developed to enforce: Law on State Surveillance on Public Health No 10- XVI of February 3 rd, 2009 (Official Monitor, 2009, no 67, Art. 183) Law on prevention of HIV/AIDS No 23-XVI of February 16 th, 2007 (Official Monitor, 2007, No 54, Art. 250) Global Commitments to Millennium Development Goals, Objective 6 “Halt HIV/AIDS and TB by 2015 and begin reversing the spread” Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS of 2001 Commitment to provide Universal Access

National Program Developed according to: National Development Strategy for the period approved by Law No 295 of December 21 st, 2007 Plan of Actions to implement the National Development Strategy, approved by government Decision No 191 of February 25 th, 2008 National Health Policy, approved through Government Decision No 866 of National Strategy for the National Healthcare System Reform for the years , approved in 2007

National Program Developed according to: Government Decision No 33 of January 11 th, 2007 on the rules for development and unified requirements for policy documents Methodological Guidelines on decision-making Methodological Guidelines on ex-ante analysis of public policy impact Terms of Reference of HIV/TB/STI National Coordination Council Recommendations of the: Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA), United Nations Office on Drugs and Crime (UNODC)

METHODOLOGICAL GUIDELINES on decision-making The principle of prioritizing public policy - public policy planning is performed according to Government priorities and availability of (financial and human) resources managed by the government; The principle of considering several policy options - in the public policy making process, several options are considered in order to adopt and implement the best one; The principle of predicting the impact of public policies - the policy making process ensures analysis of all important dimensions of impact; The principle of public policies continuity and coordination - in the process of elaborating new public policy, the evaluation and updating of existing public policies and their coordination with other public policy initiatives is ensured; The principle of participation - requires the involvement of stakeholders in the planning, development and evaluation of public policies.

Stages of the process to plan public policies METHODOLOGICAL GUIDELINES on decision making, State Chancellery Government program of activity National intersectorial and sectorial public policy documents Annual plan of action Public policy proposals Legal and normative acts National Response to HIV Strategic planning

Developing, reviewing and approving public policies Defining problem and objective Identifying possible solutions Analyzing the impact of public policy options and recommending an option Developing PPP Approval of the PPP by the relevant line institutions Implementing Monitoring and corrective actions Evaluation and corrective actions Internal and external consulting Developing the normative act Approval of normative act by Government

Stages of policy document development (GD 33, 2007) a) Identification of problems; b) Information collection and analysis; c) Formulating policy proposal with the definition of the problem, policy objectives, beneficiaries and scenarios of implementation; d) Carrying out impact analysis for policy scenarios (SWOT analysis); e) Consulting policy scenarios and the exhaustive nature of risk analysis using the reporting verticals of the initiating institution, and laterally at the level of units in charge of policy analysis, monitoring and evaluation from the line Ministries; f) Formulating the policy document; g) Extended consultations (including via posting on web) and reviewing of the document; h) Finalizing and presenting the final version for approval; i) Formulating requirements for the monitoring reports; j) Approving the policy document act; k) Monitoring and evaluating the implementation of the policy document. The National Program on HIV was additionally examined by all the TWG of the HIV/TB/STI NCC

National Program Developed based on the: Midterm evaluation of the NAP Final evaluation of the NAP / National Response Analysis Ex-ante analysis of the NAP draft Estimates of sizes of MARPS and epidemiological estimations and projections (using the Estimations and Projections Package-EPP and Spectrum ) Behavioural and biological studies among vulnerable groups (IDU, FSW, MSM, migrants, prisoners) Results of the modeling of probable Modes of Transmission and triangulation Evaluation of prevention in the 2006 – 2010 NAP (2011) Other relevant studies

Ex-ante analysis SCENARIO A Reduced financing (state) SCENARIO B Treatment based financing SCENARIO C Tratament+ prevention Prevalence in final year %1.15%0.75% Reduction of prevalence in final year %-155%-17% Incidence in final year %0.52%0.10% Decrease of incidence in final year %-12.93%-69% New registered cases of HIV Prevented HIV cases Life years Cost per scenario, USD

Number of new infections by risk groups category, Scenario B,

Analysis of risks and opportunities Risks identified in the strategic planning phase of developing the National Program - the National Program document includes strategies for mitigating risks Risk analysis overarching for the national prevention and response efforts Integration in existing national disaster preparedness and response mechanisms

National Program Developed based on 6 principles: a) National Response to HIV/AIDS is evidence-informed b) Human rights based approach in prioritizing interventions for an equitable coverage of the most affected/marginalized groups c) Ensuring that the gender equality principle is respected d) Ensuring universal access to quality prevention, treatment and care e) Involving communities and people living with HIV / AIDS in developing, implementing and evaluating the program f) Monitoring and evaluation

Logical framework of NP results Determining the hierarchy of results based on the priorities identified through the situational analysis/national response analysis SMART Objectives (Specific, Measurable, Achievable, Realistic and Time bound). Impact, outcome and process indicators, disaggregated to measure equity of access to various services/thematic areas of the NAP Baseline (2009) and targets (2015) stipulated for impact and outcome indicators Targets established through a participatory process, based on modelling exercises/estimates/projections and expert opinion consensus, in line with Universal Access principles Annual targets established by interpolation and validated participatively

NP purpose and impact indicators ResultsIndicatorsBaseline indicatorTarget ValueYearSourceValueYearSource Programme GoalImpact indicators The aim of the programme consists in the promotion of a healthy lifestyle, forming safe and risk-free behaviors, extending prevention activities among the population, including rural population, mobile populations, extending access to health services (voluntary counselling and testing, early diagnose, treatment and support) as well as maintaining the epidemical situation of HIV in the concentrated epidemic stage HIV prevalence in the general population Estimates and projections Estimates and projections HIV prevalence in IDUs 16,4%2009 IBBS 20%2015 IBBS HIV prevalence in FSWs 6.10%2009 IBBS 11%2015 IBBS HIV prevalence in MSM 1.70%2010 IBBS 5%2015 IBBS HIV prevalence in pregnant women 0.29%2009 Administra tive statistics 0.16%2015 Administra tive statistics

Objective 1: Objective 1Outcome indicators Incidence of HIV by 2015 will not exceed 20,0 per population in the 0-39 age group (on both banks) HIV incidence to 100,000 population Administ rative statistics Administr ative statistics % of women and men aged 15 – 49 who have had sex in the last 12 months and have used a condom at the latest sexual encounter 68%2009 Behavio ural study 70%2015 Behavio ural study % IDUs who have used sterile injecting equipment (did not share directly and indirectly) at last injection 99.30%2009IBBSIBBS99%2015IBBSIBBS % IDUs who have used a condom at last sex 35,62009 IBBSIBBS 55%2015 IBBSIBBS % FSW who have used a condom at last commercial sex 90.8%2009 IBBSIBBS 90%2015 IBBSIBBS % MSM who have used a condom at the last anal sex 61,9%2010 IBBSIBBS 75%2015 IBBSIBBS

Objective 2: Objective 2Result indicators Mortality of HIV/AIDS infected persons from the total number of estimated persons will decrease by 10% till 2015 AIDS deaths Estimations and projections Estimations and projections % adults and children with HIV that are still on ARV treatment 12, 24, 36, 48, 60 months after initiation 12: % 2009 Administrative statistics 12: % 2015 Administrative statistics 24: 88% 36: 72%36: 85% 48: 79%48: 80% 60: 57%60: 70%

Planning interventions Based on specific NAP objectives Based on lessons learned by implementing previous programme cycles Based on interventions that have proven their cost efficiency Based on international good practices recommendations/guidelines For the coverage of key groups with high risk of infection For equity and increasing accessibility

Planning for the provision of sustainability Planning to increase the share of funding from public sources over the years Interventions to strengthen programme management Integrated interventions to consolidate systems - health system, social protection system, education system, M&E system Capacity building on levels of decision-makers, operational-technical levels and service provision levels Technical assistance plan for strengthening systems and capacities of human resources

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