40650 Strengthening Partnerships in HIV Monitoring and Evaluation: How joint missions build and strengthen partnerships to support the realization of the third "one" ­ national M&E systems Emmanuel Baingana Kasheeka, George Bicego, Marelize Görgens-Albino, Verne Kemerer and Masauso Nzima Summary effort, increases transaction costs for countries, and detracts from impact. There is growing interest in joint M&E missions from countries and development partners. They are proving to be one way to strengthen regional and national M&E partnerships, and provide more effective, efficient support to countries working to develop functioning national HIV and AIDS Monitoring and Evaluation systems. This note explains the background to joint missions, and the results they have achieved. It offers suggestion for preparing for a joint mission and follow-up activities. `The grip of AIDS will only be broken by effective programmes at country level. The difficulty is that agencies and funders ...operate quasi-independently of one another. What never happens is an event or process to develop integrated country strategies that focus only on the country ­ not on the interests of the agency, funder, or constituency...' Richard Horton, The Lancet, Vol. 368, August 26, 2006: pp 716-718 Photo: courtesy of UNAIDS During the "Making the money work"2 meeting held on 1. The importance of harmonization: the Three March 9th 2005, development partners, governments Ones principles and GTT recommendations from low and middle income countries, civil society, UN agencies, and other multilateral and international The "Three Ones" principles for managing HIV institutions agreed to form a Global Task Team (GTT) to responses at country level1 suggest that every country develop a set of recommendations aimed at improving should have: one national HIV strategic plan, one institutional support of the AIDS response at national AIDS coordinating authority and one national international and country levels, with a particular focus HIV M&E system. These principles were set up to guard on multilateral organizations. Weaknesses in against the proliferation of strategies, committees and implementing the HIV response were identified and the monitoring systems, which adds confusion, duplicates GTT was tasked with suggesting solutions to these challenges. 1A working group developed these guiding principles at the 13th ICASA conference in Nairobi in 2003. This led to 2`Making the money work' is a call to harmonize and a consultation on harmonization of AIDS support held in align the global response to put existing and future funds Washington D.C. on 25th of April 2004, where to optimal use while reinforcing the need for continued representatives of countries, donors and international scale-up of the national AIDS responses organizations formally endorsed the "Three Ones" (http://data.unaids.org/publications/irc-pub06/jc935- principles. 3onesinaction_en.pdf) 2. The importance of partnerships: status of The GTT developed 25 `actionable' recommendations in operationalising the 3rd of the "Three Ones" four thematic areas.3 The recommendations aimed at streamlining and simplifying the HIV response at international level, while at the same time harmonizing Why are partnerships important? Experience suggests procedures and practices to improve effectiveness of that partnerships are important because: country-led responses. GTT recommendations 4.1 and 4.2 relate to joint participatory reviews and M&E, and a) Most HIV M&E systems are not fully functional: A suggest that: rapid assessment undertaken by the UNAIDS Regional Support Team (RST) for East and Southern Africa in 2006 indicated that most Within existing participatory reviews of national AIDS countries (65% - 13 countries out of 20)4 in the East programs, UNAIDS assist national coordination and Southern Africa region have in place M&E plans authorities to lead participatory reviews of the that have yet to be implemented. The assessment performance of multisectoral institutions, made it clear that more support is required to international partners and national stakeholders that operationalise the 3rd of the Three Ones. Creating build upon existing Organisation for Economic Co- partnerships can help ensure harmonization at operation and Development / Development country level (among country level actors and Assistance Committee (OECD/DAC) standards and international development partners) and will criteria for alignment and harmonization; maximize the benefits to countries. Multilateral institutions and international partners assist national AIDS coordinating authorities in the b) National HIV M&E systems will benefit more from strengthening of their M&E mechanisms and a combined and coordinated approach than structures that facilitate oversight of and problem- disjointed actions by individual solving for national AIDS programs. agencies/organizations in pursuit of the same goal. Furthermore partnerships ensure that all partners Six specific GTT recommendations that focus on M&E follow the same vision: Building partnerships are elaborated within these two broad recommendations: require that all interested parties subscribe to a common goal and agree to use a uniform approach 1. development of a scorecard accountability tool or at least complimentary approaches to attain the and global review of partner alignment; goal. This means that all partners' plans should be in line with the national priorities as guided by the 2. a joint monitoring and evaluation facility; national M&E operational plan -- a "roadmap" to 3. joint monitoring and evaluation country support achieving the national set of M&E objectives. teams; c) Partnerships promote the use of similar 4. placement of UNAIDS M&E advisers in national offices; concepts: "Cross fertilization" of ideas encourages sharing/ transfer of knowledge and experience in 5. increased M&E role of civil society and academic developing innovative approaches to monitoring and institutions; evaluating programmatic responses. The `road map' concept (see Getting Results series) is very useful. 5 6. improved dissemination of M&E information. A road map is an agreed summary of all the activities needed to implement the national HIV M&E These GTT recommendations for HIV M&E can only be plan that also defines responsibilities of all actors implemented if there are M&E partnerships among and costs. After joint missions observed the benefits development partners and with governments. This paper of a road map in one country, the concept was also shows how joint M&E missions can serve as one avenue used in other countries to ensure that there are no for strengthening regional and national M&E critical gaps in the national M&E plans; to define partnerships. resource requirements, partner roles and responsibilities; to ensure optimum use of resources 4 This information is based on direct discussions between the UNAIDS RST-ESA and countries in the region. 3The full list of recommendations is available at: 5 See "Using National HIV Monitoring and Evaluation http://www.unaids.org/html/pub/una- Road Maps to reach the "Third One" more quickly and docs/implementrecommend_24aug05_en_pdf.pdf efficiently", GAMET and Country Partners, available on line at www.worldbank.org/aids (please go to "Getting Results") 2 through efficient allocation; and to prevent was determined to be a useful step in supporting country duplication and unplanned information products. efforts to establish one national HIV M&E system. So far, five countries have benefited from joint M&E d) Partnerships create a common platform for missions: Lesotho, Namibia, Rwanda, Swaziland, and sharing information on plans, results, and new tool Tanzania. The missions were planned well in advance, and method developments in the field of M&E. lasted up to five days and afforded an opportunity for the relevant officials from NACs, line ministries, various stakeholders including implementers (mostly civil 3. Establishing and maintaining partnerships society) and development partners to provide adequate input and most importantly tap into the visiting technical Partnerships take time and energy to maintain. It is expertise of the group. Benefits of these missions were: crucial for partners to build trust and a strong bond and spirit of team work. Creating partnerships requires: a) Development partners met with key stakeholders Defining the potential partners in strengthening the and shared technical information. During the five system. days the mission got firsthand knowledge about exactly what was going on, an opportunity to have a Defining key priorities for each partner and close look at the operations (if any) of the existing assessing available financial and human capacities. M&E system(s), meet with key players in the country Reaching consensus on roles and responsibilities, to discuss successes and challenges, hold in-depth including leadership. discussions with relevant staff within the NAC (or equivalent) ­ where necessary even with staff based Agreeing on a common platform to share at sub-national levels ­ on their roles and information, including plans and progress reports. responsibilities, and participate in national M&E Developing a joint support plan that clearly defines Technical Work Group (TWG) meetings. The host strategic areas to be supported, individual governments, through the NACs or equivalent, responsibilities and resources requirements. Within received a significant level of feedback and technical the acknowledged realities of differing funding input to national programmatic processes (in this mechanisms and administrative cultures, the plan case M&E) in a timely fashion. should also show the resources available and any remaining funding gaps. Each individual b) The joint mission could support the country- agency/organization will be responsible for providing level partners. The joint mission partners were able leadership in the areas specified in the plan. to assist the country-level M&E technical advisers to develop new strategies or find new solutions ­ Building information sharing platforms at the regional particularly where the country-level partners were and national level, e.g. regional M&E partners' forum facing a difficult issue that they were unable to solve. and national technical working groups (TWGs) are instrumental in joint planning and information c) The joint missions served as an opportunity to sharing. introduce new country-level staff, to discuss at length the challenges at country level and Organizing joint missions brings internal and external possible adjustments to the M&E advisers' job technical resources together in time and space. Such description to respond effectively to these missions ensure a common voice and promote advocacy needs. This also shortened the learning curve. For on priority issues because they enable all partners to more established officers on the ground, the mission speak with one voice. They also ensure joint periodic re-focused the existing scope of work (job monitoring of progress on the joint plan. While the description) to better respond to the needs of the driving ethic of harmonized technical support is to host country. The UNAIDS M&E advisers' and other strengthen in-county ownership and leadership, we have existing expatriate support is thus deliberately come to understand the value and recognize the need refined to help maximize and harmonize local and for periodic injection of coordinated external technical internationally committed resources for support and mentorship. implementation of effective M&E systems. d) It raised the credibility of development partners. 4. Results from joint M&E missions to five This approach raised the credibility of the partners, countries in East and Southern Africa both internally and externally, among key stakeholders, and especially governments, through their NACs (or equivalents). The missions created At the beginning of 2006, key partners working in East an `enabling environment' for on-going and Southern Africa, including the US Government, programmatic reviews of key documents such as the World Bank, UNAIDS, and the Global Fund, held a M&E roadmap (where a roadmap was not available number of meetings where the idea of joint missions the host country has relied on visiting expertise to 3 guide the process of its development). The that the comparative advantages of the partners implementation of a well developed roadmap has compliment and not compete with one another; invariably incited tremendous interest in collaboration from partners (especially international the decision to partner with any given organization partners) in-country. should be regarded as a dynamic and symbiotic process; e) It provided NACs with an opportunity to a series of meetings addressing a variety of relevant advocate for targeted support. The NACs (or topics with key stakeholders representing both equivalents) have used this assistance to effectively development partners and different governments advocate for targeted support to the national M&E ministries may also be a vital prerequisite. agenda, hence establishing a basis for synergy. The roadmap in particular also validates the work of The preliminary meetings provide a forum for various country level partners. It also brings to the fore partners to compare their strategic objectives and partners who have historically worked in an isolated intermediate results. The meetings also offer an manner, as they are able to see how and where they opportunity to thoroughly discuss the perceived and can apply their comparative advantage. stated needs of the host country for technical assistance and to identify which organizations are capable of f) It provided national stakeholders with an supporting those requests. These partnerships usually opportunity to participate more effectively in the are most productive if the relationships initiated during national HIV M&E system. One national entity in preliminary meetings are nurtured and developed and Swaziland determined that if they did not are responsive to the changing needs of the host collaborate, their efforts ran the risk of being missed country. on the national M&E radar screen. In short, based on assessments of the information shared by the Discussions that determine whether a joint M&E country mission, potential stakeholders concluded - at their mission makes sense can be initiated n the context of own discretion - that the benefits of being part of the the UN AIDS Theme Group, NAC, or one or more national M&E agenda far out weighed the costs, and development partners on the ground. Note that the that not collaborating would be disadvantageous. decision to proceed on this course is at all times based on the guidance and request of the host country. g) Joint mission partners were able to share Discussion with the national counterparts is usually an experiences and lessons with members of the important and necessary step. If partners agree to a joint M&E TWG. Although the entry point is the NAC (or mission, the initiating partner may take the lead in equivalent), the second most important entity is the organizing other partners' participation, thereby M&E technical working group (M&E TWG) ­ a lessening the burden of scheduling and facilitation of grouping of government ministries, implementers, meetings to both the host country agency and the development partners, universities/research mission partners. Prior to the joint mission, thorough institutions etc, all with a role to play in implementing review of relevant information pertaining to the host the national M&E agenda. Given its mandate to country's M&E agenda is paramount. The information oversee the national M&E aspect of the HIV should normally be provided several weeks before the response, the M&E TWG draws directly from the visit, to ensure that all participating partners have ample missions' input to guide and help sustain their time to read and digest materials. operations. The opportunity to share experiences, lessons and practical examples from other countries An initial draft of joint mission objectives will form the in the region in a timely manner has been a key basis of discussion and finalization of plans for the joint achievement of the joint missions. In particular, mission between the host country and development challenges related to implementation of the national partners participating in the specific mission. M&E system are easily identified, in a participatory Additionally, the draft of joint mission objectives may manner, and discussed thoroughly for plausible identify gaps in the implementation of the technical solutions, drawing on other countries' experiences. assistance and provide the opportunity to engage further partners. If the country has an M&E Plan or M&E Road 5. Important issues to consider in organizing Map, this document needs to be reviewed by multiple partners to be certain that the mission objectives joint missions correspond to the documented M&E technical assistance needs of the host country. The initiating Joint partnerships, through their synergy, can add value partner will produce the first draft of the mission through efficient and effective implementation of objectives; other mission participants add to the draft in technical assistance and support to host country turn. Once a draft is complete, it is sent to a selection of agencies. The following principles may be key to development partner and host country stakeholders for establishing effective partnerships: review. Finally, the mission objectives will be deemed final and act as a work plan for the mission. 4 Technical documents that address the key Schedules for the mission should be based on recommendations of the GTT must also be appropriately availability of development partners and of host country warehoused and easily accessible to stakeholders. The agencies. Again, this is a dynamic and idiosyncratic aforementioned website could also act as an appropriate process that requires flexibility. Once dates have been repository for these documents, which would be proposed, the necessary actions by host country produced in and by the host country, by development agencies to ensure that appropriate meetings and partners providing technical assistance to the host activities are scheduled must commence. In this sense, country, as well as other development partners and joint missions may be viewed as a true partnership ­ academic institutions. each agent is responsible to complete a task in order for the mission to proceed as planned. 7. Going forward 6. Follow-up Activities after a joint mission The first few joint missions may be the beginning of a more formalized process in future. The joint missions To ensure sustainability and continuation of the activities that have been carried out so far have been the result of engaged in by the joint mission, it will be necessary to structured discussions between individuals providing provide all stakeholders with information about the technical support at country level, and not the result of a implementation of the activity and its outputs. First, a global and formalized decision to undertake joint joint mission report describes the activities completed missions. As indicated above, the missions are by the mission and the short term activities following the arranged once the host country requests a joint mission mission. The writing of the joint mission report ought to or in line with a partner's scheduled activities outlined in follow the same process as drafting the joint mission a work plan. In future, joint missions may become more objectives. Namely, the initiating partner produces the formalized through, for example, a joint program of work first draft of the report, with other mission participants at the regional level amongst all partners supporting adding to the draft in turn. Once a draft is complete, it is countries in a region. sent to a selection of development partners and host country agency stakeholders for review. Finally, the A strong indication of the value of joint missions is the mission report is deemed final and considered an output steadily growing demand for them from other countries of the entire joint mission. In addition to being an in the region. Information on the benefits of joint information product, the joint mission report may also be missions continues to filter through the UNAIDS M&E viewed as a management tool which guides follow-on advisers based in various countries and other sources activities to the mission, just as the mission objectives through "word of mouth". The UNAIDS RST for East and are used as a work plan during the mission. Southern Africa intends to include the sharing of information about the value of joint missions in their As a further option, a website may be developed that 2007 work plan to ensure that more countries can easily lists a country's development partners, the technical access the technical support they need. This note assistance they offer, and the activities in which they describing joint missions also may be useful guidance engage in-country. Such a website could provide an for similar partnerships focused on M&E at sub-national opportunity for development partners and their project levels and donor funded programs. The list of implementers to have a quick snapshot and to identify suggestions is not exhaustive and should not be taken potential collaborations, thereby reducing the need for as a rigid prescription for effective partnerships in M&E long, unproductive meetings in which partners describe technical support. Rather, it is intended to share themselves and their activities. experience and ideas, in response to growing interest in joint missions as one way for partners to find common Also, it would be beneficial to share the joint mission ground and work together more effectively and efficiently report with the Regional M&E Partner's Forum, so that to support national HIV M&E systems. they are informed of latest developments and of the status in the region. 5 Authors: Emmanuel Baingana Kasheeka, UNAIDS George Bicego, US Centers for Disease Control and Prevention (CDC), Global AIDS Program, and United States Agency for International Development (USAID) Marelize Görgens-Albino, Global AIDS Monitoring and Evaluation Team (GAMET), World Bank Verne Kemerer, MEASURE Evaluation/Tulane School of Public Health Masauso Nzima, UNAIDS For further information, or feed-back, please contact: Jody Zall Kusek, Lead M&E Specialist, World Bank Global HIV/AIDS Program, jkusek@worldbank.org November 2006 6