Multi-Country HIV/AIDS Program (MAP) Public Sector Response: Lessons Learned

1. Multi-Country HIV/AIDS Program (MAP)Public Sector Response:Lessons Learned Africa Region HIV/AIDS Consultation Addis Ababa February 14-18, 2004 John F. May, World Bank

2. SOURCES • In-country experiences • Turning Bureaucrats into Warriors, 2004 • MAP Interim Review, 2004

3. BACKGROUND • HIV/AIDS is recognized as a development issue • Multi-sector approach necessary • Involvement of all groups in society • Fostering a stronger demand to use available services

4. RATIONALE • HIV/AIDS is much broader than a public health problem • HIV/AIDS touches virtually ALL sectors of the economy • Some sectors may be contributing to the epidemic, but at the same time are a MAJOR asset in the fight against it (e.g., education in Cameroon)

5. THE CHALLENGES (1) • Identify and involve the constituencies: • Line Ministries employees & families • The groups they interact with (their own external clients and stakeholders)

6. THE CHALLENGES (2) • Identify full-time Focal Points/Teams • Create strong commitment • Mitigate high turn-over • Increase absorptive capacity • Obtain counterpart funding • Change work place policies • Include PLWHA and their families

7. KEY QUESTIONS (1) • Involve all Line Ministries or only key Line Ministries? • Vertical or integrated approach? • Roles of NAS and NAC? • How to build capacity in Line Ministries?

8. KEY QUESTIONS (2) • How to coordinate all Line Ministries programs on the ground? • How to M&E these programs? • How to link them with other HIV/AIDS activities, e.g. communities activities?

9. MIXED EXPERIENCES (1) • Line Ministries are usually signed up • Slow implementation of Actions Plans • Lack of strong ownership • Weak commitment • Limited capacity • Low absorptive capacity

10. MIXED EXPERIENCES (2) • Line Ministries operate on their own • They operate at the central level; less activities at the decentralized levels • Lots of IEC, but much less BCC • Are beneficiaries actually seeking services? • Lack of strong linkages with Communities and Civil Society Initiatives (CCSI)

11. MIXED EXPERIENCES (3) • Successes may be linked to one outstanding individual (Focal Point, NAS Line Ministries coordinator, one dedicated Line Ministry) (e.g., Sierra Leone, Cape Verde) • Financial architecture problems • No real out-sourcing culture in public sector

12. MIXED EXPERIENCES (4) • Revitalization of public sector response is difficult • Some restructuring at Mid-Term Reviews • Promising attempts to jump start public sector response with Accelerated Results Implementation (ARI) approach (e.g., Sierra Leone, The Gambia)

13. LESSONS LEARNED (1) • Line Ministries are essential partners for mainstreaming HIV/AIDS, but are not yet fully involved • HIV/AIDS is seen as Ministry of Health’s mandate • Lack of resources • Low capacity

14. LESSONS LEARNED (2) • Scaling up in line ministries is taking longer than expected, in part because of institutional weaknesses within sector ministries • Too few and powerless Focal Points • Move beyond Focal Points to Units (AIDS Control Units, e.g. Kenya)

15. LESSONS LEARNED (3) • Political will is necessary to mobilize sector ministries • Need for support from highest levels of leadership • Need for budget lines in annual budgets

16. LESSONS LEARNED (4) • The Ministry of Education is pivotal in the fight against HIV/AIDS, but often among the most difficult to mobilize • Largest employer in many countries • Difficulty to create consensus

17. LESSONS LEARNED (5) • Getting started • Situation analysis (among staff and clients) • Sensitize Line Ministry leadership • Liaise with NAS • Build bridges between countries

18. LESSONS LEARNED (6) • The partnership with the NAS has to be stronger • Mutually beneficial, not adversarial relationship • NAS needs to provide proactive capacity building

19. LESSONS LEARNED (7) • Contracting additional support is an option • Private sector • NGO • Other public agencies

20. LESSONS LEARNED (8) • Lack of funds for scaling up sector responses Some Line Ministries may need more resources than others

21. LESSONS LEARNED (9) • Although all ministries should be given equal opportunity to start HIV/AIDS activities, let a few ministries take the lead in the first year

22. THE WAY FORWARD (1) • The Three Ones: • One National HIV/AIDS Strategy • One Coordinationg Authority • One M&E System

23. THE WAY FORWARD (2) • Stronger Political Commitment • Stronger ownership • Line Ministries specific HIV/AIDS budgets • Contracting out additional support • Linkages with other partners

24. THE WAY FORWARD (3) • Five priority areas • Prevention and advocacy • Care and support • Socio-economic impact mitigation • Monitoring and evaluation • Management and coordination

25. CONCLUSIONS • The Public Sector Response remains fundamental in the fight against HIV/AIDS • Need to go beyond a template approach • Need to tap Line Ministries’ comparative advantages • Emergence of a second-generation implementation mode

26. Ameseghinalehu ! (Thank you !)