Efficiency & Effectiveness (E 2 ) in the HIV/AIDS Response Involving Implementers in Kenya

1. Efficiency & Effectiveness (E2) in the HIV/AIDS ResponseInvolving Implementers in Kenya April 20, 2012 Health Policy Project

2. Outline • Current Financing of HIV/AIDS in Kenya • Understanding the role of implementer • Why should E2 be a component in Kenya’s strategic planning process? • USAID|Health Policy Project and E2 in Kenya • Current areas of investigation, two examples • Responses and areas of future collaboration

3. Current Financing of HIV/AIDS in Kenya • More 70% of targeted HIV funding comes from external resources • Resources constrained, with the exit of certain large funding sources from the sector • Government considering • Planning for predictable and sustainable HIV/AIDS financing - discussion on innovative financing • Improving efficiency and effectiveness in HIV programming

4. Role of Implementers in Managing HIV/AIDS Funds

5. Role of Implementers • Implementers make decisions on both allocative and technical efficiency • Good entry point for E2 work • Different approaches and definitions to E2 • HPP’s approach – Apply evidence on what works • Solution-centered approach to make E2 tangible: ↓ long-term costs without changing outputs or quality ↑ outcomes in prevention, treatment & care

6. Why is E2 right for Kenya? The objectives of an E2 approach reflect the current demands on Kenya’s HIV/AIDS response. • Kenya’s programs are still working to expand coverage, access, and results… • However, decreasing donor funding is likely to shrink the resources available for this response. • Program managers are being asked to do more with less!

7. The Health Policy Project and E2 • USAID OHA funds activities through the Health Policy Project (HPP) in 2011 • NACC formally requested support on E2initiatives (June 2011) • The KNASP-3 Mid-Term Review offers platform • Country-led multisectoral TWG was set up to lead the E2 process, identify focus areas • Government owns the solutions emerging from the TWG, working with HPP

8. Areas Open to Investigation • Blood Safety • Safe Injections • PEP & PrEP • Community-Based Programming for HIV • Key High-Risk Population Interventions • Voluntary Male Medical Circumcision • Procurement/Logistics • HTC • Goals Modeling • Training and Human Resources for HIV services • ART for Prevention…

9. Selecting Focus Areas • Through a multisectoral technical working group led by NACC/NASCOP, a number of initial focus areas were selected and analysis is continuing: • Goals Modeling of the Prevention Portfolio • HIV: Community-Based Programming • Investigating Best Training Modes for HRH needed for HIV • Blood Safety * • HIV Testing and Counseling (HTC) * * We look at the last one focus areas as an example later

10. Examples: Research Questions from Prioritized Areas • Goals Modeling of Prevention Portfolio • How would programmatic scale-up impact HIV outcomes in terms of infections averted, and total costs? • HIV Community-based Programs (HCBC) • Are HCBC programs in Kenya evidenced-based? • Can HCBC programs in Kenya be made more effective by altering the mix of interventions? • Training/HR for HIV service delivery • Which model(s) for provider training is the most efficient and feasible: off-site, mentoring, roving clinicians? • Do training models have different outcomes in terms of provider empowerment, motivation, capacity, etc.?

11. HIV Testing and Counseling Example

12. HTC: Increasing coverageKNASP 3 Pillar:1 Organization: NASCOP Context: The KNASP 3 target is 80% knowledge of status by the year 2013. The current coverage is 58% for women and 42% for men, implying a significant gap. Data needs Key issues for analysis • Distribution of key population groups by province • Distribution of incidence by province and key population • Cost of testing strategies • Can HTC resources be used more efficiently and effectively through different target-setting schemes? • Given established goals, what is the best combination of testing strategies?

13. Areas of analysis… • We find that structuring HTC targets based on prevalence may increase testing effectiveness. • Can regional targets be based on distribution of incidence? • How do we incorporate key population data and relevant testing methods into the targeting strategy? • When time and costs associated with testing methods are included, which testing strategies… • Minimize costs (maximize efficiency)? • Minimize time to universal knowledge (maximize effect)? • Maximize effect (as above) with a fixed budget (maximize E2) • What are efficient and effective re-testing targets?

14. Future Collaboration and Strategic Planning

15. How can HPP and the E2 team support further analysis? • The HPP E2 activity has been and will continue to be a country-led process. • Opportunities in E2 : Long-term partnership with GOK • Multi-partner Consultation on E2in Nairobi • Building upon modeling and economic/impact analyses • Roadmap for improved program activities through the end of KNASP III • Support for strategic planning around E2 for KNASP IV • Sustained focus through embedded E2 staff at NASCOP and NACC, funded through HPP

16. Thank you!