MAINSTREAMING HIV AND AIDS An Implementation Guide for National IN SECTORS & PROGRAMMES Responses Table of contents T Acronyms ___________________________________________________________________ 2 Foreword____________________________________________________________________ 4 Acknowledgements ___________________________________________________________ 6 PART 1: Essentials of Sector and Programme Mainstreaming _____________________ 7 1. Introduction _______________________________________________________________ 9 1.1 Essentials of sector and programme mainstreaming ________________________ 9 1.2 Purpose of the guide _________________________________________________ 10 1.3 Mainstreaming HIV and AIDS defined ___________________________________ 11 1.4 Addressing the direct and indirect causes of HIV and AIDS __________________ 12 1.5 Definition of sector and programme ____________________________________ 14 2. Understanding Mainstreaming as Action ______________________________________ 16 2.1 Why mainstreaming as action _________________________________________ 16 2.2 Guiding principles for mainstreaming HIV and AIDS ________________________ 19 2.3 Internal and external dimensions of mainstreaming _______________________ 21 2.4 Mainstreaming lessons _______________________________________________ 24 3. Expected Results of Mainstreaming HIV and AIDS ______________________________ 27 4. Developing Capacity for Mainstreaming ______________________________________ 29 PART 2: Mainstreaming as Action _____________________________________________ 31 1. Introduction ______________________________________________________________ 33 1. 1 The Mainstreaming Planning and Implementation Cycle _________________ 33 2. Getting Started ___________________________________________________________ 35 2.1 Choosing entry points _______________________________________________ 35 2.2 Selecting sectors and programmes _____________________________________ 36 2.3 Building support within the organization ________________________________ 37 2.4 Assessing available resources__________________________________________ 38 3. Mainstreaming Steps ______________________________________________________ 41 STEP 1: Developing a shared goal and commitment ____________________________ 43 STEP 2: Preparing an HIV and AIDS profile ____________________________________ 49 STEP 3: Formulating an activities plan for mainstreaming________________________ 65 STEP 4: Costing Mainstreaming Activities_____________________________________ 75 STEP 5: Implementing planned activities and documentation ____________________ 81 STEP 6: Taking stock ______________________________________________________ 89 Conclusion ________________________________________________________________ 93 Annexes __________________________________________________________________ 95 1. Suggested Readings __________________________________________________ 97 2. Suggested Tools for the 6 steps ________________________________________ 103 3. Planning and Implementation Tools _____________________________________ 134 4. Suggested Websites _________________________________________________ 138 1 A Acronyms A AIDS Acquired Immune Deficiency Syndrome NGO Non-Governmental Organization ART Antiretroviral Treatment NSF National Strategic Framework BCC Behavioral Change Communication NSP National Strategic Plan BDP Bureau for Development Policy UN – OHRLLS United Nations Office of the High Representative for the Least Devel- oped Countries, Landlocked Developing Countries and Small Island CBO Community Based Organization Developing States CSO Civil Society Organization PRA Participatory Rapid Appraisal DRI District Response Initiative PRSP Poverty Reduction Strategy Paper FAO Food and Agriculture Organization SEAHIV South East Asia HIV and Development Programme FHI Family Health International SRA Situation and Response Analysis HIV Human Immunodeficiency Virus SPP Strategic Planning Process IEC Information, Education and Communication TOR Terms of Reference ILO International Labour Organization UN United Nations LGA Local Government Authority UNAIDS United Nations Joint Programme on HIV and AIDS MAP Multi-Country HIV/AIDS Programme UNDP United Nations Development Programme MDGs Millennium Development Goals UNESCO United Nations Educational, Scientific and Cultural Organization M&E Monitoring and Evaluation UNFPA United Nations Population Fund MoA Ministry of Agriculture UNGASS United Nations General Assembly Special Session MoH Ministry of Health UNICEF United Nations Children Fund MPF Ministry of Planning and Finance UNIFEM United Nations Development Fund for Women MTP Medium-Term Plan UNODC United Nations Office on Drugs and Crime MTEF Medium Term Expenditure Framework USAID United States Agency for International Development NAA National AIDS Authority VCT Voluntary Counselling and Testing NAC National AIDS Commission WB The World Bank NAF National AIDS Framework WHO World Health Organization NEPAD New Partnership for Africa’s Development WFP World Food Programme 2 ACRONYMS ACRONYMS 3 F Foreword F What sets AIDS apart as a growing global concern is its unprecedented impact on What is new about this guide? The guide serves as a resource to enable immediate and development. The economic and social impacts of AIDS are not uniform across countries nor practical action to implement National Action Frameworks for HIV and AIDS. It provides within societies, yet wherever it strikes, AIDS affects individuals, communities and sectors, a unified approach which implementing stakeholders can use in close collaboration with relentlessly eroding human capacity, productivity and prospects. National AIDS Authorities, with overall responsibility for monitoring national results. The 2001 UNGASS Declaration of Commitment enjoins countries to integrate AIDS The guide is presented in two complementary parts: Part I presents the essential concepts responses into their development frameworks at national, sectoral and local levels. To and lessons of mainstreaming, while Part II offers a simple step by step approach to achieve this, key stakeholders are to engage in a process of mainstreaming HIV and AIDS mainstreaming AIDS-related strategies and activities into sectors and programmes. for multisectoral action in order to scale up AIDS responses. Effective AIDS responses are The sector and programme focus gives a more targeted scope for implementation, making premised on strong interactive links between national development instruments, National the guide useful to a wide range of stakeholders, including: line ministries, development Action Frameworks for HIV and AIDS, and sector plans. This integrated development and programmes, decentralised institutions, local government and civil society organizations. governance approach also provides a sound basis for countries to achieve the interrelated Importantly, the guide offers a link to the upstream and downstream dimensions of targets of the Millennium Declaration. multisectoral responses, where sector and programme mainstreaming effectively contributes Substantially increased global financial resources available for HIV and AIDS multisectoral to the re-formulation of National AIDS Frameworks and national development strategies, action provide a unique opportunity to accelerate country level responses to the epidemic. including PRSs. We welcome inputs and suggestions from users for continued refinement But a major challenge facing countries is to ensure that sufficient technical resources are based on additional lessons learned through using this guide and the related documents. available to strengthen capacity for effective implementation of the national response. A further challenge is how to coordinate and harmonise multi-stakeholder efforts that aim to achieve sustainable joint results. The adoption of the Three Ones principles bolsters efforts to address these challenges, ensuring collective harmonisation and alignment with national policies and strategies. The UNAIDS Secretariat, UNDP and the World Bank collaboratively are developing Elhadj Sy Michel Sidibe Debrework Zewdie a series on mainstreaming documents that promote advocacy, share lessons learned and Director Director Director provide tools for undertaking mainstreaming. This guide responds to the urgent need for HIV and AIDS Group, Department of Country and Global HIV/AIDS Program Bureau for Development Policy Regional Support World Bank a practical resource tool to support implementation of these principles in countries. It is a UNDP UNAIDS result of the growing international experience and consensus around what mainstreaming HIV and AIDS entails. It has been developed in response to demand on how to mainstream HIV and AIDS from designers and practitioners, National AIDS Authorities, and both public and private sectors. 4 FOREWORD FOREWORD 5 A Acknowledgements This Guide is the result of a very interactive and participatory process involving mainstreaming practitioners. The Guide was prepared by Joseph Annan and Ni- cole Kouassi, HIV and AIDS Group, Bureau for Development Policy, UNDP. Special thanks go to the Core Review Team: Bob Verbruggen and Oussama Tawil UNAIDS Secretariat; Roland Msiska and Benjamin Ofosu-koranteng, Regional Service Cen- tre, UNDP Johannesburg; Lee-Nah Hsu, independent consultant, for their invalu- able work and inputs, especially at the consultation meeting held in New York in June 2005. Many thanks also to Karin Santi for facilitating the HIV and AIDS SURF PART 1 Network electronic dialogue and to our Regional Bureau colleagues in Asia, Arab States, Latin America and Caribbean and Africa for their most constructive inputs. We wish to express our gratitude to Mirjam Van Donk, the UNDP consultant who provided the initial draft and to Peter Stegman, National AIDS Coordinating Agency, Botswan (NACA) for his hands-on country perspective. Finally, we express our appreciation to the numerous organizations including Family Health Inter- Essentials of Sector and national (FHI), Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ), the Health Economics and HIV and AIDS Research Division (HEARD), OXFAM, UNDP Programmes Mainstreaming South East Asia HIV and Development Programme (UNDP-SEAHIV) and and the Swiss Agency for Development and Cooperation (SDC), whose works are liberally included in the Guide. 6 ACKNOWLEDGEMENTS Introduction 1 1.1 Essentials of sector and programme mainstreaming As the HIV and AIDS epidemic unfolds, it increasingly poses complex development challenges for countries. Mainstreaming HIV and AIDS into national development pro- cesses remains a key approach to addressing both the direct and indirect causes of the growing epidemic. By ensuring the integration of planning, resource and programming issues, mainstreaming enables a multisectoral and multi-stakeholder response. The critical relationship between sector mainstreaming and mainstreaming in national development processes is represented in Figure 1 below. The close interdependence of the two processes usually involves interaction between the same national actors, plan- ning authorities and development partners. Countries should undertake mainstream- ing at the sectoral level as a way of establishing a multisectoral, multi-level response that is also responsive to larger national development goals. However, the key is to understand sector mainstreaming as implementation action, where individual sectors and institutions commit to specific activities to achieve joint outcomes for the national AIDS and development responses. MAINSTREAMING AIDS into National SECTOR MAINSTREAMING Development Processes National development strategies incl. Education MOP PRS and MDG’s Transport MOF Finance and Planning Ministries Health Local action, Food security service delivery Social services JOINT OUTCOMES and implementation Employment of national response National AIDS Framework NAA/MoH/AIDS Ministries Local Government Etc. Figure 1: HIV and AIDS mainstreaming inter- Specific issues as relate with national entry points for sectors development process 8 PART 1: INTRODUCTION 9 1 1 The national HIV and AIDS response is an essential component of a country’s national around mainstreaming. 2 This ‘how to’ guide complements the existing documents and development strategy. To achieve agreed upon joint outcomes, all key stakeholders need tools by providing a synthesis of the practical experiences in mainstreaming gained over to work collaboratively to define strategies and priorities for implementation. the years by different sectors in countries. This guide stimulates active sectoral participa- This guide serves as a tool to implement national HIV and AIDS priorities within the wider tion while anchoring HIV and AIDS concerns within the mandatory functions of sectors national development context which include achieving the targets set for the Millennium and programmes. While the focus is on HIV and AIDS, the approaches and methods of- Development Goals (MDGs), United Nations General Assembly Special Session (UNGASS) fered can easily be adapted for mainstreaming other cross-cutting concerns, particularly and other internationally agreed upon development goals. gender and poverty. The guide does not address specific thematic HIV and AIDS issues directly, such as how to roll out Antiretroviral Treatment (ART), impact mitigation projects, or Behav- 1.2 Purpose of the guide ioural Change Communication programmes. Instead, it locates mainstreaming in a multi- sectoral development context that outlines what individual sectors (including the This guide aims to stimulate much-needed action and promote a programmatic approach health sector), institutions and programmes can do to achieve HIV and AIDS and devel- to mainstreaming HIV and AIDS in sectors so that sectoral programmes incorporate HIV opment priorities. and AIDS relevant actions in their regular functions and annual institutional budget cycles. This step by step process guide is primarily directed at national policy makers, develop- ment planners and HIV and AIDS focal points in sector ministries and local governments. In 1.3 Mainstreaming HIV and AIDS defined addition, it is a useful capacity development resource for private sector business and trade unions and not-for-profit sector, such as NGOs and community groups. UNAIDS has recently proposed the following working definition of mainstreaming AIDS: The guide is useful in strengthening the knowledge and capacity for implementing the Mainstreaming AIDS is a process that enables development actors to address the National AIDS Framework where sector responsibilities for implementation have been causes and effects of AIDS in an effective and sustained manner, both through defined.1 It is also useful in the following situations where: their usual work and within their workplace. ❑ Resources are allocated for specific sectors to mainstream HIV and AIDS concerns but the sectoral implementation strategies have not been defined Mainstreaming addresses both the direct and indirect aspects of HIV and AIDS within ❑ Sectoral and local government strategies have been developed but responsibilities are the context of the normal functions of an organization or community. It is essentially a not yet defined process whereby a sector analyses how HIV and AIDS can impact it now and in the future, and considers how sectoral policies, decisions and actions might influence the longer- ❑ Sectoral strategies and accountabilities have been defined but there is a need to term development of the epidemic and the sector. mobilize resources for their implementation To respond effectively to the epidemic, it requires exceptional responses that demon- ❑ The National AIDS Framework calls for a multi-sectoral response but key sectoral entry strate timeliness, scale, inclusiveness, partnerships, innovation and responsiveness. In points, strategies, roles and responsibilities have yet to be defined other words, to stay on top of the rapidly evolving epidemics, actions need to be incor- porated into sectors’ normal operations while simultaneously continue seeking innova- Multisectoral action for HIV and AIDS responses are gaining recognition as central to re- tions and extending new partnerships. Mainstreaming HIV and AIDS is a collective and versing the epidemic and a body of literature, documents and tools have been developed 2. 1. Although the National Action Framework for HIV and AIDS should be used as a frame of reference for mainstreaming efforts, in some instances these frameworks may require revision UNAIDS and UNDP have jointly compiled these resources in a user-friendly CD-ROM, also available on: www.unaids.org and www.undp.org to reflect a broader and deeper conceptualisation of HIV and AIDS. In particular, it may be necessary to shift the NAF from a narrow focus on AIDS work towards a broader focus on mainstreaming HIV and AIDS. 10 PART 1: INTRODUCTION PART 1: INTRODUCTION 11 1 1 iterative process of learning, engagement, action, experimentation and reflection. TABLE 1. KEY FACTORS FOR HIV VULNERABILITIES AND POSSIBLE RESPONSES The National AIDS Authorities must take on and strengthen their critical coordination role in mainstreaming. HIV Vulnerability Factors Possible Responses Fear, denial, stigma and discrimination Provide awareness education in schools and workplaces and promote understanding through media-based advocacy 1.4 Addressing the direct and indirect causes campaigns and community out-reach efforts. of HIV and AIDS Gender inequality and power differentials Involve both men and women to ensure equal access to education, employment and protection of human rights in addition to promoting an enabling environment for A critical feature of mainstreaming is to take account of an organization’s mission, man- negotiation of safe sex with partners. date and comparative advantages and relate these to the direct and indirect aspects of the epidemic. Many HIV and AIDS responses to date address the direct causes and impacts Poverty and livelihood insecurity Take actions at local and national levels especially for remote or poor areas, by mobilizing and promoting local of the epidemics. For example, changing risky behaviours associated with HIV transmis- talent and resources to alleviate hunger and reduce unem- sion, providing treatment and care or on other immediate and measurable impacts of ployment through sustainable means. the epidemic. Mainstreaming HIV and AIDS includes these direct efforts but also critically Migration and displacement Implement policies and programmes to enable access addresses the underlying causes of vulnerability to HIV infection and the longer term to healthcare and workers’ protection, especially for consequences of AIDS. migrant workers, both domestic and foreign, while Not all organizations are expected to take on the same tasks and responsibilities. Rather, ensuring safe workplaces. mainstreaming means integrating HIV and AIDS into functions relevant to the core man- Social-cultural norms, values and practices Place HIV and AIDS issues in social, economic and security date of each sector and entity. Thus, mainstreaming in practical terms may differ between context of a society. Proactively engage people living education and agriculture, mining and the media. However, there are certain strategies with and affected by HIV and AIDS to help the society and actions which are common to different sectors reducing vulnerabilities to HIV infec- understand which norms and behaviours are potential factors to increase the risks of contracting the virus. This is tion and mitigating impacts of AIDS. region-specific and depends on the religions and values Lessons learned and knowledge gained from countries in the past two decades have of each community. shown that the underlying causes of vulnerability to HIV infection and impacts of AIDS are National legislative and policy environment Enact national laws which support mainstreaming efforts systemic and structural as well as influenced by societal values and cultural norms. To turn at all levels. Workplace policies and community-based the tide of the growing epidemics, responses must go beyond the direct to confront and awareness and treatment support by programmes should respond to the indirect factors that perpetuate vulnerability to HIV infections. Table 1 pro- be supported by legislation to ensure their effective implementation. Engage politicians to take a leadership vides examples of some of the key indirect factors and suggestions of possible responses. role on HIV and AIDS, based on the national commitment to UNGASS and MDGs in considering HIV and AIDS as a national priority, given its threat to national security and a crisis with international implications. 12 PART 1: INTRODUCTION PART 1: INTRODUCTION 13 1 1 HIV and AIDS are perpetuated by a vicious cycle as the factors that enhance Mainstreaming HIV and AIDS into sectors often begins through programmes. vulnerability to HIV infection are themselves aggravated by HIV and AIDS. Break- These programmes may be governmental, ministerial, run by multi-sectoral ing this vicious cycle requires exceptional actions. The pro-active involvement agencies or donor-initiated. They may belong to a private business, a commu- of people living with or affected by HIV and AIDS is essential to maintain this nity or other charitable groups. Youth, transportation, environmental, resettle- exceptionality and keep a clear focus on the ‘why’ of mainstreaming to effectively ment, employment-creation programmes, depending on the context, can be overcome the negative impact of the epidemics. useful entry points to begin mainstreaming into sectors. 1.5 Definition of sector and programme Sectors and programmes are context specific. Sectors are often conceived as a sociological, economic, or political subdivisions of a given society. A country’s di- vision of ministries influences the definition of a sector in that particular country. The Ministry of Agriculture of one country, for example, represents the agricultural sector whereas in another country, the Ministry of Agriculture and Rural Develop- ment covers dual functions within the agriculture sector of that country. Sectors can be public, private or both. Some sectors, such as mining, are operated in certain countries predominantly by the private sector. Mainstreaming in such a context would require engaging both the Ministry of Mining for policy level actions as well as engaging the private operators of the mines for maximum ef- fectiveness. For the purposes of this guide, ‘sector’ refers to the main categories of government ministries covering local governments, NGOs and the private sector. An organization may encompass more than one sector. In addition, mainstream- ing in a sector may involve different levels of an organization. For example, the different departments of an organization or ministry cover different tasks, target groups or other operational divisions. An organization needs to consider the relevance and priority in deciding whether to mainstream the entire sector or selected segments within the sector. A programme, on the other hand, can be defined as a group of projects or ser- vices intended to meet a defined public or private need. Programmes may cover a single or multiple sectors. For example, a water and sanitation programme would involve several sectors and institutions. 14 PART 1: INTRODUCTION PART 1: INTRODUCTION 15 2 Understanding Mainstreaming as Action 2 2.1 Why mainstreaming as action What mainstreaming HIV and AIDS would entail in practice varies depending on country, community or sector-specific factors, such as: Mainstreaming as action is an essential approach for expanding, scaling up and ❑ The size, trend and stage of the epidemic implementing multisectoral responses to HIV and AIDS. The health sector remains ❑ The specific factors that actually facilitate the spread of HIV, such as stigma key, but non-health sectors are also to take action on HIV and AIDS based on one or poverty National Action Framework. This is more obvious in countries affected by a severe ❑ How HIV and AIDS manifests itself and where the impacts of the epidemic epidemic, but it is equally paramount in countries that have a relatively low, yet are felt most growing, HIV prevalence. Even for countries with low HIV prevalence, mainstream- ing is crucial for addressing vulnerabilities to HIV infections in order to avert ❑ The capacity of sectors – public, private, non-profit or voluntary organiza- potential negative impacts. Early mainstreaming actions may help stem the surge tions and Local Government Authorities (LGAs) – as well as communities of HIV epidemics and reduce the likelihood that concentrated epidemics will and households to respond to HIV and AIDS, and their resilience become generalized. Moreover, because HIV and AIDS is closely linked with other development concerns such as poverty, gender inequality and institutional exclu- BOX 1 IMPACT OF THE HIV AND AIDS EPIDEMIC ON LOCAL GOVERNMENT AUTHORITY sion, mainstreaming HIV and AIDS in low prevalence settings provides additional support to the national development process. It also provides experience on how Local governments are finding it increasingly challenging to conduct their core business of service delivery in what is in many countries to integrate other pressing, cross-cutting and multisectoral issues which affect a crisis environment as a result of HIV and AIDS (among other factors). Increasing demands for services (health, welfare, cemetery lands, development in many countries. etc.) are being coupled with declining economic growth (through loss of productivity, declining investment) and increasing poverty and vulnerability among those losing income-earning household members and/or gaining additional dependents. The functioning of local The implementation of multisectoral National Action Frameworks is often weak.3 governments, as workplaces, is also being challenged by loss of staff due to AIDS. The mainstreaming process facilitates multisectoral actions. It is a good starting While it is not appropriate to expect all LGAs to roll out extensive HIV and AIDS programmes, in general they can play an important role point to engage sectors that ought to but have as yet not participated in the over- in identifying local needs, mainstreaming HIV and AIDS activities within LGA departments, and coordinating local responses (i.e., facili- all national HIV and AIDS responses. tating partnerships). The fight against HIV and AIDS requires good governance in its most basic form: inclusive and accountable priority Multisectoral action requires harmonisation and coordination, which can be a setting and managing partnerships for effective service delivery at the local level. challenge to the existing governmental and international organizations. Main- Source: World Bank website: http://www.worldbank.org/urban/hivaids/urbancontext.htm streaming, however, enhances the articulation of sector goals, accountabilities and resources. This articulation builds stronger alignment around one National AIDS Action Framework and one monitoring and evaluation system, coordinated There are different levels of mainstreaming: global, regional, national, sectoral by one National AIDS Authority, as expressed under the ‘Three Ones’ principle. and sub-national. There are various instruments and organizations or institu- tions for mainstreaming at each of the levels. Refer to Table 2 for examples of The need to maintain multisectoral action for HIV and AIDS cannot be overstated. levels and related organizations and instruments. As noted earlier, building For example, great strides have been made with regard to access to antiretroviral linkages between sector mainstreaming, national development and regional drug treatment. Unfortunately, as of 2005, only 12% of those who need treatment efforts would ensure more sustainable and effective outcomes. received it. This fact underscores the reality that actions and efforts are required from multiple sectors and communities to scale up the treatment coverage. 3. Supporting National HIV and AIDS Responses: An Implementation Approach, UNDP Bureau for Development Policy – HIV and AIDS Group, April 2004 16 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PART 1: UNDERSTANDING MAINSTREAMING AS ACTION 17 2 2 2.2 Guiding principles for mainstreaming TABLE 2. LEVELS OF MAINSTREAMING HIV and AIDS There are six principles emerging based on the consolidation of international Level Instruments Organizations and Institutions experiences in mainstreaming HIV and AIDS. These principles are useful in ❑ Millennium Development Goals ❑ United Nations and other international guiding mainstreaming efforts within sectors and organizations but should Global ❑ United Nations General Assembly Special development organizations not be taken to be exclusive of others that may emerge. Session on HIV and AIDS ❑ Multinational companies PRINCIPLE 1: A clearly defined and focused entry point or theme for main- ❑ New Partnership for African Development streaming HIV and AIDS must be identified in order to ensure adequate buy-in ❑ South East Asia Memorandum of Under- and maintain the critical focus necessary to make an impact within a specific ❑ Regional development institutions standing for joint action to reduce HIV ❑ Association of South East Asia Nations target sector. Regional vulnerability related to population move- ❑ Caribbean Community/CARICOM and Pan ment 2004-2009 PRINCIPLE 2: National Action Frameworks for HIV and AIDS or their equivalent Caribbean Partnership Against AIDS/PANCAP ❑ Caribbean Partnership to respond to the should be used as the frame of reference for setting national development HIV epidemic strategies, priorities and sector accountabilities. Mainstreaming efforts should ❑ Ministries of Finance and Planning, Justice, be located within existing institutional structures, support one AIDS authority ❑ Poverty Reduction Strategies ❑ National NGOs, including faith-based and one national monitoring and evaluation system consistent with the National ❑ Medium Term Expenditure Framework organizations principles of the Three Ones. ❑ National Development Plans ❑ National employers and labour organizations PRINCIPLE 3: Advocacy, continuous education and capacity-building are ❑ Ministries, private companies and civil required to place people in a better position to undertake mainstreaming. society organizations working in the Mainstreaming cannot be expected to develop on its own. ❑ Sectoral plans and programmes respective sectors (agriculture and rural Sectoral PRINCIPLE 4: A distinction must be made between two domains in main- ❑ Sector Wide Approaches development, construction, education, health, industry, maritime industry, streaming: the internal domain or workplace, where institutional policies, staff mining, labour, transport and others) risks and vulnerabilities are addressed; and the external domain, where HIV ❑ Local government (urban and rural) and AIDS interventions are undertaken in support of local or national strategic Sub-national, ❑ Development projects and programmes ❑ Small companies efforts based on the sector’s or organization’s mandate and capacities. local community ❑ Local development strategies ❑ Local NGOs or community PRINCIPLE 5: Strategic partnerships based upon comparative advantages, based organizations cost effectiveness and collaboration must be developed for effective implementation. PRINCIPLE 6: Exceptional action must be maintained throughout, at the sec- toral, national and international levels, to ensure that HIV and AIDS responses remain relevant and effective as the epidemic evolves. 18 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PART 1: UNDERSTANDING MAINSTREAMING AS ACTION 19 2 2 BOX 2 AN EXAMPLE OF MAINSTREAMING THAT SUCCESSFULLY EMPLOYED ALL SIX OF THESE PRINCIPLES 2.3 Internal and external dimensions of mainstreaming IS THE MILITARY IN CAMBODIA There are two interlinked dimensions of mainstreaming: internal and external. PRINCIPLE 1: For these two dimensions, the process involves engaging with two sets of A clearly defined and focused entry point. The military in Cambodia was identified as a high-risk population. It is easy and issues concurrently: socially acceptable in Cambodia for men to go in groups to brothels, and the low cost of such activities meant that poorly Internal • Identifying and responding to factors – individual, organiza- paid military men could afford this form of entertainment. In 1995, the HIV prevalence rate was 5.9% in the military, rising to 7% in 1997. tional and societal – that are likely to increase vulnerability to PRINCIPLE 2: HIV infection for sector staff, immediate family members and National Action Frameworks or their counterparts should be used as a frame of reference. The Ministry of National community Defense cooperated with national HIV and AIDS policies and later, the National AIDS Authority (NAA), which was • Recognising and pre-empting, reversing or mitigating likely established in 1999. impacts of HIV and AIDS on staff and on the organization as a PRINCIPLE 3: whole Advocacy, sensitisation and capacity building are required. Commanders were brought on board through pre-training sensitisation sessions and special training programmes outlining the threat of HIV and AIDS to the safety of their troops. External • Identifying and responding to factors that are likely to increase A system of peer education was implemented, where the peer educators were responsible for implementing education. vulnerability to HIV infection for communities or those consid- PRINCIPLE 4: ered clients of the sector The internal and external domains should be addressed. The internal domain was addressed, and the military’s AIDS prob- lem was seen as a threat to the community because 61% of married military men reported having sex with entertainment • Recognising and pre-empting, reversing or mitigating likely im- workers in 1996. Further, the peer educators were recognized as resource persons by both the military and the community. pacts of HIV and AIDS on those considered clients of the sector PRINCIPLE 5: – and the communities it works with – and on broader sector Strategic partnerships must be developed. The Ministry of National Defence collaborated with NGOs (such as Family mandates Health International) and international agencies (WHO) as well as the Ministry of Health to develop, collect, and disseminate materials. • Understanding what the national HIV and AIDS priorities are PRINCIPLE 6: Exceptional actions. The Peer Education Network was established because low rates of literacy and the remoteness of many Internal mainstreaming is related to HIV and AIDS policies, guidelines and activi- military stations called for a special response. By the year 2000, the Ministry of National Defence had established HIV and ties for sector employees. A sector often starts with the internal domain especially AIDS Prevention committees throughout the Royal Cambodian Armed Forces. HIV and AIDS prevention has become a routine when the workplace is vulnerable to infection due to work-related situations such part of military life, yet it continues to expand, presenting itself as a model to the Indonesian military, to the Lao People’s as frequent travel or working in remote areas away from family and home. Democratic Republic and to India. INTERNAL MAINSTREAMING Various activities have been developed to address the organization’s internal or workplace environment. These often focus on vulnerable groups, risk situations, and identified gaps in current HIV and AIDS activities. These activities mostly consist of preventive education, treatment, care and support. Box 3 below provides examples of internal activities undertaken in a number of workplaces in different countries. 20 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PART 1: UNDERSTANDING MAINSTREAMING AS ACTION 21 2 2 considered as a productive ‘entry gate’ for external mainstreaming, experiences BOX 3 EXAMPLES OF ACTIVITIES IN THE WORKPLACE with gender mainstreaming in particular have shown that a focus on internal mainstreaming does not automatically result in external mainstreaming efforts. Prevention of HIV infection through IEC/BCC: Recent experience with the World Bank Multi Country HIV and AIDS Programmes • Weekly facilitated discussions or meetings on HIV and AIDS-related topics among staff in departments • Peer education at the various levels within the organization (MAP) has also shown that sectors at times move very slowly with external • HIV and AIDS/STI material distribution mainstreaming. The key is to ensure that mainstreaming HIV and AIDS takes into • Promotion of voluntary counselling and testing (VCT) through one-on-one staff counselling and referrals account the clients of the sector as well as the potential contribution to HIV and • Referral linkage with health facilities for STI management among staff AIDS response through its mandated role and functions. Box 4 provides additional Prevention of HIV infection through the promotion of ABC (Abstinence, Be faithful and proper use of Condoms) examples of external sectoral efforts in mainstreaming. • Education on abstinence and faithfulness • Demonstrations of proper female and male condom use for various levels of staff • Make condom widely available in the workplace and the community BOX 4 EXAMPLES OF USEFUL EXTERNAL MAINSTREAMING Provision of treatment, care and support to staff and families: • Initiation of sustainable livelihood schemes by poverty reduction sector • Provide HIV and AIDS counselling services to employees & their families • Revise health and workplace insurance to provide for ART • Introduction of early maturing/high protein crops for communities in the agricultural sector • Establish support groups for HIV-positive employees and their families • Provision of scholarships for orphans and vulnerable children in the education sector • Establish a support fund for affected families and orphans of employees • Review and enforcement of the legal framework for prevention and protection against rape and sexual • Initiate annual/bi-annual/quarterly food and clothing drives to support affected families and orphans of employees violence by the social and legal sectors • Revision of land acquisition laws that prevent access by women • Factoring HIV and AIDS into the national budget and medium-term expenditure by the finance EXTERNAL MAINSTREAMING and planning sector The formulation of a sector’s or institution’s external response should be in line with its mandated services. Sectoral strategies or programmes that are devel- It is crucial to clearly define existing institutional arrangements as to how these oped should be in line with the priorities and objectives of the national action are relevant in HIV and AIDS mainstreaming and assign appropriate account- framework thus contributing not only to the improvement of sector efficiency but abilities. In essence, sectors need to be made accountable at local, national and also the overall national responses. However, each sector/organization will not international levels by including HIV and AIDS responsibilities as part of sector or necessarily take on the same activities. Rather, a sector is to take on the strategies institutional performance management. and objectives of the national action framework which are relevant to the sector within the context of the sector’s or organization’s comparative advantages. Only by so doing will the sector’s actions add value to the overall national efforts. A sector should address both the internal and external dimensions of main- streaming although the scope and relative focus will depend on the context and sector mandate. Whilst it has been suggested that internal mainstreaming can be 22 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PART 1: UNDERSTANDING MAINSTREAMING AS ACTION 23 2 2 2.4 Mainstreaming lessons In 2005, UNAIDS, UNDP and the World Bank have jointly assessed experi- BOX 5 AN EXAMPLE OF THE ROLE OF THE AGRICULTURAL SECTOR IN ADDRESSING HIV AND AIDS ences on mainstreaming into sectors and national development instruments. A number of important lessons drawn from HIV and AIDS and other main- Prevention streaming experiences such as that on gender and environment are summa- • Strengthen the resilience of agricultural systems and create reliable income sources. This will reduce responses rized below. to hunger and poverty that pose a high risk of HIV infection, such as migration and engaging in commercial sex as survival strategies. The first lesson is that there are considerable misconceptions about the term mainstreaming; however understandings of the expected practical outcomes • Review and revise agricultural policies, programmes and practices with regard to their contribution to social capital. This is necessary in prevention and mitigation of HIV and AIDS: for example, increasing social cohesion, are increasingly converging. There is also a misconception that addressing raising collective awareness on the linkages between HIV and AIDS and development, and mobilising com- cross-sectoral issues – HIV and AIDS, gender, environmental sustainability – is munities can reduce HIV-risky responses to poverty and destitution. usually the sole responsibility of a given ministerial sector. In the case of HIV Care and AIDS, this is the health sector. However, even within the health sector, it • Nutrition is a relevant issue for people living with HIV and AIDS (FAO/WHO, 2002). International experts and is often only the designated unit responsible for HIV and AIDS that takes ac- local activists advocate “nutrition is the first medicine for HIV and AIDS.” tion. The assessment showed that other sectors have their respective roles in • Improving micronutrient intake can strengthen the immune system and thus assist people living with HIV and preventing and mitigating the effects of HIV and AIDS. Box 5 gives an example AIDS to control HIV infection and opportunistic diseases. of the unique comparative advantage and role the agricultural sector has in • Good nutrition and appropriate meals can help sick people to recover from disease faster and more com- addressing HIV and AIDS. pletely. The second lesson is that mainstreaming is multi-layered and includes a pro- • Nutrition is also critical because the HIV pandemic increases the vulnerability of groups that are prone to cess of individual and institutional change. This means that mainstreaming is malnutrition, such as households headed by orphans, women and elders. not just a one-time intervention. It is a continuous process that requires com- • Using medicinal plants can be instrumental in the health care around HIV and AIDS. mitment to long-term institutional transformation that changes norms, values • Psychosocial support to people and households affected by HIV and AIDS may be enhanced through projects and systems to bring about new and comprehensive results. and approaches that foster the integration of people affected by HIV and AIDS into the dynamics of their communities. A third important lesson is that sector mainstreaming and mainstreaming of HIV and AIDS into development processes – such as Poverty Reduction Mitigation • Implement projects and practices that are responsive to labour shortages and poverty. This is relevant because Strategies – are closely related and feed into each other. The first is a practical HIV and AIDS create labour shortages and undermine household economic security due to: (i) disproportion- implementation modality for the multisectoral response; the second serves ate levels of sickness and death of productive members (ii) need to divert time from agriculture and productive to redirect macro policy frameworks to take account of AIDS, including the activities towards caring for the sick and orphans, and (iii) continual medical expenses. financial and human resources effects of the epidemic. • Foster the transmission of agricultural knowledge and skills, thus reversing the long-term and worrying ef- fects of HIV and AIDS on social reproduction systems, particularly among the young. A final lesson is that, to avoid fragmented multisectoral responses, sector and programme mainstreaming requires strong leadership, coordination and Source: Plant Diversity, Sustainable Rural Livelihoods and the HIV and AIDS Crisis by Joseph A. Garí, UNDP-SEAHIV and FAO, June 2004, p. 3. tracking of outcomes of multiple sectors, NGOs and international partners by a central authority. 24 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PART 1: UNDERSTANDING MAINSTREAMING AS ACTION 25 2 Expected Results of Mainstreaming HIV and AIDS 3 Another misconception about mainstreaming is that the issue can become invis- Mainstreaming outcomes differ from sector to sector and from place to place. ible or rhetorical rather than actually change practice. Merely referring to the On one level, mainstreaming HIV and AIDS results in the epidemic becoming importance of gender mainstreaming, for example, does not result in change in part and parcel of the routine functions and functioning of sectors, provid- the real life situations of women and girls. Clearly mainstreaming needs to be ing prevention services, support for people living with AIDS and mitigation translated into actions that can show results and which bring about long-term of the impact on client communities. Through well organized and concerted necessary systemic changes. mainstreaming action, groundbreaking outcomes can be achieved that can be In summary, mainstreaming requires a dual approach and understanding. On the immediately attributed to the sector. one hand, the issue needs to become a normal part of operations for individuals and institutions; on the other hand, exceptional action needs to be taken, with constant innovations based on overall lessons learned. Thus, the challenge for BOX 6 EXAMPLES OF KEY RESULTS OF MAINSTREAMING HIV AND AIDS sectors is to ensure that addressing HIV and AIDS, in all its manifestations and complexities, becomes integrated in each sector’s routine functions, while main- SHORT-TERM RESULTS (OUTCOMES) LONG-TERM RESULTS (IMPACT) taining space for innovative, transformative and exceptional action. • Increased awareness of HIV and AIDS among staff • Reduced HIV prevalence among staff • Referral mechanisms for treatment or pilot projects • Comprehensive treatment regime available to for infected staff and spouses in place infected staff and spouses • Policy of non-discrimination on the basis of HIV • Staff living with HIV employed at all levels of the status adopted organization, including senior posts • Organizational systems modified to address specific • Organizational systems enabled to respond to inter- internal aspects of HIV and AIDS nal direct and indirect aspects of HIV and AIDS • HIV and AIDS focal point and team established • Staff capacity for mainstreaming HIV and AIDS • Cross-section of staff trained in mainstreaming throughout the organization • Specific mainstreaming actions costed • Embedded capacity for financial planning and and budgeted for forecasting for HIV and AIDS • Targeted support measures in place to address par- • Effective support in place, strengthening household/ ticular aspects of HIV and AIDS (aimed at reducing community safety nets and coping capabilities to vulnerability or enhancing coping capabilities) deal with HIV and AIDS • Articulation of effects of HIV and AIDS on sector and • HIV policies and activities used to change sectoral sector activities on HIV and AIDS practices, service provision or products for clients 26 PART 1: UNDERSTANDING MAINSTREAMING AS ACTION PA RT 1: E X P E C T E D R E S U LTS O F MA I N S T R E AM I N G H I V A N D A I D S 27 3 Developing Capacity for Mainstreaming 4 Effective mainstreaming of HIV and AIDS can result in longer-term institutional Mainstreaming HIV and AIDS in sectors cannot happen without developing strengthening and development: doing what sectors are supposed to do better adequate capacity. At the basic level, this means that responsibility and account- by addressing the causes and effects of HIV and AIDS. In reality, this may result in abilities must be defined and the needed capacity established for different institu- a change of the way sectors execute their functions and relate to their employees tional situations: and clients. • In large organizations it may be possible to employ specialist staff to initiate, Comprehensive mainstreaming of HIV and AIDS will result in addressing both facilitate and support the process of mainstreaming HIV and AIDS. This may be the direct and indirect (underlying) aspects of the epidemic through establishing a one-off start up event or maintained throughout the life of the programme. well-monitored programmes and activities. In low prevalence countries, address- ing the indirect aspects of HIV and AIDS and focusing on vulnerable populations • In smaller organizations or departmental units, it is often appropriate to ap- is possibly the most effective strategy for keeping HIV levels low. But changing point focal persons. Because focal points tend to be allocated HIV and AIDS the course of the epidemic by addressing its underlying aspects is of course an responsibilities over and above what they were originally employed to do, it important result for all countries, regardless of HIV prevalence levels. is important that they and their colleagues are clear on their additional role. They also need to be provided with enough time, resources and management In the medium to long–term, effective mainstreaming of HIV and AIDS is expected support to fulfil their designated function as a focal point. A useful way of to lead to a different way of functioning. In the short term, a number of key results ensuring this is including their additional role and responsibilities in their job can be identified in relation to the workplace and mandate in terms of the sector’s descriptions and as part of their performance evaluation. clients. The scope and success of short-term or long-term results will clearly de- pend on sector and institutional capacity: where sufficient resources and exper- • Establish an HIV and AIDS unit with designated personnel and expertise. This tise exist, more in-depth actions may be embarked on early in the mainstreaming is often essential to promote effective action in larger institutions with decen- process. In other instances, it may be more appropriate to phase in the response tralized units. Attempts at mainstreaming have often failed as programmes by focusing on key priority actions initially, to be expanded in subsequent plan- and projects did not have adequate capacity for mainstreaming. Experience ning cycles. suggests that sufficient and appropriate capacity development programmes Box 6 on page 27 gives examples of key short-term and long-term results at the for staff should accompany all mainstreaming efforts. sector level. These examples are not exhaustive; they are intended to give an indi- It is also important to encourage focal points and their colleagues to develop cation of how immediate actions with short-term results can, over time, be scaled commitment, motivation and skills to fulfil their roles and tasks. The exact skills up and bring about long-term results. and capacities required will of course depend on the nature and depth of main- streaming efforts in each sector and should be carefully selected to complement existing functions. It is worth remembering that mainstreaming HIV and AIDS implies that respon- sibility for actions is located throughout the organization. Even if focal points or specialist posts are created, responsibility for mainstreaming actions does not rest solely or ultimately with them. It is therefore important to ensure that appropriate processes and support as well as accountability mechanisms are in place to build the required capacity and expertise throughout the organization and that institu- tional ownership and leadership are attained. 28 PA RT 1: E X P E C T E D R E S U LTS O F MA I N S T R E AM I N G H I V A N D A I D S PART 1: DE VELOPING CAPACIT Y FOR MAINSTREAMING 29 4 It might be possible to enter into a partnership agreement with other organiza- tions that have specialised knowledge and expertise on a particular aspect of HIV and AIDS response. Although there may be clear advantages in hiring external expertise especially when internal capacity is low or specific expertise is lacking, an obvious drawback is that this may undermine the institutional ownership of mainstreaming efforts. As part of capacity building efforts for mainstreaming, UNDP and UNAIDS offer country and regional level expertise and experience as technical support for mainstreaming. 30 PART 1: DE VELOPING CAPACIT Y FOR MAINSTREAMING Introduction 1 This section is the “how to” part of the guide. It is designed to provide practical steps for mainstreaming HIV and AIDS into sectors and programmes. The process of mainstreaming has been grouped into six distinct but interrelated steps. Each step is designed to be simple, task-oriented, and to provide overall direction for mainstreaming, as well as the necessary resources and tools. The process is not in- tended to be top-down, but to provide useful suggestions based on mainstream- ing experiences in the field. 1.1 The mainstreaming planning and implementation cycle The mainstreaming steps described below are based on the familiar strategic planning and implementation cycle. It is a simple and useful tool designed to ensure that all stages are included. Most organizations worldwide have some kind of cycle that allows for planning and budgeting as well as time for imple- mentation. In rare cases, some organizations may function on an ad hoc basis or simply follow directives coming from top management down. The mainstreaming planning and implementation cycle shown in Figure 2 distinguishes between five stages of planning and implementation. It is usually an annual cycle and can be entered into at any stage. Defining common goals & commitment Preparation of sector Evaluation EXCEPTIONAL ACTION HIV/AIDS profile National policy & planning (e.g. NSF, PRSP, MTEF) Figure 2: Routine implementation Formulation of action plan Mainstreaming & documentation for mainstreaming Decentralised planning planning and & implementation implementation cycle PART 2: INTRODUCTION 33 1 Getting Started 2 Although the strategic planning cycle presents mainstreaming HIV and AIDS as Sector a logical progression from stage to stage, in reality it should be an interactive • Identification of sector/programmes HIV and AIDS Focal for HIV and AIDS mainstreaming process. The sector profile preparation stage, for instance, informs the formula- Person or Team tion of an action plan for mainstreaming HIV and AIDS. However, once the plan is • Selection of entry points Creation of a multidisciplinary formulated, it is important to revisit the sector profile regularly and allow for new HIV and AIDS response team or previously unexamined information and issues to be incorporated. • Assess available resources Advocacy for (human, tools and documents, funds) Mainstreamed action is essentially a recurring function, synchronized with the internal annual organization planning and budgeting cycle. The five stages in the cycle Partnerships • Mobilizing external resources are used as the basis for guiding mainstreaming steps. The following sections will including the NAA discuss each of the five steps in detail and propose documents, tools and tem- plates for mainstreaming action and implementation. It is not the intention of this guide to provide an exhaustive list of methodologies , but to provide a number of suggested readings (Annex 1) and suggested tools (Annex 2) for each step that A frequently asked question when discussing mainstreaming HIV and AIDS is can encourage innovative approaches to HIV and AIDS mainstreaming and inspire where to start. There are four key starting points the sector needs to consider initiative and action. as they move toward mainstreaming HIV and AIDS into their current or planned programme. These include choosing an entry point, defining the sector or pro- gramme level, building support within the organization itself for the involvement of all major actors and resource persons, and, finally, assessing available human, technical and financial resources. 2.1 Choosing entry points An entry point is not easily defined, but for the purposes of mainstreaming we can consider three categories of entry points: existing processes, thematic issues and specific vulnerable populations. It is important to look around for established opportunities in the sector that can be used as entry points. Existing Processes: The regular planning processes of organizations can be used as a starting point. The development of the national action framework for HIV and AIDS, a sectoral strategic planning process, religious organizations’ forums, media events, community programmes, a donor strategic programming cycle, or the preparatory phase of development projects can all be used as entry points to introduce HIV and AIDS mainstreaming. For example, workers in South East Asia 34 PART 2: INTRODUCTION PART 2: GET TING STARTED 35 2 2 mainstreamed compassionate care and spiritual consolation of people with HIV PRINCIPLES FOR SELECTING SECTORS and AIDS into community forums held by Buddhist monks who were already serv- Many national HIV and AIDS responses call for nearly all sectors to engage in mul- ing the community. Monks were also encouraged to speak about HIV and AIDS tisectoral action against the epidemic. However, in low prevalence countries in prevention and palliative care in their sermons.4 particular, the question is often asked: why every sector? The following principles Thematic issues: Poverty reduction, gender, population movement and food assist in selecting sectors effectively: security are examples of development issues that provide a good opportunity for 1) Select sectors with vulnerability – both in terms of their human resources HIV and AIDS mainstreaming. How the spread of the virus reduces results in the and the impact HIV and AIDS already has or will have on the economy and identified area can be used as an explicit link to start the mainstreaming process. society through this sector. One example is migration, which is often clearly interrelated to HIV transmission. 2) Identify influential and dynamic sectors – it is best to look for the sector Migration can serve as an entry point to several different sectors, such as trans- that can bring about accelerated change, e.g., the media, political port, infrastructure, labour, borders and security. Typical questions to ask are: what leaders, etcetera. are the impacts of migration on the spread of HIV and AIDS? How are migrant populations vulnerable to HIV infection? What specific dimension can be included 3) Look for high-visibility individual champions and advocates. Committed and in a migration programme that can reduce vulnerability to HIV and AIDS? The use passionate individuals and groups within a sector are as important as the of thematic issues as entry points is extremely helpful in both high and low HIV sector itself. prevalence settings. Specific vulnerable populations: These are particularly good entry points in 2.3 Building support within the organization low prevalence settings where the epidemic is still confined to small groups and populations who are often marginalized. Groups such as injecting drug users and Often, organizations’ and sectors’ involvement in the national response is trans- commercial sex workers can serve as entry points. The targeted programme can lated into the nomination of a single focal person. This person usually has the be expanded or mainstreamed into an entire sector or be made much more com- responsibility of all HIV and AIDS programmes in the organization, including prehensive later, addressing the needs of a much greater population and entering mainstreaming HIV and AIDS. other intervention areas. Effective mainstreaming of HIV and AIDS within the sector is, however, a task that by nature requires leadership, networking and forming partnerships. It cannot be 2.2 Selecting sectors and programmes achieved alone and is usually best carried out by a team. Often in low prevalence settings, priority is not accorded to HIV even when the sector or organization As stated above, some entry points offer multiple sectoral opportunities. In some decides to undertake mainstreaming. The focal person often has little influence. Asian countries, for example, migration has been used as the key entry point. The It is therefore important to make certain that policy-makers, people living with programme has then been able to involve critical sectors including: agriculture HIV and AIDS, sectoral development planners, budget officers, human resource of- and rural development, construction, energy, the maritime industry, land trans- ficers and gender focal persons are involved in the mainstreaming process as part portation, labour, and the uniformed services. of a wider team or HIV and AIDS Committee. 4. Our Families, Our Friends: An Action Guide, UNDP-SEAHIV and UNAIDS-APICT, January 2001. 36 PART 2: GET TING STARTED PART 2: GET TING STARTED 37 2 2 These additional sets of players can help to facilitate the sector mainstreaming Mainstreaming in a sector inevitably requires generating a broader support process in a number of ways: network. International, national and local partners need to be engaged. Interna- a. The application of participatory tools in analysing the causes and impacts tional partners include UNAIDS, UNDP, the World Bank and other co-sponsors, multi- and bilateral organizations, as well as international NGOs and founda- b. The drawing of clear linkages between HIV and AIDS and the overall sectoral tions. National partners include the National AIDS Authority, various ministries or development process sectors: energy, construction, rural development, poverty reduction, transport, c. Better integration of strategies and actions into the overall sectoral planning maritime, labour, defense, foreign affairs, etcetera. Local partners may be found in and implementation processes the community, in civil society organizations, among youth and women’s organi- d. Provision of a framework for costing and budgeting within the sectoral bud- zations, and among religious leaders as well as in organizations of people living getary allocation and estimation of additional resources with HIV and AIDS. b) Technical tools and documentation 2.4 Assessing available resources As noted in this guide, there have been many tools, resources and documents developed for mainstreaming. The National AIDS Authority (NAA) should be the Part of the initial process is for the HIV and AIDS team to look at what potential re- first orientation entity in the country to provide tools or to support sectors in sources already exist and can be used by the sector to support their mainstream- finding the necessary information, documentation and assistance. There may be ing process. This includes human resources outside the organization, technical a documentation centre or an HIV and AIDS documentation section at the MoH tools and basic information on the epidemic and documentation on mainstream- where it is possible to find essential information. National resources on HIV and ing, as well as financial resources. AIDS from inside and outside the sector should be explored. Beside the NAA and other international partners, NGOs and other sectors already working in the field a) Human resources may be good sources of information and support. Mainstreaming HIV and AIDS may be a challenging process if this is the first time The guide suggests a set of tools, documentation and sources needed for the sector is involved. In that case, it is highly recommended that the mainstream- each step. ing team identify potential partners or allies. Quite often experienced institutions and resources exist in other organizations and can be called upon. This will avoid c) Financial resources duplication and will add to cost- and time-effectiveness. There is no need to start Financial considerations must run through the entire planning and implementa- from the ground up when experiences and resources already exist. The National tion process. There must be at least a general understanding of the resources AIDS Authority will be the most obvious partner and support. The questions available for internal and external activities in order for realistic and implementable should be raised: Who else is mainstreaming? Who can provide the necessary action plans to be developed. Planning without an understanding of funding or information, experience, expertise and lessons learned? While the purpose of this with unrealistic expectations is, unfortunately, a common occurrence. There are guide is to enable readers to “learn by doing,” the possibility of hiring national and many examples of sectors and organizations with visions and well-developed ac- international consultants or experts should be explored. Assembling adequate tion plans that cannot be implemented due to the above-mentioned factors. resources for this, including terms of reference for consultants, should also be con- It is important not to wait for additional funding before taking steps. Many first sidered as part of getting started. steps can be zero cost and this includes collecting documentation, organizing in- ternal teams and meetings, working with the NAA or international organizations. 38 PART 2: GET TING STARTED PART 2: GET TING STARTED 39 2 A guiding principle when planning is to start small. Begin with a basic set of activi- ties that can be implemented and documented and which can be easily budgeted for from within the funding currently available. More complex and ambitious ac- tivities and programmes can be pursued after confidence and buy-in are gained, capacities are built, and familiarity with planning and implementing responses to HIV and AIDS has grown. STEP 1: Developing a Shared Goal and Commitment 40 PART 2: GET TING STARTED Mainstreaming Steps 3 STEP 1: Developing a Shared Goal and Commitment Multidisciplinary HIV and AIDS • Identification of sector/programmes response team for HIV and AIDS mainstreaming • Selection of sector entry points Parcipatory Process • Assess available resources (human, tools and documents, funds) Sector vision • Mobilizing external resources Institutional commitment including the NAA COMMON GOAL It is important at the beginning of the planning cycle or during implementation that the organization envisions goals and makes an institutional commitment to addressing HIV and AIDS through appropriate sector mainstreaming. Often a country’s priorities have been expressed in the National Action Framework (NAF). Throughout the planning and implementation cycle, this vision and commitment will serve as a reference point to assess current and proposed actions as well recognise as emerging opportunities. A shared vision and institutional commitment to action serves as a critical start- ing point for mainstreaming HIV and AIDS. For change to happen, one needs change agents, or people who are willing to champion a cause and who can inspire others to become involved. Effective mainstreaming requires that such commitment transcend the level of a few individuals to become an institutional commitment, shared by the sector as a whole. At the same time, institutional commitment needs to become personal commitment for those working in the sector and tasked with the responsibility to execute its mission and mandate. The National Action Framework for HIV and AIDS, as the overarching framework for the national response, should reflect the national vision and priorities for the response to HIV and AIDS. It thus guides sectors in defining a sector-specific vision and commitment. PART 2: STEP 1: DE VELOPING A SHARED GOAL AND COMMITMENT 43 3 3 The goal and commitment process involves key persons within institutions reach- MALAWI: AN HIV AND AIDS CITY CONSULTATION PROCESS ing a common understanding of the overall challenge of HIV and AIDS within the sector. The major objective is for the organization to identify a set of common According to 1998 estimates by the National AIDS Commission of Malawi (NAC), Blantyre City had 69,600 HIV posi- goals that reflects the organization’s core mandates and responsibilities. Some- tive adults. It was estimated that by December 2005, the adult HIV infections would reach 105,236, with 7,436 times inclusion of resource persons outside of the organization, such as people new orphans. In light of these alarming statistics, the City Assembly of Blantyre decided to transform its response to the HIV and AIDS epidemic. living with HIV and AIDS or representatives of community organizations, is critical The Urban Management Programme (UMP) provides support to an innovative programme, assisting Blantyre City to achieve this. At the end of this exercise, the organization would have identified Assembly and local civic organizations to enhance their capacity to manage HIV and AIDS. UMP has developed an concrete goals and objectives for future projects. HIV and AIDS City-Consultation process to help mobilise the resources and potential of the Blantyre City Assembly, civic organizations and communities at large and enable them to collaborate in order for innovative and strength- ened responses to be instituted. There are eight key tasks in the process, and these will be facilitated through a partnership between UMP and its SHARED GOALS, KEY POINTS: regional anchor institution, the Municipal Development Programme, and Blantyre City Assembly. The team should agree on shared goals for an HIV and AIDS sectoral or organizational response. This can be ex- 1. Launch the HIV and AIDS Initiative in Blantyre and mobilisation of stakeholders (January 2003). pressed in terms of an HIV vision or mission statement based on the points below. 2. Implement training for transformational leaders with facilitation support from UNDP (May 2003). 1. Determine how HIV and AIDS-related illnesses, deaths and stigma affect the human and institutional capac- 3. Undertake a base line survey of HIV and AIDS and its impacts in Blantyre City Assembly using a participatory ity of the sector/ government/ministry/region or local government authority to deliver on its stated goals, rapid urban assessment methodology. mandate or core business. 4. On the basis of the survey, implement a city-wide consultative process to develop a common vision on man- 2. Determine what aspects of the sector/government ministry’s operations (development efforts) facilitate the aging HIV and AIDS in the city and to strengthen partnerships to achieve this vision. spread of HIV. 5. Nurture citizens’ conversations to reinforce the capacity of individuals to better understand the HIV and AIDS 3. Determine what is the current or future impact of AIDS-related illnesses and deaths on the capacity of staff or epidemic and provide space to debate their concerns with facilitation support from UNDP. target populations to meet their development objectives. 6. Hold an action planning workshop to develop an HIV and AIDS Prevention and Management Strategy for the 4. Review National HIV and AIDS priority strategies. Blantyre City Assembly. 5. Discuss what policies, strategies and actions could be implemented to prevent/mitigate these negative im- 7. Establish the Blantyre City Assembly Information Corner on HIV and AIDS with support from Southern Africa pacts. AIDS Information Dissemination Service (SAfAIDS). 6. Ensure that all employees throughout the organization share the institutional commitment to mainstream- 8. Share the experience of Blantyre with other municipalities in Malawi and support the launch of the National ing HIV and AIDS and that there is a shared sense of ownership of the planned actions. Chapter of the Alliance of Mayors Against HIV and AIDS in Malawi with support from Malawi Local Govern- ment Association and the secretariat of the Alliance of Mayors Against HIV and AIDS. Key anticipated outputs from the process include a forum or task team within the city to provide a continuing focus on the epidemic in council decision-making processes, and an increased level of coordination between civil society organizations working in the area of HIV and AIDS at a city level. Additional HIV and AIDS City Consultations are SUGGESTED READINGS: (See Annex 1) underway in seven cities. • Support to Mainstreaming AIDS in Development: UNAIDS Strategic Note and Action Framework, Source: World Bank website: http://www.worldbank.org/urban/hivaids/bestpractice.htm#malawi UNAIDS, 2004-2005. • A Multi Strategy to the expanded response to HIV and AIDS, UNAIDS and Aus AID, 2001. SUGGESTED TOOL: (See Annex 2, Suggested Tools for Step 1 pg. 103) Conversations for generating possibilities and opportunities 44 PART 2: STEP 1: DE VELOPING A SHARED GOAL AND COMMITMENT PART 2: STEP 1: DE VELOPING A SHARED GOAL AND COMMITMENT 45 STEP 2: Preparing an HIV and AIDS Profile Mainstreaming Steps 3 STEP 2: Preparing an HIV and AIDS Profile Sector vision Institutional commitment COMMON GOAL SECTOR SECTOR HIV/AIDS HIV and AIDS Assessing Assessing Sector Sector and AIDSProfile HIVHIV/AIDS Profile PROFILE • Situation • Situation andand response response analysis analysis • Impact • Impact analysis analysis • Institutional • Institutional assessment assessment • Human • Human and and financial financial resource resource assessment assessment Potential Strategies A sector profile typically includes an HIV and AIDS situation and response analysis, an assessment of current and anticipated impacts of HIV and AIDS, an institutional assessment, and a human and financial resources assessment. The sector profile can be a short process that can be deepened with each cycle of planning and implementation. This section provides information on how to conduct a rapid assessment of the effects of HIV and AIDS on the sector or programme as well as the effects that the sector or programme may have on the spread of virus. For a long time, mainstreaming HIV and AIDS has been thought of in terms of impact assessment. It has often taken the form of lengthy research and studies on how the sector is impacted or how it may impact the spread of HIV and AIDS. This guide stresses that impact assessment is an integral part of mainstreaming HIV and AIDS in a sector or programme and is not an end in itself. Rapid and brief assessment can be undertaken in the sector in order to quickly move on to planning and implementation. Long-term research can be done later PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 49 3 3 or during the same assessment process, but it should not delay the process 1. INTERNAL MAINSTREAMING of mainstreaming. 1.1 Situation and response analysis The methods and tools used for sector-specific assessment of the internal and Often the situation and response analyses are separated. Yet experience with national external domains are often the same. However, since these two dimensions of strategic planning5 has shown that this separation might be somewhat artificial. The mainstreaming target different populations, this section will address internal and situation analysis is directly or indirectly linked to the analysis of the response. There- external mainstreaming separately. fore, the two should be treated as interactive and largely interdependent. An HIV and AIDS situation and response analysis for the internal domain needs to focus on the inside of the organization: the employees or staff. It should also THE MINING SECTOR AND HIV AND AIDS reflect the sector’s mission, mandate, objectives and core functions in relation to the employees and their overall vulnerability to HIV. Mining is a key revenue earner in many Least Developed Countries. In Burkina Faso, an estimated 100,000 to The same principles of assessment apply to both the internal and external do- 200,000 people work in this sector. One response that particularly serves miners and artisans in the industry was to replace all-male hostels with accommodations for families in a bid to prevent HIV transmission and foster a more mains. Yet for the internal domain, there is perhaps no need for extensive epide- stable workforce. It is hoped that such initiatives can reduce the rate of HIV transmission significantly – possibly miological research and data. It may be approximated from national prevalence by as much as 40%. rates and trends. It is worthwhile, however, to get 1) a demographic profile of the Source: Hoping and Coping: a Call for Action workforce; 2) their mobility – i.e., how many days staff spend away from home The Capacity Challenge of HIV and AIDS in Least Developed Countries, UNDP and UN-OHRLLS each month, or year; and 3) an understanding of the norms and values driving the workforce e.g., power relations, and gender disparities, sense of self-worth, et cetera. These can be ascertained by collecting information on factors like alcohol consumption, violence and known risk factors. Overall, the objective is to assess what working situations may increase or indeed inhibit staff vulnerability to HIV infection. ZAMBIA: IMPACT OF AIDS ON THE EDUCATIONAL SECTOR The HIV and AIDS epidemic is causing considerable turbulence in the educational sector. AIDS among teachers is resulting in increased absenteeism and disruption in the schools. Training costs for teachers (and other education officers) are rising to replace those lost to the epidemic. Public finance funds need to be used to address the manifold impacts of the epidemic. Because an AIDS death of an adult results in the loss of household labour and income, children are often required to leave school and remain at home or go to work to compensate for losses and to avoid schooling costs. For social and cultural reasons, girls are asked to leave school more often than boys to care for sick family members. The loss of one or both parents to AIDS means that children often lose the necessary financial, material and emotional support they need for successful schooling. Source: The HIV and AIDS Epidemic in Zambia – Where are we now? Where are we going?, National HIV and AIDS/STI/TB Council and USAID, September 2004 5. Supporting National HIV and AIDS Responses: An Implementation Approach, UNDP Bureau For Development Policy – HIV and AIDS Group, April 2004. 50 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 51 3 3 1.2 Impact assessment INTERNAL SITUATION AND RESPONSE ANALYSIS, KEY POINTS: The second component of the HIV and AIDS assessment of the internal domain is The team should conduct a combined situation and response analysis and produce a brief document that outlines the HIV and AIDS impact assessment. To some extent, this may already be reflect- the following ten points: ed in the situation and response analysis; there will be some crossover between 1. Based on national adult prevalence, estimate the HIV prevalence among employees in general and among the two components. specific categories of employees, e.g., professional level, gender, age in particular. Which category of em- Assessing the impacts of HIV and AIDS involves noting current impacts and, as ployees is most affected? Is a higher prevalence rate related specifically to the nature of their work, e.g., much as possible, predicting future impacts based on current trends and lessons mobility, migration, frequent travel? learned. A crucial aspect of the impact assessment is a focus on the staff’s ability 2. Determine what behavioural, organizational and environmental factors may enhance or reduce vulner- to execute its functions and maintain organizational capability to preserve maxi- ability to HIV infection among employees and contribute to HIV spread. How do these factors affect groups of employees with disproportionately higher rates of infection? mum levels of service provision. 3. Estimate the consequences of the epidemic on employees and the organization. These consequences might The private sector has been most advanced in developing sophisticated model- include morbidity and mortality rates due to HIV and AIDS, treatment costs, costs of health insurance and ling tools and techniques to predict future impacts of HIV and AIDS on their staff funeral benefits, labour and productivity, stigma and discrimination. and profits, and to calculate cost-effective ways of responding. Such models 4. Estimate the anticipated impacts of HIV and AIDS in the medium to long-term; these can be based on cur- can be simplified and adapted to suit non-profit organizations and the public rent trends and national epidemiological projections. sector. Large institutions can develop models that would suit their specific reali- 5. Estimate the current and future human capacity erosion in the sector caused by HIV and AIDS. ties and mandates.6 6. Determine what other factors apart from HIV and AIDS can affect the sectors’ human capacity, e.g., out- For example, UNDP’s internal mainstreaming effort, We Care, supports the imple- migration, economic decline, et cetera. mentation of UN personnel policy on HIV and AIDS, and promotes a work environ- 7. Determine the scope, nature and effectiveness of workplace interventions, if any. What is actually done by ment free from stigma and discrimination. The UN Learning Strategy on HIV and the sector to reduce staff vulnerability to the infection and to support and care for its HIV–positive employ- ees? What needs to be done in terms of workplace policies, guidelines, etcetera, to protect, support and care AIDS, which develops the knowledge and competence of UN and its staff to sup- for staff? port national responses, on the other hand, is an example of addressing internal 8. Determine resource allocations and resource use, including financial and human resources for HIV and AIDS- and external aspects of mainstreaming together. related programmes. 9. Determine the nature and value of existing partnerships or collaboration with other sectors and organiza- IDENTIFYING RISKY BEHAVIOURS AND THEIR CAUSES tions regarding HIV and AIDS in the internal domain. Often research stops at identifying ‘risky behaviours’. For effective programme planning, research needs to go be- 10. Establish gaps in the current response and opportunities for improving or scaling up the response. yond identifying risky behaviours to explaining what factors are influencing or leading to the risky behaviours. Sometimes the factors are sub-cultures of the mobile population. In other cases, it could be the context of the new environment that influences risky behaviours – such as the number of entertainment centres in a port city. Only by addressing these influencing factors can one attempt to make long-term changes in attitudes and behaviours of the population group. This is true for any population, but particularly critical when working with mobile populations. Source: Multisectoral Responses to Mobile Populations’ HIV Vulnerability: Examples from People’s Republic of China, Thailand and Viet Nam, UNDP South East Asia HIV and Development Programme, February 2003 http://www.hiv-development.org/text/publications/Multisectoral.pdf 6. An example of a more simplified model for non-profit organizations has been developed by Oxfam GB and is referred to in the list of tools as “cost benefit modelling of organizational impacts of HIV and AIDS”. It works on a five-year cycle and combines envisaged impacts related to labour, financial costs and productivity (absenteeism). For a discussion of the model, see Holden (2004), p. 300-302. 52 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 53 3 3 Figure 3 is a useful framework to assess the socio-economic impact of HIV and 2. EXTERNAL MAINSTREAMING AIDS on sector overtime. 2.1 HIV and AIDS situation and response analysis The HIV and AIDS situation and response analysis for the external domain will Progression of HIV and AIDS Economic Impact Timeline in the Workforce on the Sector mostly focus on the client population and the communities to which the sector provides products and services. Similar to the internal domain, it should reflect the sector’s mission, mandate, objectives and core functions. Year 0 Employee becomes infected No cost to Sector at this stage The external domain of a sector may be limited to certain regions in a given coun- try or be quite large, covering the whole country, and sometimes other countries Morbidity–related costs are incurred (e.g. absenteeism, individual & workforce in a region. Whatever the coverage is, the guide recommends that, to achieve Year 1-5 Morbidity begins productivity, management resources, maximum impact, the organization start in the places most affected by the epi- medical care & insurance) demic and scale up progressively. Termination–related costs are incurred Year 6 or 7 Employee leaves workforce (e.g. payouts from pension provided (resigns or dies) found, funeral expenses, loss of morale, experience & work–unit cohesion) IMPACT OF ROAD CONSTRUCTIONS ON THE SPREAD OF HIV AND AIDS Turnover costs are incurred When roads and bridges are built, they link low- and high-HIV prevalence areas such as villages and cities, respec- Figure 3: Year 7 or 8 Sector hires replacement employee (e.g. recruiting, training, tively. This is true not only domestically but also inter-nationally. reduced productivity) The Socio-economic Impact of HIV and AIDS Diverse sectors of mobile populations may interact at certain key points, often involving sedentary community Source: UNECA populations. The behaviours and practices of these sectors are dynamic with respect to one another and the sed- entary community populations at their points of intersection. These complex interactions can synergistically ac- celerate the spread of HIV in areas previously isolated from external contacts. From the perspective of the HIV epidemics, stretches of roads joined together are more than just a network. The mobility systems and the road networks being established could contribute to the formation of dynamic hubs that have the potential to connect INTERNAL IMPACT ASSESSMENT, KEY POINTS: different epidemics into a larger pandemic, with a possible multiplier effect. The team should conduct an internal impact assessment and produce a summary document that analyses the The Mandalay-Muse Highway, constructed in 1997, links Mandalay, Myanmar via Muse to Yunnan, China. An over- effect of the epidemic on human capacity, productivity, profit and service delivery of the sector: all increase of HIV prevalence amongst injecting drug users was observed after the completion of the highway. NB: Impact assessments do not have to be completed in Step 2. A similar phenomenon was also observed in Guangxi, China, when the highway linking Kunming (Yunnan) to Nanning (Guangxi) was completed. Overall documented HIV cases for Guangxi jumped from 10 to 525 within this 1. Estimate how HIV and AIDS-related illnesses, deaths and stigma within the sector affect the capacity of the short three-year period. The improvement of National Highway One in Viet Nam has also facilitated the increase sector to deliver on its stated goals, mandate or core business. of HIV cases in the North (Ha Noi and Hai Phong). This rapid increase in HIV prevalence in the North is associated 2. Determine the internal workplace procedures, policies and aspects of the sector’s development efforts that with the improved linkages that characterized the pre-existing high HIV prevalence area in the South, such as Ho increase the vulnerability of the employees to HIV infection. Chi Minh City. 3. Establish the current and future impact of AIDS-related illnesses/deaths on the capacity of staff to meet their Source: Lee-Nah Hsu, Building an Alliance with Transport Sector in HIV Vulnerability Reduction, development objectives. In low prevalence countries in particular, prepare longer-term scenarios based on UNDP South East Asia HIV and Development Project, March 2001 http://www.hiv-development.org/text/publications/cambodia_prip.pdf extrapolations of current prevalence figures, experiences from higher prevalence countries, other sectors, population models, et cetera. 4. Determine policies, strategies and actions that could be implemented to prevent or mitigate these negative impacts. 54 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 55 3 3 Epidemiological HIV and AIDS data is not always available, and additional research 2.2 HIV and AIDS impact assessment or estimates may be required for the sector to understand the nature of the As for the external domain, the sector needs to assess the current and projected spread of the epidemic in their area of work. However, the NAA, MoH and national impact of HIV and AIDS on the external aspect of its work, based on analysis statistical and research institutions often have unpublicized data. of current trends and lessons learned. It should examine the sector’s ability to execute its functions and its organizational capability to maintain maximum levels of service provision and productivity. EXTERNAL SITUATION AND RESPONSE, KEY POINTS: The purpose of this section is to summarize existing information normally available from the NAA or EXAMPLE OF PARTICIPATORY PLANNING other partners. 1. Ascertain the HIV prevalence among the sector’s clients, or in associated communities. Participatory research is considered a good practice in HIV and AIDS programme planning. Participatory research involves bringing in stakeholders as part of the research team or the study process for design, data collection and 2. Determine prevailing norms and values of the community that can increase or reduce the spread of the interpretation of findings. Programme planners often make the mistake of ‘assuming’ that they know enough about epidemic. the target population and develop an AIDS prevention programme with little research. This is a critical mistake when 3. Determine the extent and intensity of population movement. dealing with both cross-cultural populations and people with the same language and national culture. There are ‘sub- 4. Determine which social groups of stakeholders or communities/regions are more vulnerable and more af- cultures’ that are unique for each population group which are not easily identified by an ‘outsider’. In addition, travelling fected by the epidemic. people engage in circumstantial behaviours. For example, young men travelling often have an expectation of having sex with a local person, most often with a sex worker. This is an attitude based on curiosity and novelty, not solely based 5. Analyse how the sector activities increase or reduce these communities’ vulnerabilities to infection, e.g., on physical need. It happens due to the circumstances of being away from home. promotion of alcohol, unemployment, et cetera. Source: Multisectoral Responses to Mobile Populations’ HIV Vulnerability: 6. Determine what factors are contributing to the spread of HIV and enhancing vulnerability to HIV infection Examples from People’s Republic of China, Thailand and Viet Nam, among specific groups, including women, youth stakeholders or communities/regions. UNDP South East Asia HIV and Development Programme, February 2003, http://www.hiv-development.org/text/publications/Multisectoral.pdf 7. Estimate the epidemic effect on communities, e.g., morbidity, mortality, health care demands, orphan- hood, AIDS-induced poverty, stigma and discrimination, etc. 8. Estimate the anticipated impacts of HIV and AIDS in the medium to long term (based on current trends, epidemiological projections and lessons learned elsewhere). 9. Determine the scope, nature and effectiveness of the region/community response to HIV and AIDS. EXTERNAL IMPACT ASSESSMENT, KEY POINTS: 10. Determine availability of social services in the target communities, e.g., access to health care – availability, For external impact assessment, a summary document should be produced highlighting the points provided below: cost, STI clinics, VCT services, home-based care, etc. 1. Analyse how HIV and AIDS-related illnesses, deaths and stigma currently affect the target community and their 11. Analyse the nature and value of existing partnerships or collaboration with other sectors/organizations potential implications for demand for the sector service provision. regarding HIV and AIDS in the external domain. 2. Estimate the future impact of AIDS-related illnesses and deaths on the sector’s ability to have clients and continue its business within the target community (e.g., reduction of household income associated with increases in expendi- 12. Determine gaps in the current response and opportunities for improving or scaling up the response. tures will reduce their access to education, food, farmer products etc., impacting the sector service delivery). 3. Estimate how sector and organization activities (development efforts) facilitate the spread of the epidemic and increase population vulnerabilities within the target region/community. 4. Where possible, explore scenario building that can anticipate trends in social and economic determinants. 5. Analyse aspects of the sector/government ministry’s external operations. 6. Discuss what policies, strategies and actions could be implemented to prevent or mitigate these negative impacts on the development objectives. 56 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 57 3 3 3. INSTITUTIONAL AND FINANCIAL RESOURCE ASSESSMENT ZAMBIA: AGRICULTURE AND FOOD SECURITY The institutional assessment focuses on how the organization manages itself overall. It entails a review of organizational culture, structures and systems. For The chronic illnesses that accompany deterioration of the immune system deplete household assets, reduce la- HIV and AIDS, an important aspect of the institutional assessment is to under- bour, and lead to reduced food production. In Zambia, the high prevalence of HIV and AIDS has resulted in a large number of households being unable to meet their own food needs. Several studies in Zambia show that AIDS-af- stand where the organization is in terms of approaches and leadership style and fected households are more likely to face food shortages and suffer from malnutrition than other households. in what ways it can strategically change its focus, goals and operational structure Women-headed households are particularly vulnerable. The vulnerability is especially important because women to address the epidemic. in rural areas are 1.4 times likely to be infected than men, and they constitute the majority of infections. When a It is clearly important to review focal points or committees, including existence of family member becomes ill with AIDS-related opportunistic infections, it is usually the woman who cares for the sick person. Women in rural areas are thus faced with competing demands to maintain crop production, care for structures, their functions, and how these structures relate to the overall manage- family members suffering from AIDS, and protect their own health. ment of the organization. Part of this is to look at what authority and influence Evidence also suggests that good nutrition is important to maintaining a healthy immune system among those these structures can have on directing and supporting the sector response to HIV who are HIV-positive. and AIDS and what the reporting arrangements are. Another important element Source: The HIV and AIDS epidemic in Zambia – Where are we now? Where are we going?, is an assessment of resources and support provided to these structures, which National HIV and AIDS/STI/TB Council and USAID, September 2004. gives a proxy indication of institutional commitment to and engagement in main- streaming HIV and AIDS. Mobilisation of financial resources depends on a number of interrelated factors, including how large the target population of the sector is, flexibility of use in The smooth flow of funds is critical for sustaining an effective response to the epi- existing sector resources, and overall national commitment to fighting AIDS. For demic. The financial resource assessment explores where funds for HIV and AIDS the educational sector, for example, the target population is very large, including come or may come from, how these funds are disbursed and used, and possible students, parents and communities in which schools function. Mobilising part- funding gaps. The level of resource allocation, or the extent to which an organiza- ners and financial resources will be key for this sector to undertake substantive tion actively pursues external funds from development partners, are indications of programmes aimed at its wide-ranging ‘clients’. institutional commitment for multisectoral HIV and AIDS intervention. Accountability arrangements and well-organized reporting arrangements are a critical feature of management. Documentation, information flow, and sharing at INSTITUTIONAL ARRANGEMENT, KEY POINTS: all levels and between all stakeholders are necessary to record successes and best This section provides a rapid assessment for institutional capacity and financial resources. practices, build institutional memory, and catalogue benchmarks in the response 1. Assess the HIV and AIDS committee’s terms of reference, objectives and responsibilities. to HIV and AIDS. 2. Assess opportunities for integrating HIV and AIDS into regular management meetings. Another important issue here is the capacity of the sector to mobilize and col- 3. Determine the current level of training in HIV and AIDS-related matters, e.g., in strategic planning, laborate with other partners already working on HIV and AIDS. The sector should participatory planning techniques, proposal writing, record keeping and reporting, monitoring, etc. take into account that it does not work alone. Other organizations, institutions 4. Establish relations with other sectors, national institutions and international agencies relevant and community-based organizations have, in one form or another, HIV and AIDS for HIV and AIDS. programmes in progress. It is essential for the sector or programme to identify 5. Assess both internally and externally available financial resources that can be deployed others and work with them, taking into account each other’s comparative advan- for HIV and AIDS- related work. tages. This will enhance and reinforce the response in the community, maximize 6. Determine personal and management practices that can include performance evaluation resources, and at the same time avoid duplication of efforts. on HIV and AIDS work. Institutional arrangement, key points: 58 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 59 3 3 4. SECTOR PROFILE WRITE-UP This section helps pull together the preceding parts of the work undertaken in and programmes. The situation and response analyses should be written up as Step Two. Once the data has been collected and the various analyses undertaken, a joint assessment to facilitate an understanding of what can be done and what it is useful to produce a succinct sector profile as a reference document. This is innovations can be brought in. It is useful to provide a brief description of current often disseminated and used as an advocacy document within the sector. Many partners and potential stakeholders, making a note of their stake in the activities times it is this document that will make the extent of the HIV and AIDS challenge of the sector and what they may be able to provide. clear to stakeholders and decision-makers. The document also can inspire and As noted earlier, summary information of the impact of HIV and AIDS on the sec- show that it is possible to take incremental action to address the epidemic from a tor, both internally and externally, will serve as effective motivation to generate sector or programme perspective. At this stage, and before formal action plan- action, particularly for management. Therefore, any available data, research and ning, a useful exploration of possibilities and opportunities should be undertaken scenario-building models should be included, even if more detailed, longer-term where strategic options for the sector can be looked at in line with the overall studies and research are planned. strategic priorities laid down within the National Action Framework. Each profile should also have a summary, which will provide an overview Anticipating strategies, programmes and actions begins a process of looking of the key issues such as capacity within the sector, financial resources and forward, whereas the response analysis taken by itself largely looks back. As all strategic intentions. possibilities are explored, and as various factors are taken into account, critical intervention areas will begin to emerge as opportunities. These factors include SUGGESTED READINGS: (See Annex 1) the sector’s agreed upon visions for addressing HIV and AIDS, its mandate, its • Guide to Strategic Planning Process for a National Response to HIV and AIDS: current HIV and AIDS situation, the potential impacts of the epidemic, as well as Introduction, Situation Analysis, Response Analysis, UNAIDS breakthrough ideas from the team. The gaps or weaknesses in the way the sector or organization has responded to date can be addressed from a strategic stand- • Supporting National HIV and AIDS Responses: An Implementation Approach, UNDP, 2004 point. As these critical intervention areas emerge, more meaningful and effective • Toolkit to support the mainstreaming of HIV and AIDS: Fundamental Disciplines responses to the epidemic may be formulated for both the internal and external UNDP, 2004 domains. • Africa Scenarios, UNAIDS Examples of broad potential strategies that can emerge during and after the joint assessment of situation and response as well as the impact assessment include: SUGGESTED TOOLS: (See Annex 2, Suggested Tools for Step 2. pg. 105) deciding to undertake a community-based approach, expanding partnerships Wilbur Four-Quadrant Framework: Mapping HIV and AIDS situation and response; Situation Analysis tool; with civil society, providing treatment options for workers, addressing the under- Response Analysis tool; Predicting the impacts of AIDS on the organization, and analysing the options for lying or indirect causes of the spread of the epidemic, etc. responding; Likert’s Levels of Organization Development The profile document will typically consist of a general introduction, a descrip- tion of the core functions and mandate of the sector or ministry and an outline of their overall sector objectives and strategies. These, of course, also apply when developing a profile for departments, decentralised government institutions 60 PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE PART 2: STEP 2: PREPARING AN HIV AND AIDS PROFILE 61 STEP 3: Formulating an Activities Plan for Mainstreaming Essentials of Sector and Programme Mainstreaming Mainstreaming Steps 3 STEP 3: Formulating an Activities Plan for Mainstreaming SECTOR HIV and AIDS Potential strategies PROFILE National priorities & sector comparative advantages Activities for internal New opportunities Sector HIV and AIDS strategies and external domain Gaps More detailed action planning for implementation can be undertaken based on national priorities and sector comparative advantages, goals and institutional commitment to respond to HIV and AIDS. The established profile, as well as op- portunities and gaps identified during the previous steps may also inform more detailed planning. Before this stage of activity formulation, alignment and institutional linkages with other planning frameworks (such as the NAF and PRSP) are particularly important to ensure that there is policy coherence, consistency, and a resource envelope with respect to programming for HIV and AIDS. Attention also needs to be given to decentralised planning and implementation of actions for mainstreaming HIV and AIDS, such as district development plans found in many countries. PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G 65 3 3 the overall national priorities. Of course, where there are similarities in the profile CHALLENGES IN ALIGNING THE MAINSTREAMING PLANNING CYCLE WITH THE NATIONAL of different sectors, similar actions may be adopted, though every effort must be PLANNING CYCLES made to avoid duplication. An action plan for mainstreaming HIV and AIDS needs One clear mainstreaming challenge is aligning mainstreaming processes at the sectoral level vis-à-vis NDP or PRSP. to take into account both the direct and indirect aspects of HIV and AIDS in both In most cases, these are de-linked from ongoing processes driven by, for example, NAAs. This challenge finds ex- the internal and external domains. pression in three different ways: (a) there are different actors involved, leading to poor ownership and fragmented implementation, (b) there are different planning and budgeting cycles, leading to the view that mainstreaming is an add-on, with no funding attached and (c) they use different tools and methodologies, often creating confusion AN EFFECTIVE LGA RESPONSE TO HIV AND AIDS SHOULD BE: in application. Recent UNDP support experience in Mozambique is showing the way to overcome this issue of alignment: • Consistent in what it does with National AIDS Policy and oriented to needs of the local context Identify all the key staff involved in sectoral development planning and implementation processes as the core team • Informed by an understanding of local realities, norms and trends: specifically, the impact of HIV and AIDS on the local of all the committees for HIV and AIDS, Gender, ICT, Environment, etc. Such a team includes senior development community and on municipal functioning, as well as the existing resources and possibilities for responding to HIV and planners, HR directors, directors of budgets, and HIV and gender focal points. AIDS. Sensitive to the special risks facing women and young people • As a team, they share ideas among themselves and develop a shared understanding of all ongoing main- • Promoted and supported by LGA leadership and a Task Team of LGA and community stakeholders streaming processes by NAC; develop a strategy for operationalizing the NAF, MPF and mainstreaming into • Multisectoral, recognizing that the impact of HIV and AIDS and the response require a multi-pronged approach PRSP and sectoral operations, and bi-lateral donor initiatives as well as dealing with specific sectors/minis- • Comprehensive in assessing how best to deal with prevention, treatment/care, and impact mitigation tries, etc., some of which were not known to other members of the team before. • Two-pronged, with an internal (LGA staff and their families) and external (service delivery and coordination) focus • Revisit sectoral goals/mandates and jointly explore how their achievement may be inhibited by different the- matic challenges such as HIV, gender, environment, etc. • Oriented to achieve functional integration of programmes and services addressing HIV and AIDS, both within the LGA (especially integration of health and welfare services) and between the LGA and community agencies working in HIV • Jointly define expected mainstreaming results. and AIDS (integration of efforts of different providers) • Design a process of conducting simple HIV and AIDS assessments, strategy formulation exercises TOGETHER, • Mainstreamed into development programmes of the LGA rather than treated as a stand-alone area of intervention using all existing plans, reports and studies to deepen the linkages between the different thematic areas as a team, not as individual committees or task forces. • Committed to enhance community participation in planning, programme design and implementation. This includes the need to proactively include people infected and affected by HIV and AIDS and their representative organizations The information gathered is also used as (a) inputs into the PRSP, developed on thematic lines and (b) inputs to be- in consultation processes gin more direct sectoral engagement for the current planning and budgeting process. In this way, national, sectoral and HIV and AIDS processes have been linked, using the same core group and a set of agreed upon instruments in • Committed to address issues related to stigma and discrimination as well as the gender dimensions of the epidemic. collaboration with UNIFEM and UNAIDS. • Oriented to mobilizing and coordinating resources within (business and civil society) and beyond the LGA environ- ment (external funding and support) for responding to HIV and AIDS • Based on a developmental approach of learning by doing, using monitoring and evaluation systems to strengthen 4. ACTIONS FOR INTERNAL AND EXTERNAL MAINSTREAMING response frameworks over time Source: Local Government Response to HIV and AIDS: A Handbook, World Bank, Actions for mainstreaming HIV and AIDS clearly need to be relevant to the sector http://www.worldbank.org/urban/hivaids/handbook/handbook.pdf and appropriate for the sector’s HIV and AIDS situation. Thus, to the extent that the scale, nature and consequences of HIV and AIDS vary between sectors like ag- riculture and education, these sectors should undertake different sets of interven- tions to ensure that their mainstreaming efforts are effective and responsive to 66 PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G 67 3 3 BOX 7 ACTIONS FOR MAINSTREAMING HIV AND AIDS IN THE INTERNAL DOMAIN As with the sector HIV and AIDS profile, the number, depth and complexity of proposed actions can be incrementally adjusted over time, as knowledge of the Examples of responses to direct aspects of HIV and AIDS: epidemic, resources and capacity to respond increase. Boxes 7 and 8 outline ac- 1. Activities to help employees reduce their vulnerability to HIV infection by providing: tions for mainstreaming in the internal and external domains respectively. Some • HIV and AIDS education for employees to increase knowledge, attitudes and good practices through active and of these actions are relatively straightforward, yielding immediate results; other participatory methods actions are of a more long-term and systemic nature. The examples given are not • Behavioural change communication activities through peer education, personal vulnerability and risk assessment exhaustive, nor are they sector or programme specific, as this is a generic guide. • An awareness-raising campaign, including activities to reduce stigma, discrimination, denial and fear with partici- pation of people living with HIV Institutions will need to determine which actions are appropriate or what other • Regular on-going series of discussion sessions for staff on HIV and AIDS-related topics actions need to be developed. • HIV and AIDS/STI materials development and distribution • Promotion of basic hygienic and protective methods BOX 8 ACTIONS FOR MAINSTREAMING HIV AND AIDS IN THE EXTERNAL DOMAIN 2. Create an enabling environment for treatment, care and support to HIV-positive employees • Provision of comprehensive Voluntary Counselling and Testing (VCT) services Examples of responses to direct aspects of HIV and AIDS: • Referral linkage with health facilities for STI management among staff • Comprehensive treatment programme for infected employees and their families • Provision of behavioural change communication programmes, including peer education, within the target communities • Provision or revision of health insurance to include AIDS-related treatments (opportunistic infections and ART) • Provision of referral service to voluntary counselling and testing centres • Provision of disability and funeral benefits • Provision of referral service to existing treatment and support programmes for infected clients • Creation of support groups for infected employees and their families (e.g., for pupils at schools) • Creation of a support fund for affected families and orphans of employees • Support programme for affected populations (e.g., households, orphans, the elderly, etc.) • Development or revision of HIV and AIDS workplace policy and programmes to support and care for HIV and AIDS • Support programme aimed at reducing AIDS-related stigma and discrimination infected staff. Examples of responses to indirect aspects of HIV and AIDS: Examples of responses to indirect aspects of HIV and AIDS: • Support poverty reduction programmes • Revision of organization policies and guidelines based on the impact assessment to reduce staff vulnerability to HIV infection • Job creation and sustainable income-generation programmes, especially for vulnerable groups (youth, women, etc.) • Sector reform programmes based on re-skilling and redeployment, rather than retrenchment • Skills training • Affirmative action/inclusive employment practices (i.e., to overcome gender barriers to employment and • Empowerment programmes for women and girls career advancement) • Policy measures aimed at overcoming gender discrimination and gender disadvantages • Fair remuneration system (equal pay for equal work and reasonable wage gap between personnel scales) • Equitable access to assets (land, housing) and services • Sexual harassment policy and programme • Cross-subsidisation and redistributive measures (to ensure financial sustainability and continuous access to services for infected and affected populations) • Financial support or benefits (housing, education, etc.) for employees to move with their families to postings Some activities planned by the sector will require experts, and it is important to keep in mind that resources exist in other institutions and in the country as a 68 PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G 69 3 3 whole. For example, a well-trained person in behavioural change communication SUGGESTED READINGS: (See Annex 1) programming may not be available within the organization, but may be found • Guide to Strategic Planning Process for a National Response to HIV and AIDS: Introduction, Situation through the National AIDS Authority. Launching a condom programme within Analysis, Response Analysis, Strategic Plan Formulation and Resource Mobilisation, UNAIDS, 1999 a community can be contracted with a specialized agency, for example. The formulation of actions for internal and external mainstreaming may be SUGGESTED TOOLS: (See Annex 2, Suggested Tools for Step 3. pg. 118) initiated by a select group of people within the sector or institution. It is, HIV and AIDS Mainstreaming Action Planning Template; Conversations for Generating Action; however, important that broader consensus and commitment is gained around Template and example of HIV and AIDS Mainstreaming Plan the planned actions from the institution and communities it serves. This is so for obvious reasons: • To ensure that all employees throughout the organization share the institu- tional commitment to mainstreaming HIV and AIDS and that there is a shared sense of ownership of the planned actions • To ensure that the proposed actions are relevant and appropriate and to allow for flexible revision where necessary • To get the highest level of ‘buy-in’ and encourage active participation of other stakeholders, including community members ACTION PLANNING, KEY POINTS: It is important at this stage of the mainstreaming process that a clear action plan be elaborated by the sector, taking into account implementation modalities and accountabilities. The following need to be considered during this process: 1. Define and agree on a clear set of actions to be undertaken for internal and external mainstreaming. 2. Ensure that the proposed actions are relevant and appropriate and allow for flexible revision where necessary. 3. Obtain the highest level of ‘buy-in’ within the sector/organization and encourage active participation of other stakeholders including people living with HIV and AIDS, community members, NGOs, etc. 4. Ensure that adequate human and financial resources are available for the implementation of the plan. If the sector plans to mobilize additional resources, a clear plan should be elaborated. 5. Establish implementation arrangements – i.e., issues related to the management and execution of projects and activities, including decentralised planning and implementation. 6. Establish a monitoring and evaluation plan, including key indicators. 7. Involve the NAA and other relevant sectors as much as possible during the whole process. 70 PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G PA RT 2: S T E P 3: F O R M U L AT I N G A N AC T I V I T I E S P L A N F O R MA I N S T R E AM I N G 71 STEP 4: Costing Mainstreaming Activities Essentials of Sector and Programme Mainstreaming Mainstreaming Steps 3 STEP 4: Costing Mainstreaming Activities Sector HIV/AIDS Strategies Activities Costing Estimated resources Budgets Resource mobilization (internal and external resources) Proposed actions for internal and external mainstreaming need to be properly financed; otherwise the intended results are unlikely to be achieved. Planning without an understanding of funding options often leads to unrealistic expecta- tions. As a result, well-developed action plans may not be implemented. This in itself could be a reason to start small, with relatively simple actions at first, which can be expanded on as resources are mobilised and organizational capabilities to act are enhanced. Of course, financial constraints are often mentioned as soon as innovative action is suggested. This can immediately foreclose opportunities for action and change. At times, the issue is not so much that there are no funds available, but which ac- tions are prioritised and how existing funds are allocated or reallocated. Resource allocation can be an indication of institutional commitment to mainstreaming HIV and AIDS. It is also worth remembering that HIV and AIDS actions do not always require additional resources, as they need to become part and parcel of routine functions and activities. As mentioned earlier, some activities may not cost anything if the organization mobilises adequate experts from the NAC or international agencies present in the country. PART 2: STEP 4: COSTING MAINSTREAMING ACTIVITIES 75 3 3 However, sectors sometimes need to mobilise additional resources to support The first is erosion of human capacity caused by AIDS, which results in falling hu- their programme, especially regarding the external domain. Local processes man and institutional capacity to run programmes and services. The second is that should be encouraged. There are already convincing experiences from many human resource ceilings imposed through strict macroeconomic conditionality in parts of Africa, where sectors and even community organizations contribute in a many badly affected countries affect service delivery of all kinds and must be fac- significant way to HIV and AIDS activities. These financial contributions are often tored into the plan. Representation from the sector must be made to the Ministry a strong indication of local commitment, and they enhance the prospects of a of Finance and international partners to mitigate this additional constraint. sustained response. DEFINITION OF COSTING AND BUDGETING COSTING, KEY POINTS: During the costing and budgeting process, the sector needs to analyse carefully the availability of the Costing can be defined as determining the expenditure required to purchase the resources needed to achieve an following dimensions of costing activity or strategy. Budgeting, on the other hand, can be defined as the allocation of resources to match requirements. Once the cost 1. Internal human resources and experts 5. Drugs of an activity is determined, the total number of desired activities will then determine the desired funding. The 2. Infrastructures and equipment 6. Monitoring and evaluation of the programme number of activities will be adjusted to fit the amount of funds allocated, which will become the budget. 3. Training and planning 7. Administrative costs Together, costing and budgeting help the planning process by ensuring that the goals are financially affordable 4. Commodities and products 8. Other and able to be implemented. Source: Planning, Costing and Budgeting Framework: User’s Manual, UNAIDS November 2003. Activities are considered to be the basic cost object. Expenses should be separat- ed and matched to the level of activity that consumes the resources. The budget For costing and budgeting of planned HIV and AIDS-related activities, the or- is usually broken down per year or quarterly. It is also important that individuals ganization is invited to use internal budgeted staff and limit the use of external familiar with the programme be involved in the budgeting as well as the valida- experts, which would result in additional costs. tion process. WHAT NEEDS TO BE COSTED AND BUDGETED? SUGGESTED READINGS: (See Annex 1) Costing for HIV and AIDS mainstreaming should not be seen as an extraordinary • Costing Guidelines for HIV and AIDS Intervention Strategies, UNAIDS, 2004 process. Most of the cost centres are already defined. The usual sector budgeting • Planning, Costing and Budgeting Framework: User’s Manual, UNAIDS, November 2003 process and Charts of Accounts should be used. Activities that require zero costs • Resource Needs for HIV and AIDS: Model for Estimating Resource Needs for Prevention, Care, should be noted in the budget. and Mitigation, Futures Group International, 2002 In-house capacity for costing should be used, and partnerships with other minis- • Cost-effectiveness Analysis, Economic Impact, UNAIDS, 1998 tries, donors, etc., formed for specific areas that require more elaborate costing. It is likely that an existing programme has undertaken the same or a similar exercise. SUGGESTED TOOLS: (See Annex 2, Suggested Tools for Step 4. pg. 122) The extensive literature and documentation on costing can be researched. Costing and Budgeting: Methodology and Layout of the Framework In all costing for implementation of services, the cost of additional human re- sources must be planned for and factored in. Two issues stand out in this regard. 76 PART 2: STEP 4: COSTING MAINSTREAMING ACTIVITIES PART 2: STEP 4: COSTING MAINSTREAMING ACTIVITIES 77 STEP 5: Implementing Planned Activities and Documentation Essentials of Sector and Programme Mainstreaming Mainstreaming Steps 3 STEP 5: Implementing Planned Activities and Documentation Sector HIV and AIDS Strategies Planned activities Define roles and responsibilities Budgets Work with partners & networks Implementation activities Progress monitoring Although formulating the action plan and implementation are identified as dis- tinct stages in the strategic planning process, in reality, planning and implemen- tation happen simultaneously. Implementation may lead to a revision of plans or immediate modification of intended plans in practice. In a way, the implementa- tion process is about testing whether stated objectives and activities will realize the intended outcomes. It is important that the implementation process and experiences gained during this stage are documented and eventually fed into the monitoring and evaluation processes of the national response. Documentation and information sharing at all levels and between all stakeholders are necessary to record lessons and suc- cesses, to build institutional memory, and to catalogue institutional achievements in mainstreaming HIV and AIDS. 1. IMPLEMENTATION ARRANGEMENTS To ensure that internal and external mainstreaming actions are implemented ef- fectively and the desired results are achieved, clear implementation arrangements are crucial. This includes aspects related to decentralised planning and implemen- PA RT 2: S T E P 5: I M P L E M E N T I N G P L A N N E D AC T I V I T I E S A N D D O C UM E N TAT I O N 81 3 3 tation. Without specifying responsibilities, accountabilities, coordination mecha- 2. UNDERTAKING ACTION nisms and other management issues, action plans are incomplete. Frustration is likely to arise. It goes without saying that those tasked with the responsibility to In most situations, activities will be in the form of meetings, campaigns, produc- tion of materials, service delivery and referral to other providers. These actions will execute certain actions need to be given sufficient time, capacity and resources be undertaken in the areas of prevention, care, treatment and impact mitigation. to do so; those responsible for overseeing the execution of mainstreaming ac- Clearly, the overall management of HIV and AIDS-related sector activities is an tions by others need to have the relevant authority and discretion. important area in which regular actions are required. Implementing planned activities may not be easy, and the sector will sometimes A major challenge for sectors is how best to decentralise implementation. Many call for the help of local NGOs, communities, etc. The NAA remains the main decisions, policies and strategies will be developed at the central level, but to ef- resource for support and/or orientation. The sector is also invited to build partner- fectively reach the majority of staff and sector clients is a vast exercise. Decentrali- ships with other sectors providing services in the same community. sation is required, and specific roll out programmes need to be carefully designed. This programme will include training and capacity development, disbursement of funds, and establishment of reporting mechanisms. This may be considered a vertical sector approach, but in many instances, it is needed to initiate main- IMPLEMENTATION, KEY POINTS: streaming actions at the decentralised level. In time, the horizontal integration at Below are areas that need to be looked at when implementing planned activities: the sub-national or district level is what will provide the most comprehensive 1. Establish clear responsibilities: who does what and by when? HIV and AIDS-related programme outcomes across sectors and programmes for 2. Determine accountabilities: who reports to whom, how often and in what format? the national multisectoral response. 3. Determine coordination mechanisms: what is their function or terms of reference and what level of influence do they have or need to fulfil a coordinating role? 3. DOCUMENTING ACTION 4. Assess resources: what resources are available or required for these implementation arrangements, including human and financial resources? The purpose of documentation is to ensure that experiences gathered in the 5. Establish or regenerate a departmental HIV and AIDS committee with clear terms of reference, objectives and course of the work are collected and assessed in terms of their contribution to responsibilities. the national priorities and communities served. It is also a basis for refining and 6. Mainstream HIV and AIDS reporting into routine reporting mechanisms. redesigning approaches and tools for future work both within the sector and for 7. Hold monthly/quarterly HIV and AIDS management meetings chaired by a senior person. national review and reflection. 8. Train personnel charged in record keeping and reporting, strategic planning, participatory planning tech- niques, proposal writing, monitoring, etc. Regular documentation will also serve to assess and reflect on the effective use of 9. Form liaisons with the national authority on HIV and AIDS, other sectors and international agencies. both human and financial resources and give an indication of the overall cost-ef- 10. Link HIV and AIDS work to performance evaluation of staff. fectiveness of the programme. Clearly, this closely links to staff performance and monitoring and evaluation within the sector. When documenting, we should consider a number of important related issues, particularly the coverage of interventions. For example, how many people are reached by the interventions and what is the potential estimated reach of the 82 PA RT 2: S T E P 5: I M P L E M E N T I N G P L A N N E D AC T I V I T I E S A N D D O C UM E N TAT I O N PA RT 2: S T E P 5: I M P L E M E N T I N G P L A N N E D AC T I V I T I E S A N D D O C UM E N TAT I O N 83 3 3 programme and the needed capacity to deliver? Documented information should make it possible for the sector to analyse and promote its own successes. CAPACITIES FOR EFFECTIVELY MAINSTREAMING HIV AND AIDS, Documentation of external and internal activities should be done separately, but the linkages between these should be noted and analysed. KEY POINTS: 1. Deep understanding of the national priorities of the National Action Framework 2. Basic knowledge and understanding of HIV and AIDS 3. An understanding of the direct and indirect aspects of HIV and AIDS affecting the sector, in both the internal DOCUMENTATION, KEY POINTS: and external domains 1. Forms of documentation: meetings, activities and financial reports, media releases, publications, electronic 4. An understanding of the sector’s response to the direct and indirect aspects of HIV and AIDS, including how video documentation, etc. it may unwittingly enhance vulnerability to HIV infection or undermine coping capabilities to deal with the 2. Determine the frequency: weekly, monthly or quarterly documentation. consequences of HIV and AIDS 3. Document sector activities in capacity-building. 5. Skills to apply this knowledge to daily tasks and routine functions and functioning of the sector 4. Document how the programme enhances ownership of staff and communities. 6. Strategic and creative skills to translate this understanding into effective actions 5. Document how the programme fosters partnership and enables networks. 7. Willingness and ability to involve those infected and affected by HIV and AIDS at all stages of planning and 6. Document all activities implemented, especially regarding: reduction of gender inequality, reduction of stigma, decision-making fear and discrimination, promotion of socio-economic empowerment. 8. Ability to communicate, share learning and motivate others to take a stand on HIV and AIDS 4. ENSURING SUFFICIENT CAPACITY SUGGESTED READINGS: (See Annex 1) In most cases, sectors and programmes are constrained by limited human capac- • Mainstreaming HIV and AIDS in Practice–Toolkit, SDC, 2004 ity or the speed at which capacity is developed. As noted earlier, partnerships, • Mainstreaming HIV and AIDS in Development and Humanitarian Programmes, outsourcing and networking are a critical feature for getting the needed capaci- Oxfam GB, Action Aid, and Save the Children UK, 2004 ties. The challenge is to articulate the range of capacities and skills required to successfully deliver a programme. SUGGESTED TOOLS: (See Annex 2, Suggested Tools for Step 5. pg. 127) It is important to reiterate that mainstreaming HIV and AIDS in the longer-term Implementation Framework; Activity and Financial Monitoring Template entails developing varying degrees of skills in the areas of prevention, care, treat- ment and impact mitigation. Each sector will need to decide the extent to which capacities are built in any given area. 84 PA RT 2: S T E P 5: I M P L E M E N T I N G P L A N N E D AC T I V I T I E S A N D D O C UM E N TAT I O N PA RT 2: S T E P 5: I M P L E M E N T I N G P L A N N E D AC T I V I T I E S A N D D O C UM E N TAT I O N 85 STEP 6: Taking Stock Mainstreaming Steps 3 STEP 6: Taking Stock Process Inputs Output (Re)Definition of Project goals, strategies and activities Impact Outcome Taking stock means looking at monitoring, milestones, results and evaluation as a continuum. The key purpose of this is to improve outcome and impact. The objec- tive here is to provide the reader with some guidance in monitoring and evalua- tion. A number of useful tools and documentation is provided in Annex 2, Step 6 that will help set up a monitoring and evaluation plan. 1. CAPACITY Sectors, programmes, policy makers and staff face many challenges related to the monitoring and evaluation of their HIV and AIDS programmes. Monitoring and evaluation capacity and skills are important for the successful implementa- tion, design, and measurement of effectiveness of HIV and AIDS programmes and capacity needs. Programme monitoring and evaluation focuses on the compila- tion of input and output data that can be used to measure changes in effort and context over time. Separate skills are required for these. How the sector or programme plans to monitor and evaluate the programme it is designing should be considered from the very beginning, as should the capacity requirements. To ensure that the programme produces useful results, it is essential that the sector incorporate a monitoring and evaluation plan in the programme design stage. Projects at all levels, whether single interventions or multiple integrated projects, should have a monitoring and evaluation plan to assess the project’s progress towards achieving its goals and objectives and to inform key stakeholders and programme designers about the achieved results or potential issues.7 7. Monitoring HIV and AIDS Programmes: A Facilitator’s Training Guide, Module 3, FHI, 2004. PART 2: STEP 6: TAKING STOCK 89 3 3 2. CHALLENGES OF MEASUREMENT TAKING STOCK, KEY POINTS: HIV and AIDS is a complex phenomenon requiring responses that address the underlying causes at the individual, organizational and community levels. These It is important for the sector/organization to monitor all implemented activities and document the process. 1. Determine the sector inputs: e.g., financial, technical and human resources, staff time, medicine, etc. This is changes are not easily measurable. When taking stock, we can look at what was the easiest to measure as it is mostly under the management of the sector. intended, what happened and possibly the value above and beyond what was 2. Establish the outputs: e.g., number of trained staffs, information materials produced, staff members receiv- intended and what actually happened. Monitoring tracks what happened, and ing services, community programmes for the target audience. If these outputs are well designed and reach evaluation assesses the value – i.e., the changes and whether the programme is the populations for which they were intended, the programme is likely to have positive short-term results. making a difference. Both allow programme managers to redefine the objectives 3. Determine the potential outcomes: e.g., the number of HIV-positive staff under ARV treatment, an increase in and re-allocate resources to achieve the best results. the number of persons adopting safer sexual behaviour, youth in the target community delaying first sexual intercourse, etcetera. The outcomes should lead to changes in the longer term. Many programmes will be tempted, when taking stock, to attribute outcomes and 4. Predict long-term impact based on outcomes: e.g., reduction of HIV incidence among staff, HIV-positive staff impact directly to their interventions. Impacts such as reduction in new infections, with better health and improved productivity, impact of HIV and AIDS on sector reduced. increases in life expectancy, et cetera cannot be attributed to one programme, as it is often the result of many different intervention factors. In most cases, the most that can be achieved is to describe outcomes and their direct relationship to the SUGGESTED READINGS: (See Annex 1) impact provided. • Monitoring HIV and AIDS Programmes: A Facilitator’s Training Guide, Module 3, FHI, 2004 3. INDICATORS • National AIDS Programmes: A guide to monitoring and evaluating HIV and AIDS care and support, UNAIDS, 2000 Indicators for monitoring and evaluating the process of mainstreaming HIV and AIDS are an essential component of the action plan. A good indicator set is SUGGESTED TOOLS: (See Annex 2, Suggested Tools for Step 6. pg. 129) invaluable for assessing the effectiveness of mainstreaming actions, but also for planning ahead based on observed trends. While sectors can develop their own Tool for Monitoring an HIV and AIDS Plan milestones and indicators according to their mandates and organizational capac- ity, there is a need to be in line with nationally agreed upon indicators, following the principles of the Three Ones. Part of the process of selecting indicators is to determine how they will be verified. If relevant data to monitor progress or measure success is not available, the indica- tor is of little use. Also, if it takes an inordinate amount of time and capacity to gather and analyse the relevant data, the indicator is not particularly useful. Table 3 gives examples of indicators for mainstreaming HIV and AIDS, with pos- sible means of verification. 90 PART 2: STEP 6: TAKING STOCK PART 2: STEP 6: TAKING STOCK 91 3 Conclusion C TABLE 3. EXAMPLES OF INDICATORS FOR MAINSTREAMING Twenty years into the HIV epidemic, our insights into the complex, two-way re- lationship between AIDS and development are deepening, as is our understand- Indicators Means of verification ing of its exceptional nature as both a short-term emergency and a longer-term development issue. INTERNAL Multiple efforts need to be translated and used to strengthen country level action ❑ Knowledge, attitudes and behaviour of staff regarding HIV and delivery. Sector and programme mainstreaming is a critical dimension of the AND AIDS and sexual behaviour overall integration of HIV and AIDS into national development. It can achieve a ❑ Questionnaire / survey ❑ Knowledge, attitudes and behaviour of staff regarding ❑ Questionnaire / survey level of harmonised multisectoral action that ensures workplace programmes people living with HIV AND AIDS and stigma ❑ Attendance register and responses for communities as a whole which, it is hoped, will improve de- ❑ No. of staff attending HIV AND AIDS information events ❑ Distribution schedule (by gender, age) velopment outcomes. Integrating HIV and AIDS requires national, sectoral and ❑ User register ❑ No. of leaflets distributed (by location / target group) ❑ User register programmatic dimensions. It is important that there are strong linkages between ❑ No. of staff (by gender, age) using VCT services sector and national mainstreaming, with the National Strategic Framework for ❑ Distribution schedule ❑ No. of staff making use of offered treatment ❑ Policy & programme/ survey AIDS providing the direction and priorities for all levels of mainstreaming. ❑ No. of condoms distributed per week/month (by location) ❑ Staff profile ❑ Affirmative action policy & programme Mainstreaming HIV and AIDS into national development processes and poverty ❑ Remuneration policy ❑ Change in employment profile of the organization reduction strategies remains a key way to ensure the integration of planning, re- ❑ Policy & programme/ survey ❑ Fair remuneration system established source and programmatic issues for a multisector and multi-stakeholder response ❑ Sexual harassment policy & programme in place to the epidemic. EXTERNAL Finally, not all the challenges of mainstreaming can be accommodated through ❑ No. of condoms distributed per week/month (by location) a systematic sector planning and implementation process undertaken by institu- Do you want this as #1? tions alone. National, regional and global responses will influence the outcomes ❑ Knowledge, attitudes and behaviour among of multisectoral actions. Wide-range networking and the development of com- rights-holders/communities about HIV AND AIDS ❑ Distribution schedule + sexual behaviour ❑ Questionnaire/survey munities of practice is essential to harnessing information, resources and results. ❑ Knowledge, attitudes and behaviour among rights- ❑ Questionnaire/survey This requires a long-term perspective. For this, technical assistance and capacity holders/communities about people living with ❑ Attendance register development will be the mainstay. UNDP, UNAIDS, and international partners (in- HIV AND AIDS + stigma ❑ Distribution schedule cluding other multilateral agencies, bilateral organizations of governments, foun- ❑ No. of rights-holders attending HIV AND AIDS ❑ Survey dations, NGOs and academic institutions), have relevant expertise and experience information events (by gender, age) ❑ Asset register/survey ❑ No. of leaflets distributed (by location / target group) in harmonizing their development assistance to countries. Additional technical ❑ Reduction in HIV AND AIDS-related poverty or discrimination resources, policy advice and networks to assist countries in achieving their aims ❑ Enhanced access for women to assets (land, housing, etc.) for integrating HIV and AIDS into planning for development are available. These are all resources to be tapped. 92 PART 2: STEP 6: TAKING STOCK CONCLUSION 93 ANNEXES Annex 1: Suggested Readings A1 Addressing the Impact of HIV and AIDS on Ministries of Agriculture: Focus on Eastern and Southern Africa, UNAIDS-FAO http://www.fao.org/hivaids/publications/moa.pdf This paper examines the relevance of HIV and AIDS for Ministries of Agriculture (MoAs) and their work in sub-Saharan Africa, particularly in Eastern and Southern Africa. The focus of analysis is smallholder agriculture as this has been affected most severely by the HIV epidemic. The report presents the following impacts in detail 1) MoA staff vulnerability to HIV infection and AIDS impact 2) the disruption of MoA operations and the erosion of capacity to respond to the challenges being posed by the HIV epidemic 3) the increased vulnerability of MoA clients to food and livelihood insecurity, and 4) the relevance of certain MoA policies, strategies and programmes in view of the conditions being created by HIV and AIDS. AIDS in Africa – Three Scenarios for 2025, UNAIDS, 2005 http://www.unaids.org/en/AIDS+in+Africa_Three+scenarios+to+2025.asp This book is about AIDS and Africa, and the world’s response to both. It presents three stories describing possible futures. Each of the three scenarios describes a different, plausible way in which the AIDS epidemic could play out across the whole of the African continent. They are rigorously constructed accounts of the future that use the power of story-telling as a means of going beyond the assumptions and understandings of any one interest group, in order to create a shared basis for dialogue and action about critical and difficult issues. A multifaceted response to the HIV and AIDS pandemic, Evaluation Note, N. 6, UNDP, 2002 http://mirror.undp.org/mongolia/publications/essentials/document/english/HIV_AIDS6.pdf This paper provides examples of successful approaches to mitigating the impact of the epidemic, based on the experience of UNDP and other key partners. The ‘Mainstreaming into development planning’ section gives the example of Burkina Faso, which moved from a fragmented response to a fully integrated, multisectoral national plan, including integrating HIV and AIDS into the Poverty Reduction Strategy to put it in the mainstream of development planning. A multi-ministry strategy to the expanded response to HIV and AIDS, AusAID – UNAIDS, 2001 http://www.ausaid.gov.au/publications/pdf/multiministry.pdf Changing the course of the epidemic can be done through the work of ministries and sectors that are already reaching to the population from different angles according to their development, social and business agendas. This paper, prepared for the Sixth International Congress on AIDS in Asia and the Pacific, illustrates a model of a multi-ministerial response, detailing how all ministries can be mobilised to lead a particular sector in the fight against HIV and AIDS, given their specialist knowledge and defined national development mandate. An ILO code of practice on HIV and AIDS and the world of work, ILO, 2001 http://www.ilocarib.org.tt/infsources/general_reports/aids/cop_aids.pdf The Code of Practice represents the ILO’s commitment to help secure decent work and social protection in the face of the epidemic and a framework for workplace action. It contains fundamental principles for policy development and practical guidelines from which effective responses can be developed at enterprise, community and national levels. The ILO developed the Code in response to many requests for guidance, through a widespread process of consultation with government, employer and worker constituents in all regions. A Step-by-step Methodological Guide for Costing HIV and AIDS Activities, Partners for Health Reform Plus, 2001 http://www.phrplus.org/Pubs/tool4.pdf This document provides an introduction to the procedure for calculating and analyzing the costs of HIV and AIDS programmes and describes how to measure directly the actual costs of a programme that is up and running. The step by step guide is intended to provide project managers in the field with a framework for how to measure costs for a single, recent year in the life of an HIV and AIDS programme. An illustrative activities list in the report annex will assist the user to develop an activities-based framework. The information gleaned from the costing framework will enable policymakers and programme managers to make informed resource allocation decisions. ANNEX 1: SUGGESTED READINGS 97 A1 Annex 1: Suggested Readings Annex 1: Suggested Readings A1 Cost-effectiveness Analysis, Economic Impact, UNAIDS HIV and AIDS Mainstreaming Tools: http://www.unaids.org/html/pub/publications/irc-pub03/costtu_en_pdf.pdf a set of tools for developing mainstreamed responses to the HIV and AIDS epidemic, HEARD, 2005 This document is a tool which enables programme managers and planners dealing with HIV and AIDS to make informed decisions about resource al- HEARD identified a need for a much wider, expanded and more detailed series of documents. These were to encompass more aspects of AIDS interven- location. By measuring and comparing the costs and consequences of various interventions, their relative efficiency can be assessed and future resource tions and preventions and would be targeted to specific groups. There are eleven toolkits: seven are aimed at standard government ministries or requirements estimated. departments; four are general in character, so that any given ministry’s complete toolkit would comprise five documents – that for the specific ministry, plus the four that explain and expand on the toolkit theme with frequent cross-references to the specific ministry booklets. Please refer to the HEARD website link in Annex 3. Costing guidelines for HIV and AIDS Interventions Strategies, UNAIDS http://www.unaids.org/html/pub/publications/irc-pub06/jc997-costing-guidelines_en_pdf.pdf Incorporating HIV and AIDS consideration into food security and livelihood projects, FAO, 2003 This tool is a result of several years of work and is based on experiences from Bangladesh, India and Nepal and has been field tested in Indonesia. It ftp://ftp.fao.org/es/esn/nutrition/hiv_aids.pdf builds upon the hard work of NGOs, program managers, and health planners. The tool has been successfully used for large-scale resource mobilization, to develop national strategic plans, and for financial guidelines and preparation of GFATM proposals. The tool can assist in national strategic planning This guide details how to incorporate HIV and AIDS considerations into food security and livelihood projects with a focus on protecting and promoting and in particular for achieving key principles for the coordination of national AIDS responses – the ‘Three Ones’: one agreed HIV and AIDS framework, nutritional well-being among people living with HIV and AIDS and those affected by the disease. It is intended to be used by people involved in related one national AIDS authority and one monitoring and evaluation system. policy formulation, project management and technical support. The first section outlines the relationship between HIV and AIDS and food, nutrition and livelihood security. The second section discusses how the issues can play a role in the project cycle, and the third section provides a series of key HIV and AIDS-related questions and tools to use during each cycle stage. Education and HIV and AIDS: A window of hope, World Bank, 2002 http://www-wds.worldbank.org/servlet/WDS_IBank_Servlet?pcont=details&eid=000094946_02043004023371 Local Government Responses to HIV and AIDS: A Handbook, World Bank, 2003 The paper highlights that the education of children and youth merits the highest priority in a world afflicted by HIV and AIDS, specifically because a http://www.worldbank.org/urban/hivaids/handbook/handbook.pdf good basic education ranks among the most effective – and cost-effective – means of HIV prevention. It also merits priority because the very education system that supplies a nation’s future is being greatly threatened by the epidemic, particularly in areas of high or rising HIV prevalence. Local Government Responses to HIV and AIDS: A Handbook has been written for LGA mayors, councilors, advisors and officials that are interested in developing or strengthening local responses to HIV and AIDS. The Handbook provides information, examples, and illustrative tools (surveys, checklists, modules, etc.) that guide users through the steps of recognising and publicly acknowledging the importance of addressing HIV and AIDS, assessing Guide to Strategic Planning Process for a National Response to HIV and AIDS: Introduction, Situation Analysis, the impact of HIV and AIDS on the locality, and identifying key stakeholders to initiate and coordinate a Local Government (LG) HIV and AIDS Response Response Analysis, Strategic Plan Formulation and Resource Mobilisation, UNAIDS, 1999 Strategy. The Handbook also focuses on the implementation process and suggests ways to mobilise new and existing resources, develop productive http://www.unaids.org/html/pub/publications/irc-pub05/jc441-stratplan-intro_en_pdf.pdf relationships with civil society organizations (CSOs), and establish systems of monitoring, learning and evaluation. http://www.unaids.org/html/pub/publications/irc-pub01/jc267-stratplan1_en_pdf.pdf http://www.unaids.org/html/pub/publications/irc-pub01/jc268-stratplan2_en_pdf.pdf Mainstreaming HIV and AIDS: A Conceptual Framework and Implementation Principles, http://www.unaids.org/html/pub/publications/irc-pub01/jc269-stratplan3_en_pdf.pdf http://www.unaids.org/html/pub/publications/irc-pub05/jc431-stratplan4_en_pdf.pdf UNAIDS, GTZ and JSA Consultants, 2002 http://www.afronets.org/files/mainstream.pdf UNAIDS has drafted a four-module guide that can be used by countries that want to start a strategic planning process. The draft guidelines aim to intro- duce the main concepts of strategic planning, remaining flexible enough so that they can be adaptable for planning at a national level in the different It explores the current understanding of the concept (clarifying the difference between ‘mainstreaming’ and ‘integration’) and offers examples of relevant regions and can serve as a practical assistant for planners at a district or community level. experience, with particular focus on mainstreaming at the sector and sub-national levels. It also discusses the five basic principles for mainstreaming HIV and AIDS which international experience and exchange have produced up to now. HIV and AIDS Mainstreaming: A Definition, Some Experiences and Strategies, DFID-HEARD, 2003 http://www.sarpn.org.za/documents/d0000271/P263_HIV_Report.pdf Mainstreaming HIV and AIDS in practice toolkit, SDC, 2004 http://www.deza.admin.ch/ressources/deza_product_en_1280.pdf This resource pack brings together experiences, ideas and strategies for mainstreaming HIV and AIDS into government sector ministries at all levels, whether national, regional or district. The pack uses experiences and ideas that come mainly from countries currently working through sector-wide This toolkit is a collection of resources, checklists and examples to help in mainstreaming HIV and AIDS. The toolkit offers a five step approach to main- approaches (SWAPS) and may be of particular use to countries and sectors also using this approach. streaming HIV and AIDS. The first three steps are linked to preparatory analysis of the situation. Step Four is to develop a comprehensive Workplace Policy and Programme and Step Five is to plan and implement this policy. The toolkit emphasizes the importance of developing monitoring and evaluation instruments from the very beginning. HIV and AIDS mainstreaming checklists and tools – Mainstreaming HIV and AIDS into our sexual and reproduc- tive health & rights policies, plans, practices and programmes, International Planned Parenthood Foundation, 2004 Mainstreaming HIV and AIDS in Development and Humanitarian Programmes, http://www.aidsconsortium.org.uk/MainstreamingWG/Mainstream%20Downloads/IPPFMainstreamToolkit.pdf Oxfam GB, Action Aid, and Save the Children UK , 2004 A checklist and a set of seven tools have been developed for use by IPPF Member Associations to assist them in mainstreaming HIV and AIDS into their http://www.oxfam.org.uk/what_we_do/resources/downloads/mhivaids.pdf services and programmes. The seven tools are: 1) Actions for effective HIV and AIDS mainstreaming into sexual and reproductive health organizations and programmes 2) Mainstreaming HIV and AIDS into existing sexual and reproductive health services 3) Participation of youth and people living This document has two main aims: 1) to show how agencies can adapt their external programmes to reduce susceptibility to HIV infection and vulner- with HIV and AIDS in sexual and reproductive health and HIV and AIDS programmes 4) Community consultation guide 5) Guidelines for conducting a ability to the impacts of AIDS, and 2) to demonstrate how they can modify their internal policies and systems to protect the interests of their staff and partner/stakeholder analysis 6) Checklist for conducting an HIV and AIDS capacity audit for IPPF Member Associations 7) Template for an HIV and AIDS preserve the viability of their operations. workplace programme audit in a sexual and reproductive health organization. 98 ANNEX 1: SUGGESTED READINGS ANNEX 1: SUGGESTED READINGS 99 A1 Annex 1: Suggested Readings Annex 1: Suggested Readings A1 Mainstreaming HIV and AIDS into Development instruments, Sectors and Sub-national level: Documents Database CD-ROM UNAIDS, UNDP, HLSP institute and JSI Europe, 2005 Planning, Costing and Budgeting Framework: User’s manual, UNAIDS, 2003 This CD-ROM is a very exhaustive collection of documents, policy notes, strategic papers, reports, guides and toolkits that has been produced by all This tool aims to introduce the basics of planning, costing and budgeting to HIV and AIDS Programme Managers, most of whom may not be experts in national and international partners working on HIV and AIDS mainstreaming. It is the result of a review of experiences and technical support with these areas. The Framework is presented in a logical, step by step format. First, the approach of moving from each goal down through mainstreaming HIV and AIDS in national development instruments and sectors undertaken jointly by UNAIDS and UNDP. The CD-ROM is available on the the planning levels to the activities and inputs level accentuates the need to quantify each level and link it to the preceding level. Second, it encourages websites of the authors the identification and quantification of the critical inputs needed for each activity and putting a cost to each of these inputs, thereby arriving at an informed cost of any activity, strategy or objective. Third, the summation of these costs provides a reasonable budget estimate for HIV and AIDS programmes. Mainstreaming HIV and AIDS: Policy research document for an expanded multi-sectoral approach for the Belgian Development Co-operation, HIV/STD Research & Intervention Unit (Institute of Tropical Medicine, Antwerp) Revised HIV and AIDS toolkit for local government, HEARD, 2001 http://www.dgcd.be/documents/nl/themas/aids/bvo_mainstraiming_execsum.pdf http://www.ukzn.ac.za/heard/publications/LocalGovToolkit/Local%20Govt%20toolkit%2001_website.pdf This paper recommends mainstreaming as a strategy to achieve a set of key interventions for an integrated and expanded response to HIV and AIDS. The toolkit was developed to assist Local Government in South Africa to define their role in the Partnership Against AIDS and to initiate their responses It presents a definition of mainstreaming, areas of relevance, an overview of mainstreaming in the internal and external domains, and possible entry to the epidemic. Nominated Local Government Councilors and officials and their support structures will be the primary users of the toolkit. For such a points and responses. It also covers mainstreaming HIV and AIDS into strategy documents and into the programme cycle. toolkit to be of optimal use, those who use it should be trained in basic HIV and AIDS information, AIDS and development, advocacy and the application of the toolkit. Mainstreaming HIV Prevention in the Military: A case study from Cambodia, UNDP – SEAHIV, 2004 http://www.hiv-development.org/publications/defense.htm Resource Needs for HIV and AIDS: Model for Estimating Resource Needs for Prevention, In response to the HIV threat in the military, the Royal Cambodian Armed Forces, in partnership with local and international non-governmental organi- Care, and Mitigation, Futures Group International, 2002 zations and international agencies, developed a comprehensive strategy for reducing HIV vulnerability in the military through education, empowerment http://www.futuresgroup.com/software/Resource%20Needs/ResourceNeedsManual.pdf and capacity-building as part of a larger national HIV prevention strategy. This case study documents the Cambodian defense sector’s effort in building HIV resilience and reflects both constraints as well as lessons learned. The Resource Needs Model (RNM) calculates the total resources needed for prevention, care, and orphan support for HIV and AIDS on a national level. The RNM can assist national-level strategic planning efforts by providing a tool and methodology to examine the financial resources needed to imple- ment a variety of prevention interventions, care and treatment programs, and orphan support. The model contains three sub-models: 1) the prevention Mainstreaming HIV and AIDS Using a Community-led Rights-Based Approach, ACORD, 2003 model, which calculates the cost of twelve prevention interventions, 2) The care and treatment model, which estimates the cost of five care and treat- http://www.acord.org.uk/TZ%20Maintstreaming.pdf ment programs and 3) The orphan support model, which calculates the cost of three interventions to support children orphaned by AIDS. It is suggested in this report that mainstreaming HIV and AIDS goes hand in hand with a rights-based approach, as it allows the agency to identify and tackle some of the underlying causes of HIV and AIDS vulnerability which are rooted in social inequality and social exclusion. Supporting National HIV and AIDS Responses: An Implementation Approach, UNDP, April 2004 Monitoring HIV and AIDS Programmes: a Facilitator’s Training Guide, FHI, 2004 http://www.undp.org/hiv/docs/supporting-national-hivaids-responses.pdf http://www.fhi.org/en/HIVAIDS/pub/guide/meprogrammeguide.htm This document aims to complement existing tools and UNAIDS guides to the strategic planning process for national responses, and will assist in promot- This training resource is designed to build skills for conducting quality monitoring and evaluation activities. The course is anchored by three core ing HIV and AIDS mainstreaming in countries’ development planning processes. Its purpose is to introduce new methodologies aimed at promoting modules: Introduction to M&E; Collecting, Analysing and Using Monitoring Data; and Developing an M&E Work Plan. The course features seven ad- a deeper understanding of the complexity of the epidemic, and to strengthen the process of strategic planning, so that it is made more viable and is ditional modules designed for specific contexts, such as home-based care programmes, voluntary counselling and testing programmes, programmes geared to support a continuum of planning, implementation, evaluation and assessment of national responses. for orphans, and clinical care activities. Each module includes both a facilitator’s guide and a participant’s guide. The training is based on adult learning theory and is a combination of lectures, discussions, small group work, interactive practical exercises and role-plays. Support to mainstreaming AIDS in development–UNAIDS Strategic Note and Action Framework, UNAIDS, 2004-2005 Multisectoral responses to HIV and AIDS: a compendium of promising practices from Africa, USAID, 2003 http://www.unaids.org/html/pub/una-docs/mainstreaming_strategynote_en_pdf.pdf http://sara.aed.org/publications/hiv_aids/aids_in_africa/Multisectoral_Responses.pdf The UNAIDS Programme Coordinating Board instructed the UNAIDS Secretariat in 2003 to assist countries in developing their capacity to measure the This document describes promising practices identified by USAID-supported private voluntary organizations. It includes new ideas that as such, do not impact of AIDS, as well as to incorporate AIDS into major development instruments and sectoral programmes. This instruction has been translated into yet have hard evidence to show that they work. The compendium covers the following sectors: Agriculture, Food Security and Nutrition; Capacity and a Key Result in the Secretariat’s Biennial Action Framework: “HIV and AIDS is integrated and mainstreamed into relevant development frameworks.” Human Resources Development; Care and Support; Children; Conflict and Humanitarian Relief; Democracy and Governance; Economic Development and The objective of this strategy note is to promote a common understanding of the concept of mainstreaming, to summarize the lessons learned from Microfinance; Education. documented current practice, including the main challenges to effectively mainstreaming AIDS (section 4); and to propose the UNAIDS Secretariat’s Action Framework to strengthen support to mainstreaming processes in partner countries 100 ANNEX 1: SUGGESTED READINGS ANNEX 1: SUGGESTED READINGS 101 A1 Annex 1: Suggested Readings Annex 2: Suggested Tools A2 Toolkit to Support the Mainstreaming of HIV and AIDS: Fundamental Disciplines(CD-ROM), UNDP, 2004 STEP 1: DEVELOPING A SHARED GOAL AND COMMITMENT http://www.undp-saci.co.za/ This Fundamental Disciplines toolkit presents a range of concepts, methods and tools for reviewing and integrating HIV into UNDP-supported country Conversations for Generating Possibility and Opportunity programmes and approaches to solving problems that are likely to be encountered. The purpose of this toolkit is to provide readers with basic concepts in organizational learning and change, systems thinking, strategic thinking and planning so as to facilitate a clear understanding of the interlocking 1. Conversation for Generating Shared Possibility challenges of HIV and AIDS, poverty and disaster, with the view of developing policies, strategies and actions that will enable countries to meet their national development goals. The outcome of this conversation is that together, we are able to see a new future as possible and desirable. That future may be beyond our current skills and knowl- Turning Bureaucrats into Warriors: Preparing and Implementing Multi-Sector HIV-AIDS Programs In Africa - edge, and is certainly not ‘predictable’, but we can see it as within our realm of A Generic Operations Manual Jonathan C. Brown, Didem Ayvalikli and Nadeem Mohammad possibility. It is through this we can jointly develop goals. http://www.worldbank.org/afr/aids/gom/manual/World%20Bank%20GOM%20Final%20June.pdf Appropriate Speaking: The purpose of this Generic Operations Manual (GOM) for Multi-Country HIV-AIDS Programs in Africa (MAP) is to provide guidance and lessons learned to turn HIV-AIDS bureaucrats, wherever they may be, into “HIV-AIDS warriors,” to recognize that halting the spread of the epidemic and reducing its • Declarations: A declaration literally makes something so just by saying so. impact requires a war-like commitment and a warrior mentality. These guidelines on preparing and implementing multi-sector HIV-AIDS programs are based on many lessons learned in Africa over the last three years and are designed as a generic operations manual (GOM) from which countries and It is a statement made by someone who has the authority in the matter at implementing agencies can learn and adapt for their own use. hand. We all grant a person the authority to speak for themselves in the mat- ters of what they see as possible and what they are committed to. UNAIDS Joint Report – National AIDS Programme: A guide to monitoring and evaluating HIV and AIDS care and support, UNAIDS, 2000 • Affirmations: By making an affirmation you demonstrate your support for http://www.unaids.org/html/pub/publications/irc-pub06/jc1013-caresupport_en_pdf.pdf and alignment with the other person and their expression of their vision. This guide aims to support national AIDS programme managers in monitoring and evaluating public and private care and support programmes for HIV • Questions for Clarity: Since the speaker is the authority in saying what is and AIDS. It briefly describes what care and support programmes are, what a system for monitoring and evaluating care and support should look like, and indicators for monitoring and evaluating various components of a care and treatment programme. Final sections on operations research and related possible for them, they have generated that possibility just by saying it. The reading are also included. only questions to be asked should be framed in terms of: “Did you mean…” or “Could you clarify…?” United Nations Learning Strategy on HIV and AIDS: Building competence of the UN and its staff to respond to HIV and AIDS, UNAIDS, 2004 Appropriate Listening: http://unworkplace.unaids.org/espanol/common/docs/un_learning_strategy.pdf and http://unworkplace.unaids.org/ • Listening for Possibility: As the other person is speaking, ask yourself, “What UNAIDS developed a comprehensive learning strategy on HIV and AIDS for the UN system at different levels: 1) Basic HIV and AIDS competence for all does what she is saying make possible?” “If what they are saying is possible, staff 2) Broad knowledge for professional programme/project staff, to allow them to work within UN frameworks to mainstream HIV and AIDS into all programmes 3) Core competences of UN HIV and AIDS Theme Groups and heads of UN agencies 4) Specialist competence of Technical Working Groups what would that make possible?” You are then ready to declare a possibility and professionals who need to plan, facilitate implementation, monitor and evaluate joint UN programmes that expands the possibility just declared. • Listening for Alignment: As the other person is speaking, ask yourself ques- tions like, “Is this consistent with my stands, values and commitments? Am I aligned with this possibility? Is the speaker coming from where I come from and heading where I’d like to go?” 102 ANNEX 1: SUGGESTED READINGS ANNEX 2 SUGGESTED TOOLS FOR STEP 1 103 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 2. Conversation for Generating Shared Opportunity STEP 2: PREPARING THE SECTOR HIV AND AIDS PROFILE The outcome of a Conversation for Opportunity is that we build a bridge from Situation and Response Analysis Tools possibility toward action. We are seeking ways to make our new possibility achiev- able. In these conversations we make use of knowledge, evidence, preference and 1. WILBER FOUR-QUADRANT FRAMEWORK: MAPPING HIV AND AIDS opinion in evaluating possibilities for action. In this way, they honor, but are not SITUATION AND RESPONSE bound to, the past. They can transform possibilities into openings so powerful To respond effectively to the HIV and AIDS epidemic, we must develop an under- that action is irresistible. They are the point at which choice is made: Go, or no go? standing of the complexity of the problem. It is essential that we have frameworks To which plan or direction or strategy do we commit ourselves? that allow us to ask the right questions and see how the overall response matches Appropriate Speaking: the situation. • Speculative Assessments: If we were to implement this idea, how might we The Wilber Four-Quadrant Framework8 helps facilitate awareness of the interac- go about it? What are the potential benefits of this approach? The possible tion between four different domains of experience: 1) Individual attitudes that costs? How might we deal with the possible breakdowns we will encounter? fuel the epidemic 2) Individual behaviour and actions 3) Collective values, norms What could be our first steps? and culture, and 4) Systems, structures and institutions. The Framework deepens • Declarations: The successful conclusion of a conversation for opportunity understanding of the HIV and AIDS epidemic by demonstrating the links between naturally calls for a declaration of commitment. “We will make this new pos- individual and group attitudes or norms and consequent actions by individuals sibility happen!” “It shall be done!” and groups. Appropriate Listening: The Four-Quadrant Framework lends itself very well to graphically mapping the current situation and response from the perspective of four distinct domains • Listening for Enhancement: How can I take the idea that has just been ex- and clearly shows gaps in the type of responses we conduct. Most responses are pressed and expand upon it? What other actions could follow from the one in the area of the collective systems and structures. Very few address the other being expressed? the quadrants. • Listening for Feasibility: How could this idea be made to work, given what I This mapping approach looks specifically at direct and indirect factors that favour know about our shared circumstances, resources, information, etc.? the acceleration of or impede the spread of HIV, and the factors that favour or • Listening for Alignment: As the other person is speaking, ask yourself, “Can I impede achieving the best possible results, including for those living with HIV and see the opportunity that is being spoken?” AIDS or for their families and communities. For example, increasing condom use is about individuals changing their behaviours. Yet very few responses address the underlining individual attitudes and behaviours but rather on procurements, organizations and other systemic issues. 8. Adapted from the work of noted social scientist Ken Wilber 104 ANNEX 2 SUGGESTED TOOLS FOR STEP 1 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 105 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Four-Quadrant Framework Instructions for using the tool 1. Collect all available and relevant documentation describing the sector/orga- Individual – attitudes and values Individual – behaviour and skills nization and the HIV and AIDS epidemic. 2. Review the information, deciding what is of most importance for planning Collective – culture and norms Collective – systems and structures purposes. 3. Capture this critical information under the headings below, making sure that the document is written in a manner that will be accessible to decision-mak- As a group mapping exercise: ers, community and sectoral leaders. 1. Discuss and write down the direct and indirect factors driving the epidemic Create a picture of the sector/organization and of the HIV and AIDS epidemic in all four domains under the following headings: 2. On another flip chart, discuss and write down the current responses for the four domains Basic/contextual information about the sector/organization 3. Analyze the gaps and take note of the mismatch between the causes and • The strategic vision and the goals and targets of the sector/organization responses • Area covered by the sector/organization – size and any important features 4. When planning and prioritising activities, make sure to cover these gaps • Population – size, demographics, distribution, etc. • Staff composition 2. SITUATION ANALYSIS • Social and economic base and defining factors in the macro environment Source: Adapted from HIV and AIDS Mainstreaming Tools: A set of tools for developing mainstreamed responses to the HIV and AIDS epidemic, HEARD, July 2005, Tool # 3. • Structures – statutory and other • Means of coordination within the sector/organization and with other sectors Description and purpose of the tool and organizations This tool guides users through a process in order to create a picture of the epi- • Services (and sales and revenue generation) demic in a particular area. This tool can also be used (in conjunction with other tools) to develop a briefing paper that can inform the HIV and AIDS mainstream- • Planning processes ing process, as well as be used for advocacy and resource mobilisation purposes. • Partners Who will use the tool and when • Budget The tool can be used by officials or work groups tasked with facilitating an HIV HIV and AIDS information – internal and AIDS mainstreaming planning process. It should be used during the prepa- • Who is infected or susceptible? ratory steps to the actual planning process. • Why (any important determinants)? • What are the implications – now and in the future? 106 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 107 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 HIV and AIDS information – external External domain • Who is infected or susceptible? Impact - external Short Medium Long Severe Moderate Low Notes term term term impact impact impact • Why (any important determinants)? • What are the implications – now and in the future? Reduced economic growth Reduced household Document the following variables: incomes • Age and gender differences in susceptibility Reduced ability to pay for services • A description of interactions that increase susceptibility to HIV infection Affected income and • How women and men, and girls and boys, differ in how they are affected by expenditure patterns the epidemic Increasing numbers of orphans Then it may be useful to think about and record the implications in the Reduced projected population following matrix. Reduced life expectancy Internal domain Increased infant mortality Impact-internal Short Medium Long Severe Moderate Low Notes Increased need for term term term impact impact impact health care Increased poverty Increased mortality Increased aged population needing care Increased absenteeism Increased costs (benefits, training etc) Reduced productivity Quality of service delivery affected Loss of institutional memory Loss of skills Poor worker morale 108 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 109 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 3. RESPONSE ANALYSIS In addition, review the following checklist that represents a comprehensive list Source: Adapted from HIV and AIDS Mainstreaming Tools: A set of tools for developing mainstreamed responses of HIV and AIDS interventions to identify those that may be within the scope and to the HIV and AIDS epidemic, HEARD, July 2005, Tool # 4. mandate of the sector/organization: • Organizational HIV and AIDS audit – Workplace HIV and AIDS policy Description and purpose of the tool: • Co-ordinator and workplace HIV and AIDS structure This tool enables users to follow a step by step process to review how the sector or organization and its partners have responded to the HIV and AIDS epidemic. In • HIV and AIDS leadership and management commitment conjunction with the situation analysis, this tool can be used to develop a briefing • HIV and AIDS legal compliance paper that can be used in a number of situations. • Behavioural surveillance, the KAP survey, biological HIV surveillance Who will use the tool and when: • HIV and AIDS risk and impact assessment The tool can be used by officials or work groups tasked with facilitating an HIV • Managing the human resource implications of the HIV and AIDS epidemic and AIDS mainstreaming planning process. It should be used in the preparatory • HIV and AIDS social investment phase to the actual planning process. • Prevention through behaviour change communication Instructions for using the tool • Peer education, condom promotion and distribution, STI management 1. Collect all available and relevant documentation describing the past and cur- • Safe working environment rent responses to the epidemic. • Voluntary counselling and testing (VCT) 2. Follow the steps in the tool. • Prevention of mother to child transmission (of HIV) (PMTCT) 3. Carry the final list of activities forward and use as a basis for subsequent plan- ning activities. • Wellness programmes Follow the directions as described below: - Nutritional advice and support – lifestyle education One: Analyse each of the listed responses for their impact, effectiveness, accept- - Treatment of minor ailments – treatment of STIs ability and cost-efficiency to get an indication of which activities should be con- - Reproductive health services for women – tinued at their present level, which should be scaled up or rolled out and which prevention of opportunistic infections should be discontinued. - Treatment of opportunistic infections – This can also be done as a SWOT exercise, if preferred. highly active antiretroviral therapy (HAART) Two: Then select those that are in line with the national HIV and AIDS objectives - Psychosocial support – family support and are within the mandate and competency of the sector/organization and - Referral networks and partnerships should therefore be part of its HIV and AIDS plan. 110 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 111 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Three: Discard or amend any activities that are clearly outside of the scope of the 4. IMPACT ASSESSMENT sector/organization. Then cluster the remaining activities under headings that Predicting the impacts of AIDS on the organization, and analysing the options relate to the sector’s or organization’s HIV and AIDS objectives. Examples of such for responding headings may be: Source: Excerpt from -Mainstreaming HIV and AIDS in Development and Humanitarian Programmes, Oxfam 1: Enabling environment GB, Action Aid, and Save the Children UK, 2004: http://www.oxfam.org.uk/what_we_do/resources/downloads/ mhivaids.pdf 2: Prevention 3: Access to treatment, care and support services In choosing a method for predicting the impacts of AIDS, organizations need to 4: Impact mitigation services balance the accuracy that they want against the investment that they are able to make. A full institutional audit is a complex and time-consuming process that re- 5: Integrated and coordinated programme management at all levels quires external expertise. It is most often used by large businesses, which can use Four: Examine the resulting picture and note any gaps. For example, the examina- computer modelling and HIV testing to undertake sophisticated predictions and tion should reveal the services being used by people living with HIV and AIDS and analyses of the likely impacts of AIDS on their profits, as well as the cost effective- the services they need. It should also indicate any differences in the experiences ness of various ways of responding. of women and men. For other organizations, such as NGOs, which do not measure their success in This list forms the basis for other processes that will add to or refine the activities terms of profit and loss, a more basic and less costly method is likely to be more to be included in the HIV and AIDS mainstreamed response. appropriate. However, there is little guidance available to them that is specific to their needs. The process described here is a basic approach to predicting the impact of HIV and AIDS which can be undertaken without the expense of hiring external experts. The starting point is to assess the rate of HIV prevalence and cases of AIDS within the organization over a period of time; perhaps five or ten years. This is done by taking the number of employees and applying assumptions about the rate of HIV among them; the proportion of HIV-positive staff who are in the final stage of HIV infection (suffering from AIDS); and how many of the employees with AIDS leave the organization each year. Table 3 shows an example of a fictional organization with 100 employees, which finds that three of its staff may develop AIDS each year. The next stage is to consider the direct financial costs to the organization, such as health-care costs. One must build in assumptions about the average costs incurred for employees who do not have AIDS, and those incurred by staff with AIDS. Table 4 shows this stage for the organization featured in Table 3. The calcula- tions suggest that its health costs will be seven per cent higher than they would have been without AIDS. 112 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 113 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Table 3: Predicting the Prevalence of HIV and AIDS within an organizations Table 5: Predicting the indirect cost of absenteeism Predicting the direct cost of absenteeism Days Notes Predicting HIV and AIDS prevalence Employees Notes within the organization J: maximum allowable days’ paid sick leave 50 Average employee uses 50% of this per employee per year A: number of employees 100 K: maximum allowable days’ unpaid leave 60 Average employee uses none of this per employee per year B: assumed proportion of employees who are HIV+ 20% National prevalence is 20% A x B = C: estimated number of HIV+ employees 20 A x (50% of J) = L: likely absenteeism, 2,500 without AIDS D: assumed proportion of HIV+ employees with AIDS 15% National average is 15% (A – E) x (50% of J) = M: likely absenteeism 2,425 National average is 15% C x D = E: estimated number of employees developing 3 among employees who not have AIDS AIDS each year (E x J) + (E x K) = N: likely absenteeism 330 Assume staff with AIDS will take among employees with AIDS 100% of allowable sick leave and Table 4: Predicting the direct cost of health care for employees wit AIDS unpaid leave Predicting the direct cost of Current unit Notes (M + N – L) / L x 100 = estimated percentage 10% health care increase absenteeism as a result of AIDS F: maximum allowable health 1,000 cost per employee A x (30% of F) = G: likely health 30,000 Assume average employee uses The calculations above could be made more complex, to reflect more closely the costs, without AIDS 30% of allowable health costs situation in a real organization, in the following ways: (A – B) x (30% of F) = H: likely 29,100 health costs for employees who 1. Add extra columns to predict impact over more than one year. The calcula- do not have AIDS tions would need to make allowance for any likely changes over time, such as E x F = I: likely health cost for 3,000 Assume staff with AIDS will use the effects of inflation, or predicted changes in HIV prevalence. employees with AIDS 100% of allowable health costs 2. For a large organization, it may be appropriate to introduce different assump- (H + I – G) / G x 100 = estimated 7% percentage increase in health tions about levels of HIV prevalence for different types of staff. costs as a result of AIDS 3. Take account of costs incurred where employees are HIV-positive and becom- ing sick periodically, but not yet suffering from AIDS. The final stage concerns the indirect costs to the organization, such as the impacts 4. Include employees’ dependents in the figures, if they are covered by the of AIDS on staff absences from work. By making assumptions about the amount of organization’s benefit schemes. leave taken on average by staffs that do not have AIDS, and the amount taken by 5. Include other direct costs, such as terminal benefits which are paid when an staff with AIDS, one can estimate the effect that AIDS might have on overall levels employee dies or retires due to ill health. of absenteeism. 6. Include other indirect costs, such as those for recruiting and training staff to Table 5 suggests that the organization will experience 10% more days of staff replace those who leave due to AIDS, or absenteeism due to staff members absence than it would have without AIDS. taking time off to care for dependents with AIDS. 114 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 115 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Because the calculations are based on many assumptions, those assumptions with the opportunity to contribute to the transformation of that organization into have a big effect on the predictions. Once the calculations are set up as a spread- one that is more able to achieve the goals it sets for itself. sheet, different assumptions can be put in, to generate different scenarios, such Using this model helps one become aware of leadership styles and approaches, as worst-case and best-case predictions. The spreadsheet can also be used to and it works as a framework for taking the next step towards a more developed explore the effects of changing variables: for example, the number of dependents stage. This model is used to explore and actively address the constant interaction per employee who are entitled to receive benefits from the organization. Parallel between individual and institutional attitudes, goals and practices in the achieve- spreadsheets can also be used to explore the costs and benefits of options such as ment of sustainable results in HIV and AIDS. providing antiretroviral treatment for employees and/or their dependents. The process of doing such calculations might be the responsibility of one or a few Levels of Organizational Development members of staff, but it is important that a wider range of staff be consulted. Infor- mation may need to be obtained from outside the organization: for example, data Unorganized about local HIV prevalence rates, and the length of time that an employee with Coercive - Autocrat AIDS may continue to serve the organization, according to the various treatment options. Rules & Roles - Manager The quantitative findings of such an impact assessment might also be combined 1 Pragmatic - Leader with research into current impacts of AIDS on staff, to consider future impact fac- 2 tors such as quality of work, loss of experience and staff morale. The findings of 3 Principled - Facilitator both forms of research – the impacts already experienced, and the impacts that 4 are predicted – can then inform and be used to support the case for other aspects Perspectivist 5 of internal mainstreaming of HIV and AIDS. In particular, this would include the formulation or revision of a workplace policy. 1. COERCIVE (also called Authoritarian Exploitative). The most basic 4. PRINCIPLED. The leader’s position reverses – the leader is now not 5. INSTITUTIONAL ASSESSMENT TOOL form of organization is exploitative and despotic. The attitude of the at the forefront, but at the back, acting as a facilitator. The means are leader (as dictator) is that employees are animals and machines to be as important as the ends – how you achieve results is as important as used up; more can be found to replace them. getting the results. There is attention to sustainability and development. Likert’s Levels of Organizational Development Organization and leadership is values-based. The leader’s job is to em- 2. RULES & ROLES (also known as Benevolent Authoritarian). This is brute bureaucracy at its lowest form. Bosses are managers, not leaders; power others and facilitate their development. This model of organizational development is based on the Rensis Likert Scale and they tend to micromanage, creating the typical bureaucratic environ- 5. PERSPECTIVIST. This involves the ability to see through multiple was further developed and refined by Dennis Emberling. It explains how organiza- ment and rules, which include staying safe (risk aversion), obey rules no lenses and apply different solutions to different problems without at- tions, as entities, tend to be governed by certain ground rules and assumptions. It matter what (no initiative or creativity), and don’t make mistakes. Posi- tachment to one approach or perspective. Principles are important but tive aspects can be continuity and reliability. not adhered to blindly. In this stage, the intellectual and philosophical describes how organizations and institutions evolve through different stages, and perspective can shift to respond to the needs of the situation. Leadership 3. PRAGMATIC. This level is focused narrowly on results as opposed to how they – through strategic and conscious effort – can change their focus, goals narrowly focusing on process, as above. The desired result is the objective, totally decentralizes and only appears when needed. and operating structures to become more self-aware, principled and effective. sometimes ruthlessly and expediently achieved. The end is considered to justify the means. There are often unintended consequences. The boss Understanding the ‘personality’ or ‘style’ of an organization or institution helps us appears to be a charismatic and heroic leader, to guide by example, and better understand the roles we play as members of that community. It provides us consult extensively with this or her teams. 116 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 ANNEX 2 SUGGESTED TOOLS FOR STEP 2 117 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 STEP 3: FORMULATING AN ACTIVITY PLAN FOR MAINSTREAMING 2. CONVERSATION FOR GENERATING ACTION 1. HIV AND AIDS MAINSTREAMING ACTION PLANNING TEMPLATE The outcome of a Conversation for Action is that we become clear who has com- mitted to do what by when. This is particularly important during plan formulation and implementation. We can lead by focusing on results. Whereas assessments NAME OF SECTOR/ORGANIZATION: ____________________________________________________ (judgments, opinions, points of view) have their place, in a conversation for action they make no difference. In fact, once we have reached the point of committing to INTERNAL OR EXTERNAL: __________________________________________________________ one another, assessments impede action. Conversations for Action are spoken in the form of: Priority Strategy: Promises for specific actions in specific time frames: Objectives Related to Strategy Activities Time Frame Responsible Cost Person/Agency “I promise you that I will (make/produce/deliver, etc.) (some specific outcomes) by Objective 1 Activity 1 (some specific time).” Activity 2 Requests for specific actions by specific individuals in specific time frames: Etc. “I request that you (make/produce/deliver, etc.) (some specific outcome) by (some specific time).” Committed responses to a request include: Objective 2 Activity 1 • Accept, or Decline Etc. • A Counter-Offer can be made, which leads to negotiation, which leads ultimately to Accept or Decline • A promise to respond later can be made, which leads to a future conversa- tion, resulting in Accept or Decline A Request cannot be considered complete until the request has been accepted or declined. 118 ANNEX 2 SUGGESTED TOOLS FOR STEP 3 ANNEX 2 SUGGESTED TOOLS FOR STEP 3 119 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Example of an HIV and AIDS MAINSTREAMING Plan Example of an HIV and AIDS MAINSTREAMING Plan Objectives Activities Time Lead Actors Costs Partners Outcomes Indicators Objectives Activities Time Lead Actors Costs Partners Outcomes Indicators Frame Frame To provide Monthly staff Monthly HIV and AIDS People living Staff more ❑ of staff attend- To reduce Media Month Media liaison All stakehold- Significant re- # of clients adequate discussions focal point with HIV aware of HIV ing HIV and AIDS-re- campaign on 4 to department, ers working duction in AIDS- changing information on HIV and and AIDS and AIDS & AIDS events lated stigma AIDS-related month with support in the related stigma & attitudes & on HIV and AIDS-related sector response ❑ of staff aware & discrimina- stigma & 10 from HIV and identified discrimination behaviour to- AIDS to staff by topics of HIV and AIDS tion among discrimina- AIDS focal regions/ wards people the end of the and sector stakeholders tion among point communities, living with HIV current year response clients including and AIDS ❑ of leaflets people living To use BCC BCC activi- Twice a HIV and AIDS Staff changing distributed with HIV programme ties, includ- month focal point attitudes and and AIDS EXTERNAL Proportion of ing peer with peer sexual behaviour staff adopting education educators safer behaviour To ensure Cost assess- Within 3 Finance Sector is Report on loss and personal financial sus- ment of loss months department better prepared of revenue due risk assess- tainability and of revenue for financial and to HIV and AIDS ment equitable access due to HIV service delivery Understanding HIV and Every HIV and AIDS to services for and AIDS implications of of how HIV and AIDS/STI two focal point affected house- HIV and AIDS, AIDS threatens materials months holds and target which informs financial basis development population future planning & distribu- Feasibility Within 5 Finance Institutional Report on tion study into months department commitment cross-subsidisa- To overcome Conduct or- Within 6 Human Understanding cross-sub- to continued tion measures gender barriers ganizational months resource of gender sidisation service delivery in employment audit to department barriers that measures to affected and career assess restrict women’s households advancement gender rep- employment related to HIV resentation and advance- & gender ment in the barriers sector Commitment to address gender barriers Development Within 8 Human Employment Employment of employ- months resource equity policy + equity policy ment equity department programme ❑ of staff aware policy Support for of policy + employment implications equity across organization 120 ANNEX 2 SUGGESTED TOOLS FOR STEP 3 ANNEX 2 SUGGESTED TOOLS FOR STEP 3 121 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 STEP 4: COSTING MAINSTREAMING ACTIVITIES 3. Target Indicators: This block gives an indicative (targeted) unit number of ‘VCT Costing and Budgeting: Methodology and Layout of the Framework Clients’, or ‘New (VCT) sites’ or ‘Number (of counsellors) trained’. Occasionally, Source: UNAIDS Planning, Costing and Budgeting Framework – November 2003 the target indicator could be in percentages. Each year for the planned period (e.g., 3, 4 or 5 years) is assigned its own column. This layout allows for easier identification of the various elements in a scaled up response. For a five (5) year A. METHODOLOGY plan therefore, this block will occupy five columns. The Planning, Costing and Budgeting Framework is presented in a logical, step by 4. Input Measure: This occupies the next column after the Target Indicators block step format. and describes the measure of the relevant input. For example, training would • Firstly, the approach of moving from each goal down through the planning lev- normally be measured in ‘days or weeks or months’, consultancy in ‘person days’, els to the activities and inputs level accentuates the need to quantify each level posters in ‘numbers’, furniture & equipment in ‘numbers’ or ‘lots (i.e. sets)’, etc. and link each level to the preceding level. 5. Units of Inputs: This covers the Input per Target Unit and the Number of Inputs • Secondly, it encourages the identification and quantification of the critical inputs for each year of the plan period. The first part will have the number of inputs needed for each activity and putting a cost to each of these inputs, thereby arriv- per target unit. For example, if it requires 5 days to train each professional ing at an informed cost of any activity, strategy or objective. counsellor, this column will have the number 5. The next columns, equivalent • Thirdly, the summation of these costs will provide a reasonable budget estimate to the number of years for the plan period (e.g., 5 years), will each have the for the HIV and AIDS programme. total number of units required to train, say, the target number of professional counsellors for that year. These figures are obtained by multiplying the number in the Input per Target Unit Column (e.g., 5) by the target number of trainees B. LAYOUT for that year. Once again, each year is shown differently in order to show how a The planning, costing and budgeting framework is provided on an electronic particular intervention is being scaled up, if at all. spreadsheet model. It is divided into eleven (11) blocks covering the following: For activities that require inputs for the entire period under consideration 1. Objectives, Strategies and Activities: This occupies the first column of the work- (e.g., 5 years), such inputs will need to be shown for each of the five years. sheet. This column outlines the programme Objectives that contribute towards For once only types of activities, or those less than 5 years, their inputs will achieving the set Goal(s), followed by Strategies that contribute towards each only be reflected in the year(s) in which they are relevant. objective, followed by Activities that ensure the realization of each stated strat- It must be noted that Yr. 1 would, to some people, imply the current year and, egy. It should be noted that it is possible to have several strategies to achieve to others, the first year of projection. In order to eliminate this confusion, it may an objective, and several activities to achieve a strategy. be necessary to introduce a column for Yr. 0 which would hold figures for the 2. Target Description: This occupies the second column in the worksheet. The Tar- current (base) year, with Yr. 1 – 5 being only projected input figures. get Description describes what is required to achieve each objective, strategy or activity (the output). 122 ANNEX 2 SUGGESTED TOOLS FOR STEP 4 ANNEX 2 SUGGESTED TOOLS FOR STEP 4 123 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 6. Cost Type: This comes next to the Units of Inputs block and describes the ex- 10. Financing Gap: This column provides for the shortfall (gaps) that may exist penditure category of each input. Inputs can be grouped into capital (vehicles, between the estimated cost for each activity/ strategy/objective and the avail- equipment, buildings, non-recurrent training, etc.) and recurrent (personnel, able resources. This column is very critical in that it reflects financing gaps that supplies, vehicle operation, building operation, training, etc.). may exist. It is this column that countries will use when seeking additional It is advisable that the grouping of inputs should match with that used in the funding from other donors, including the Global Fund for AIDS, Tuberculosis government accounting system or with the Global Fund classification. Using the and Malaria (GFATM). latter, for example, the following expenditure categorization key is adopted: 11. Responsible Agency: This has been added to provide managers with an A. Human Resources: Consultants, recruitment, salaries of front-line indication of which agency/organization is responsible for which activity or workers, etc. programme. This column can also be useful when allocating disbursed funds for HIV and AIDS programmes, as well as in the monitoring of programme B. Infrastructure/Equipment: Building infrastructure, cars, micro- implementation. scopes, etc. A sample complete Framework worksheet would, therefore, look as shown on the C. Training/Planning: Training, workshops, outreach, meetings, etc. next page: D. Commodities/Products: Bed nets, condoms, syringes, educational materials, etc. E. Drugs: ARVs, drugs for opportunistic infections, TB drugs, anti-malaria drugs, etc. F. Monitoring and Evaluation: Data collection, analysis, reporting, etc. G. Administrative Costs: Overhead, programme management, audit costs, etc. H. Other (Specify) This column will therefore only indicate ‘A’, or ‘B’ or ‘G’, as the case may be. 7. Unit Cost (Yr. 1): This covers the next column of the worksheet and describes the unit cost of each input in the current or first year of programme implementa- tion. 8. Cost in (currency): Has a column for each year of the plan period (e.g., 5 years) that contains the cost of each input. 9. Source of Funding: Lists the major sources of funding for each activity/strategy. Each source of funding (e.g., government, donor, etc.) should be assigned a separate column for easy identification. 124 ANNEX 2 SUGGESTED TOOLS FOR STEP 4 ANNEX 2 SUGGESTED TOOLS FOR STEP 4 125 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 STEP 5: IMPLEMENTING PLANNED ACTIVITIES AND DOCUMENTATION Responsible 1. IMPLEMENTATION FRAMEWORK Agency Financing Sector / Organization / Department: Gap Internal / External Intervention area: 1 2 3 4 5 G D O Objective: Financed Objective indicator: (in Currency) By Y E A R S Strategy Activities Responsible Other Time Output Budget Technical person Partners frame Funding Source Assistance Cost Lead unit Strategy 1 Activity 1 Unit Yr. 1 Cost Type Cost Activity 2 Y E A R S 1 2 3 4 5 Strategy 2 Activity 1 Units of Measure Inputs Proto-type Complete Framework Worksheet Activity 2 Input Activity 3 Y E A R S 1 2 3 4 5 Description Indicators Target Etc. Target Activity 1.1.1 Activity 1.1.2 Activity 1.2.1 Activity 1.2.2 Activity 2.1.1 Activity 2.1.2 Activity 2.2.1 Activity 2.2.2 Etc, etc, etc.c Strategy 1.1 Strategy 1.2 Strategy 2.1 Strategy 2.2 Objectives/ Objective 1 Objective 2 Strategies/ Activities 126 ANNEX 2 SUGGESTED TOOLS FOR STEP 4 ANNEX 2 SUGGESTED TOOLS FOR STEP 5 127 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 STEP 6: TAKING STOCK 2. ACTIVITY AND FINANCIAL MONITORING TEMPLATE Tool for a Monitoring an HIV and AIDS Plan (Adapted from the Ghana District Response Initiative guide) Source: Adapted from HIV and AIDS Mainstreaming Tools: A set of tools for developing mainstreamed responses to the HIV and AIDS epidemic, HEARD, July 2005, Tool # 12 SECTION 1: Data Description and purpose of the tool: 1.1 Sector/organization’s Name 1.2 Report No.: This tool provides guidelines on how to develop indicators and a monitoring plan, 1.3 Budget 1.4 Report Period:(1st quarter, 2nd quarter etc.) and some tips on reporting on an HIV and AIDS plan. Without an effective moni- toring plan it is impossible to manage implementation, to measure progress in SECTION 2: Activity Progress (include specific outputs) a systematic way, or to report on a HIV and AIDS mainstreamed response. This is 2.1 Summarise achievements and specific outputs for the period: therefore a critical (though often neglected) part of a mainstreaming process. Who will use the tool and when: The tool will be used by the planning team, and should be used from as early in 2.2 Detail major problems identified and actions planned or taken to overcome them: the process as possible. Instructions for using the tool 1. Reconstitute the planning team, if necessary, to ensure a widely representa- Prepared by: Signature: Date: tive group of officials with information management expertise. SECTION 3: Financial Report 2. Examine available and necessary data sources to identify those that can be 3.1 Cash Position Funds Received Funds Spent Balance Available used – with or without amendments – to manage and monitor the HIV and AIDS response. 3.2 Specify disbursement as per budget 3. Then identify any information that the sector/organization is NOT currently Activities Amount Budgeted Expenditure Balance collecting that is critical for effective management and monitoring of the Activity 1 HIV and AIDS response and the actions to be taken to collect the information required to manage and monitor the HIV and AIDS response. Activity 2 Activity 3 4. Develop indicators that can be used for monitoring. Activity 4 5. And finally, formalise the HIV and AIDS reporting requirements. Etc. TOTAL 3.4 Summarise current financial status, identify problems and corrective actions. Prepared by: Signature: Date: 128 ANNEX 2 SUGGESTED TOOLS FOR STEP 5 ANNEX 2 SUGGESTED TOOLS FOR STEP 6 129 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 Follow the directions described below: • Average length of stay in medical wards • # of TB patients 1. Data sources for monitoring Monitoring requires the collection and interpretation of information over time. • # of orphans – estimated The starting point is to decide what information to collect, how often to collect it • # of orphans registered by age and sex and what the information can tell you (and what it can’t). • # of children receiving grants List the data available to the sector/organization and then mark those sources of • # of children in foster care data that can be used to track progress in implementing the HIV and AIDS plan. The data sources could include: CIVIL SOCIETY INFORMATION – # OR COVERAGE (AREA AND SERVICES) OF: BASIC DEMOGRAPHIC INFORMATION • Development NGOs with HIV and AIDS-related functions • Total population • CBOs with HIV and AIDS-related functions • Population by age and sex • HIV and AIDS Service Organizations (ASOs) • Deaths • Births HIV AND AIDS INFORMATION • Births to teenage mothers • HIV prevalence • Infant mortality rate • # of VCT centres • Under 5 mortality rate Examples of data that may be selected to track progress towards key indicators are: SECTORAL INFORMATION • HIV prevention – base-line and periodic surveys, to measure changes in knowledge, attitudes and practices; • # &/or % employed - # &/or % unemployed • Treatment and care for infected persons – records of health services, such as TB • Absenteeism days cases, to measure epidemiological (disease) trends • # of deaths in employees – # of AIDS related deaths • Social support for affected persons and households – # of children identified • # of workplaces with HIV and AIDS workplace programmes (registered) who are vulnerable or who have been orphaned, to link them to • Children in primary school by age and sex appropriate support • Children out of school by age and sex • Mitigating the socio-economic impact of the epidemic – household income levels, • Children dropping out of schools by age and sex to target poverty relief optimally • Children in secondary school by age and sex • Partnerships and multisectoral responses – HIV and AIDS activities within partners’ plans and budgets • # of STI clients Now identify any gaps in data that are critical to effective management and monitor- • # of patients admitted to medical wards ing of the HIV and AIDS response and detail the means to access this data. 130 ANNEX 2 SUGGESTED TOOLS FOR STEP 6 ANNEX 2 SUGGESTED TOOLS FOR STEP 6 131 A2 Annex 2: Suggested Tools Annex 2: Suggested Tools A2 2. Indicator development REPORT TO: _________________________________________________________ Indicators are the cornerstone of M&E. An indicator is a measure of the progress HIV and AIDS objective Indicator Data source Means of verification Deviation and reme- made towards an objective. It can be quantitative or qualitative. It can be a pro- dial action cess, outcome or impact indicator. It can also be a project target. Indicators should be: • Simple, clear and understandable as a measure of project effectiveness; • Reliable – conclusions based on any indicator should be the same, regardless of who, when and under what circumstances the assessment is conducted; • Finally, develop a reporting time line that includes deadlines for: • Replicable, allowing for comparative analysis and potential replication of the - Data collection project; and - Data analysis • Available – using data that is available. - Report preparation Select indicators carefully, since they can be difficult to change later, and make - Report submission sure that there are ways to obtain the necessary information for each indicator with a reasonable level of effort and cost. 3. Drawing up a monitoring plan The plan should state each indicator, the data to be used to measure progress or success, the time frames for monitoring each indicator and a remedial action section that will allow for changes to be made if problems are identified. 4. Reporting requirements • Identify all the sector’s/organization’s reporting requirements • Mark each of those that do (or should) include an element of HIV and AIDS reporting • Decide what is appropriate to report on in each identified instance and cap- ture this information in a template such as the example on the following page 132 ANNEX 2 SUGGESTED TOOLS FOR STEP 6 ANNEX 2 SUGGESTED TOOLS FOR STEP 6 133 A3 Annex 3: Planning and Implementation Tools Annex 3: Planning and Implementation Tools A3 Other Useful Planning and Implementation Tools Other Useful Planning and Implementation Tools Tool Uses Key Features: Strengths & Weaknesses Tool Uses Key Features: Strengths & Weaknesses Nominal Group ❑ Used to identify elements of a problem ❑ Dominance of high status and aggressive members is reduced; Boston Matrix ❑ Used to establish effectiveness of ❑ Useful for ongoing activities, suitable for response analysis Technique (NGT) especially political, social and cultural. each has equal opportunity to participate Analysis ongoing activities ❑ Could be used to establish the comparative advantages of Used to identify and rank goals and ❑ Members have opportunity to work independently institutions and implementing agencies priorities. A tool for involving person- nel at all levels in decision making ❑ Silent generation of ideas minimises interruptions in Cost Benefit Provides a comprehensive analysis of Helps to make good decisions on best allocation of to promote acceptability of the thought process Analysis costs and benefits including secondary, scarce development resources final decision ❑ Written nature increases group’s ability to deal with indirect, intangible, societal benefits and ❑ Socially desirable objectives are treated as part large number of ideas costs of a proposed project/programme of the evaluation criteria ❑ May limit cross fertilisation of ideas, reduce flexibility ❑ Helps in comparing alternatives in discussions and be expensive ❑ Many social costs and benefits cannot be quantified PEST Analysis ❑ Facilitates the analysis of the external ❑ Gives a general assessment of the political, economic, social Logical ❑ Facilitates decision making in identify- ❑ Allows users and members of the team to have a 1 page summary environment in terms of political, and technological issues that are likely to affect or improve the Framework ing project purposes and goals and in of project goals, purpose, outputs, inputs and key assumptions economic, social and technological operational success of an institution/sector planning for project inputs and outputs dimensions of a given situation ❑ Difficult and time-consuming to construct ❑ Easily adapted for programmes to include analysis of the legal, environmental, and institutional dimensions Objective Tree This technique helps to define project ❑ Facilitates the analysis and visualisation of the interrelationships Analysis objectives, their interrelationships and between objectives SWOT Analysis ❑ Used to analyse internal strengths, ❑ Provides a snapshot of internal strengths and opportunities provides a way to order them hierarchi- weaknesses, of organizations, sector, ❑ Processes for deriving the objective tree can be very involving and ❑ Used to identify the comparative advantages the organisation, cally to accomplish higher level objectives programmes, etc. and external time-consuming sector, project has over others opportunities and threats Prioritisation ❑ Used to prioritise tasks, products and ❑ Allows for the most critical activities to be undertaken first in the ❑ Not very effective if used alone Matrix services based on weighted criteria phase of limited resources (funds, manpower, time, etc.) Brainstorming ❑ Used to generate alternative solutions ❑ Original and innovative ideas are generated Also used to narrow down many identi- ❑ Tool for deciding which action to take first, where a number of Technique to a problem, identify experts fied, generated options, based on time, ❑ Promotes cross-fertilisation of ideas different possibilities exist who will aid in different problem- funds, manpower, etc. solution phases ❑ May be unproductive if members are meeting each other Scenarios ❑ Used to provide a framework for ❑ Different end results can be compared for the first time normative forecasts of desired ❑ Facilitates decision making ❑ Superior-subordinate relationships outside the session future conditions could affect the free exchange of ideas in the session Critical Path ❑ Helps in planning and managing ❑ Identifies critical activities that must be completed in time Problem Tree ❑ Used to analyse the root causes and ❑ Facilitates visualisation of problems and their effects Method the execution of activities in a project ❑ Significant reduction in project duration by avoiding Analysis effects of a given problem. It also and builds consensus among stakeholders where the activities must be unnecessary delays enables us to analyse the interrelation- performed in a specific sequence. ❑ Facilities the targeting of interventions ships between one problem and It also identifies critical activities ❑ It is difficult to analyse a CPM network if more activities are the other ❑ Demands identification of core problems which require special attention involved ❑ Process can be time-consuming ❑ Does not consider additional information a project manager Mind Mapping ❑ To investigate the aspects of any ❑ Easy to visualise may require e.g., skills base of workers situation in a very creative manner Force Field ❑ Normally used to identify the forces ❑ A good tool to identify opportunities and obstacles likely ❑ Used to generate and tease out the underlying causes of a problem Analysis that work for and against the to affect a planned activity achievement of a specific objective ❑ Cannot be used to generate solutions to problems 134 A N N E X 3 P L A N N I N G A N D I M P L E M E N TAT I O N TO O L S A N N E X 3 P L A N N I N G A N D I M P L E M E N TAT I O N TO O L S 135 A3 Annex 3: Planning and Implementation Tools Annex 3: Planning and Implementation Tools A3 Other Useful Planning and Implementation Tools Other Useful Planning and Implementation Tools Tool Uses Key Features: Strengths & Weaknesses Tool Uses Key Features: Strengths & Weaknesses Gantt Chart ❑ Used to plan or schedule activities, ❑ Simplicity; allows the timing of each task to be clearly indicated Financial & ❑ Used to gather information about ❑ Gives a summary of what activities have been undertaken determine the minimum project dura- Activity progress of ongoing activities and at what cost ❑ Sequence of critical activities is revealed and milestones can be identi- tion, given that some resources may be Reporting fied and marked ❑ Summarises the key challenges and achievements limited, and used to mark milestones Format in the project sequence. ❑ Does not emphasise the logical sequence of activities as in CPM ❑ Gives the balance of funds ❑ Facilitates management of programme ❑ Where more than one resource is limited, this does not ensure ❑ Provides opportunity for documentation and activities & resources optimum resource allocation information dissemination Work ❑ Used to break down complex projects ❑ Promotes understanding of the different activities and sub Community ❑ Used to understand the HIV and AIDS ❑ Facilitates the understanding of KAP, community responses & Breakdown into key activities and tasks activities to be undertaken within a project Assessment knowledge, attitudes and practices strategies that can be employed to check HIV and AIDS and Structure Form of a community what resources are available locally to address the problem ❑ Useful for identifying critical tasks necessary to support implementation of activities Participatory ❑ Used to solicit community level com- ❑ Promotes participation and builds confidence in the local people Rapid Appraisal munity based information; a useful Community Used to engage and animate ❑ Used as a community communication mechanisms and for identifying ❑ Promotes the use of local resources in project implementation (PRA) tool for project planning and imple- Conversa- communities to respond to key ‘burning issues’ mentation at the community level ❑ Time-consuming tion problems affecting them ❑ Useful in generating community responses and actions ❑ Effort does not always produce desired results while relying Public Sector Used to gather and analyse public sector ❑ Can be used as a checklist for national policy analysis on external agents Reform information on HIV and AIDS ❑ Usually a good tool to identify what institutions are doing Venn Diagram ❑ Used to indicate interrelationships ❑ Used to probe community conflicts, enabling, constraining Assessments ❑ Adapted from UNAIDS/WHO and used regarding HIV and AIDS, key government policies, between social/government/non- factors, level of involvement and participation of communities in DRI to assess policy, strategies, development plans, levels of implementation, etc. governmental/private/religious and institutions in HIV and AIDS activities, etc. institutional and organizational institutions and the community ❑ Used to assess public sector response to HIV and AIDS Social Mapping ❑ Used to map existing social ❑ Enables community members to know the range and number of Institutional Used for gathering and analysing ❑ Useful for understanding the scope of the sectors’ involvement institutions and significant features social institutions in the community and the activities carried Support public/private sector/NGO/CBO on HIV and in HIV and AIDS activities (e.g., type of project, target population, in a community out by these institutions For HIV and AIDS activities. Uganda & Burkina Faso are coverage of activities, and available expertise) AIDS good examples. ❑ Facilitates analysis of sources of funds, target beneficiaries and ❑ Can be used to compile a database of local institutional support for Assessment the effectiveness of the institutions HIV and AIDS activities Guide ❑ This tool is used to gather views on what developments ❑ Can be used as a process indicator of changing capacity community members would like to see in the future and how levels of institutions these could be financed and sustained Key ❑ Used to gather specific information. ❑ Human Resource intensive ❑ It is a tool for probing constraining and enabling factors Informant Used to solicit sector information on ❑ Provides detailed and targeted information, adapted from TB/HIV affecting/likely to affect development projects in the community Interview HIV and AIDS WHO Manual 1996 Guide for Community ❑ Used to gather information on ❑ Used as interview guide Integrating ❑ DRI Study Response community responses to HIV and AIDS ❑ Can be self-administered HIV and Analysis Guide either on an individual or group basis AIDS & Other Health Pro- Community ❑ Used to assess community knowledge, ❑ Facilitates community, leadership, resource mobilisation grammes Focus Group attitudes and practices and management assessments Discussion Guide 136 A N N E X 3 P L A N N I N G A N D I M P L E M E N TAT I O N TO O L S A N N E X 3 P L A N N I N G A N D I M P L E M E N TAT I O N TO O L S 137 A4 Annex 4: Suggested Websites Agency Website UNAIDS http://www.unaids.org/en/resources/publications.asp UNDP http://www.undp.org/hiv/ UNICEF http://www.unicef.org/aids/index.php UNFPA http://www.unfpa.org/hiv/index.htm WHO http://www.who.int/topics/hiv_infections/en/ ILO http://www.ilo.org/public/english/protection/trav/aids/code/codemain.htm and http://www.ilo.org/public/english/protection/trav/aids/ UNESCO http://portal.unesco.org/en/ev.php-URL_ID=1134&URL_DO=DO_TOPIC&URL_SECTION=201.html UNHCR http://www.unhcr.ch/cgi-bin/texis/vtx/directory#H WFP http://www.wfp.org/policies/Introduction/other/index.asp?section=6&sub_section=1 World Bank http://www.worldbank.org/urban/hivaids/ UNODC http://www.unodc.org/unodc/drug_demand_hiv_aids.html FAO http://www.fao.org/hivaids/publications/index_en.htm UNIFEM http://www.genderandaids.org/index.php DFID http://www.dfid.gov.uk/ GTZ http://www.gtz.de/en/themen/soziale-entwicklung/hiv-aids/894.htm Futures Group http://www.futuresgroup.com/ International HEARD http://www.ukzn.ac.za/heard/TRAINING/trainingIndex.htm SEAHIV http://www.hiv-development.org ELDIS http://www.eldis.org/hivaids/ FHI www.fhi.org 138 ANNEX 4 SUGGESTED WEBSITES ALL RIGHTS RESERVED September 2005 Publications produced by UNAIDS and UNDP can be obtained from their respective websites. Requests for permission to reproduce or translate UNAIDS and UNDP publications whether for sale or for non-commercial distribution should also be addressed to the respective addresses below. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS and UNDP concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers of products does not imply that they are endorsed or recommended by UNAIDS and UNDP in preference to others of a similar nature that are not mentioned. Errors and omissions accepted the names of proprietary products are distinguished by initial capital letters. UNAIDS and UNDP does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. JOINT UNITED NATIONS PROGRAMME ON WORLD BANK UNITED NATIONS DEVELOPMENT PROGRAMME HIV/AIDS (UNAIDS) (UNDP) Address: 20 Ave Appia, 1211 Geneva 27 Switzerland Address:1818 H Street, N.W. Washington D.C. 20433 Bureau for Development Policy (BDP), HIV/AIDS Group Telephone: (+4122) 791 46 51 Telephone: (1 202) 473 1000 Address: 304 East 45th Street New York New York 10017 Fax: (+4122) 791 41 87 Fax: (1 202) 477 6391 Fax: (1 212) 906 5023 Email: unaids@unaids.org Internet: http://www.worldbank.org Internet: http://www.undp.org/hiv Internet: http://www.unaids.org