1. The HIV/AIDS Strategy Process Glenn Post, MD, MPH Office of HIV/AIDS

2. Context Great increase in resources Great increase in resources from minor component to dominatingfrom minor component to dominating More scrutiny, reporting & interest More 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/AIDS about half on HIV/AIDS auditsaudits administratoradministrator Operational plan -- missions prepare HIV/AIDS strategy for tech approval (GH with regional bureau and PPC) Operational plan -- missions prepare HIV/AIDS strategy for tech approval (GH with regional bureau and PPC)

3. Targets, directives & strategic directions Expanded Response targets Expanded Response targets prevalenceprevalence PMTCTPMTCT community support for OVCcommunity support for OVC care & support for PLWHAcare & support for PLWHA Scale/national-level impact Scale/national-level impact Prevention-to-care continuum Prevention-to-care continuum

5. Why you need a strategy Not enough resources Not enough resources Tough strategic choices Tough strategic choices no blueprintno blueprint epidemic statusepidemic status other-partner activitiesother-partner activities direct impact/optimal use of fundsdirect impact/optimal use of funds Roadmap when resources change Roadmap when resources change funding increase/decreasefunding increase/decrease Global Fund or other-donor programGlobal Fund or other-donor program

6. At stake

7. Who needs an HIV/AIDS strategy? Missions proposing/receiving $1 million or more per year for HIV/AIDS Missions proposing/receiving $1 million or more per year for HIV/AIDS Rapid scale-up countriesRapid scale-up countries Intensive-focus countriesIntensive-focus countries Regional officesRegional offices Basic countriesBasic countries

8. What is a USAID HIV/AIDS strategy? Stand-alone document Stand-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? Note: Current approach may well be valid.

9. What is the situation? Background & problem analysisBackground & problem analysis status of the epidemic status of the epidemic critical populations & location critical populations & location supports/constraints supports/constraints prior USAID assistance/lessons learned prior USAID assistance/lessons learned national strategy national strategy other donors/Global Fund other donors/Global Fund ‹What is going on?›

10. Experience: Situation Target populations -- specify Target populations -- specify prevalence, size & locationprevalence, size & location Assess epidemic potential Assess epidemic potential comparative datacomparative data Context Context USAID activities, results & lessons learnedUSAID activities, results & lessons learned private sectorprivate sector national plannational plan other donorsother donors

11. What is the mission’s strategy? ObjectiveObjective Rationale/targetingRationale/targeting Results frameworkResults framework InterventionsInterventions Special concerns to consider -- stigma, youth, PLWHA, gender, etc.Special concerns to consider -- stigma, youth, PLWHA, gender, etc. Other programs & partnersOther programs & partners

12. Experience: Strategy Critical populations not targeted or targeted too broadly Critical populations not targeted or targeted too broadly Resources spread too thin Resources spread too thin Results framework Results framework not causally hierarchicalnot causally hierarchical key program components missingkey program components missing

13. Experience: Strategy (cont’d) How USAID complements partners How USAID complements partners strategicstrategic geographicgeographic Interventions Interventions details, e.g., how plan to develop & wheredetails, e.g., how plan to develop & where defining behavior changedefining behavior change

14. What will be the result? Nature & magnitude of expected change Nature & magnitude of expected change critical group can have national impactcritical group can have national impact Key indicators and targets Key indicators and targets Contribution to global E. R. targets Contribution to global E. R. targets prevalence, PMTCT, OVC, PLWHAprevalence, PMTCT, OVC, PLWHA Surveillance, behavior surveys, other M&E Surveillance, behavior surveys, other M&E Agency reporting Agency reporting

15. Experience: Results & Reporting Nature & magnitude of expected change unclear Nature & magnitude of expected change unclear need to put results -- prevalence, coverage -- in national contextneed to put results -- prevalence, coverage -- in national context Weak surveillance systems Weak surveillance systems Indicators don’t match results Indicators don’t match results USAID standard indicators not used (when should be) USAID standard indicators not used (when should be) Behavior change indicators limited to condom use Behavior change indicators limited to condom use

16. What are the resources? Actual or planned program funding Actual or planned program funding Staffing Staffing OE -- constraints OE -- constraints

17. Experience: Resources Present the current or straight-line budget first Present the current or straight-line budget first Resource discussion too vague -- as appropriate, give a rough breakdown Resource discussion too vague -- as appropriate, give a rough breakdown directed to at-risk groups vs. general populationdirected to at-risk groups vs. general population prevention vs. care/treatmentprevention vs. care/treatment

18. When to submit ….Submit with new country strategic plan (CSP) -- if by March 04 Otherwise: due by the end of FY 03: Rapid scale-up Jan 03 Rapid scale-up Jan 03 Intensive-focus June 03 Intensive-focus June 03 Regional office Sept 03 Regional office Sept 03 Basic ($1m/yr or more) Sept 03 Basic ($1m/yr or more) Sept 03

19. USAID/W review OHA sets up review meeting with regional bureau and PPC. OHA sets up review meeting with regional 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 welcome Mission participation welcome discussion paper comments/correctionsdiscussion paper comments/corrections at the meetingat the meeting

20. What can be the result of the technical review? Draft strategy or concept paper (not subject to approval): Draft strategy or concept paper (not subject to 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

21. How long will it take? First major submission – preliminary draft or final First major submission – preliminary draft or final allow 4-5 weeksallow 4-5 weeks Subsequent submission Subsequent submission allow about 3 weeksallow about 3 weeks

22. How USAID/W can help Provide in-country TA -- OHA or CA -- for strategy development & -- as appropriate -- M&E, PMTCT, OVC, care, treatment, support, behavior change, youth, etc. Provide in-country TA -- OHA or CA -- for strategy development & -- as appropriate -- M&E, PMTCT, OVC, care, treatment, support, behavior change, youth, etc. Identify mechanisms for CA support Identify mechanisms for CA support Provide virtual support/answer technical questions Provide virtual support/answer technical questions

23. How USAID/W can help (cont’d ) Provide relevant materials/examples Provide relevant materials/examples Practical Field Guide Practical Field Guide Carry out technical review of a concept paper or draft strategy --> recommendations for strategy development Carry out technical review of a concept paper or draft strategy --> recommendations for strategy development

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