I. Partnership Frameworks: Introduction

In July 2008, US legislation (Public Law 110-293) reauthorized US Government (USG) global efforts to combat HIV/AIDS, tuberculosis and malaria for 2009-2013. The law authorized the USG to establish compacts or framework documents with partner countries to promote a more sustainable approach, characterized by strengthened country capacity, ownership, and leadership. This approach represents a substantially new focus for PEPFAR.

This document serves as an adjunct to earlier guidance on Partnership Frameworks (primarily the “Framework for Development of Partnership Compacts in PEPFAR”) and is meant to clarify the purpose, process, and content of Partnership Frameworks. In general, this document refers to national governments, but, where needed, this guidance can be adapted to regional structures and contexts.

In this guidance, the new term “Partnership Framework” replaces “Partnership Compact” to distinguish it from a legally binding agreement. In addition, this document introduces an optional two-step process of developing a broad initial Partnership Framework and a subsequent more detailed Partnership Framework Implementation Plan.

Because this is a new approach for the USG and PEPFAR, this guidance is entitled “Version 1.” A thorough analysis of this guidance following its first phase of use with USG and host country teams is anticipated and appropriate adjustments will be made.

A. PURPOSE

The purpose of a Partnership Framework is to provide a 5-year joint strategic framework for cooperation between the USG, the partner (“host”) government, and, in some cases, other partners to combat HIV/AIDS in the host country through service delivery, policy reform, and coordinated financial commitments. At the end of the five year time-frame, the expectation is that in addition to results in the prevention, care and treatment of HIV/AIDS, host countries will be better positioned to address the epidemic over the long term. The Partnership Framework should be established with transparency, accountability, and the active participation of other key partners from civil society, the private sector, other bilateral and multilateral partners (e.g., Global Fund to Fight AIDS, TB and Malaria [GFATM]), and international organizations, and should support and strengthen national HIV/AIDS strategies.

B. GUIDING PRINCIPLES

All Partnership Frameworks should embrace the following principles:

Attention to goals and process: As in the first phase of PEPFAR, and in keeping with donor harmonization and alignment efforts, Partnership Frameworks should be fully in line with the national HIV/AIDS plan of the host country, and should continue to emphasize sustainable programs with increased country ownership (including decision-making authority and leadership). Framework documents should be aligned with the “Three Ones” principles (one HIV/AIDS action framework, one national AIDS coordinating authority, and one country-level monitoring and evaluation system), as well as the principles of the Monterrey Accords and Paris Declaration (see Annex IV). In addition, all Partnership Frameworks should further PEPFAR’s program scale-up goals of supporting treatment for 3 million people, prevention of 12 million infections, and care for 12 million, including 5 million orphans and vulnerable children, within the context of improving broader host country health policy, financing and management capacity. Partnership Frameworks should relate to broader development reform efforts (such as the International Health Partnership [IHP+] and the National Strategies Application [NSA] initiative of GFATM) and work within those contexts wherever possible.

Country ownership: A key objective of the Partnership Framework is to ensure that host countries are at the center of decision-making, leadership, and management of their HIV/AIDS programs. The development of the Partnership Framework is the responsibility of the country PEPFAR team, the host government, and host country nongovernmental partners. Each Partnership Framework should represent a transition strategy to increase country ownership of HIV/AIDS efforts

USG interagency collaboration: Like other aspects of PEPFAR, the development of Partnership Frameworks from the USG side should be an interagency effort carried out under the leadership of the USG Department of State Chief of Mission or his/her designee¹.

Engagement and participation: In developing Partnership Frameworks, all relevant parties should be engaged. Although the national government (e.g., Ministry of Health, Ministry of Finance, National AIDS Coordinating Authority and other government entities as appropriate) may be the primary or exclusive host country signatory, the approach to development, implementation, and monitoring should be that of a multi-sectoral partnership, highlighting in particular the role of civil society (including NGOs, faith-based organizations, groups or associations of people living with HIV/AIDS [PLWA], community groups, women’s groups, etc.), international partners (e.g. GFATM, World Health Organization [WHO], Joint United Nations Programme on HIV/AIDS [UNAIDS]), and the private sector. Where there are effective pre-existing coordinating bodies, for example the GFATM Country Coordinating Mechanism (CCM) or mechanisms through IHP+, consideration should be given to their potential leadership role, perhaps removing the need to create new management bodies for PEPFAR Partnership Frameworks. In addition to consulting civil society, the private sector, other donors, and international organizations, local input should be obtained from organizations representing the urban and rural poor, including women. Cross-border collaboration should also be considered, if applicable, as should engagement of organizations that may be outside the direct purview of public health but have a strong influence on public health, such as education or economic strengthening.

Strategic framework: Partnership Frameworks are 5-year strategic frameworks for the USG’s collaborations with partner countries on HIV/AIDS. Thus:

• Partnership Frameworks should cover all PEPFAR-supported HIV/AIDS activities in the country (i.e., not just new or expanded or “plus-up” activities).
• In FY09 and beyond, no new USG PEPFAR resources above FY08 funding levels will be allocated to countries unless a Partnership Framework is in place. Given the year-to-year nature of budgeting by the USG, host countries, and some other donors, all financial commitments are contingent on availability of funds.
• In future years, for countries with a signed Framework, PEPFAR Country Operational Plan (COP) planning will use the Partnership Framework and Implementation Plan as guiding documents. COPs will essentially present the annual work plan for USG-supported interventions to achieve Framework results. Annual Progress Reports (APRs) will report on results achieved within the context of the Monitoring and Evaluation Plan of the Partnership Framework.
• Partnership Frameworks must fit within the overarching USG Country Assistance Strategy (in countries which have them) and within any relevant host country strategies.

Flexibility: Different approaches to Partnership Frameworks are appropriate for different settings. In some countries, the USG is providing substantial funding and implementation support to scale up services and strengthen health systems. In others, USG support is primarily limited to providing technical assistance. For example, countries with generalized epidemics may have different areas of programmatic emphasis compared with countries with concentrated epidemics. Thus, the appropriate mix of direct services, health system strengthening, and technical assistance will vary by country and will be dynamic—addressing country needs, ideally within the context of national strategies, while transitioning programs to local ownership with reduced reliance on external financial and technical support, and taking into account other donor activities. In addition, the policy areas addressed by Partnership Frameworks should reflect the varied policy reform needs of different countries.

Progress towards policy reform and increased financial accountability: Partnership Frameworks should emphasize key policies that promote effective HIV/AIDS programs. They should also emphasize overall accountability for resources and appropriate budgeting in HIV/AIDS programs. Based on the country’s level of resources, a goal should be increased host country financial contributions to the program over time, including increased reliance on GFATM financing. Certain policy reforms are key to effective HIV/AIDS responses, and the Partnership Framework offers an important new opportunity to engage host government partners in these areas (see Annex I). The expectation is that Partnership Frameworks will explicitly address key policy issues and demonstrate PEPFAR and host government commitments to achieve progress. Partnership Frameworks also provide an opportunity for the USG to work with partner governments to more closely track HIV/AIDS and overall health financing through National Health Accounts (NHA), National AIDS Spending Assessments (NASA), and other financial monitoring and reporting systems. Working towards a costed national HIV/AIDS strategy should be an important priority for the Partnership. Principles of cost efficiency and cost effectiveness should be incorporated into the Partnership Framework.

Integration of HIV/AIDS into strengthened health systems and a broader health development agenda: Partnership Frameworks should contribute to strengthened HIV/AIDS services within the context of the broader health system in an environment with diverse development needs. Partnership Frameworks should link and achieve synergies with other relevant development efforts, in particular, other USG development efforts such as the President’s Malaria Initiative (PMI), tuberculosis, maternal child health, education, food and nutrition, economic strengthening, Millennium Challenge Corporation (MCC) and other programs as appropriate.

Monitoring and evaluation (M&E): Partnership Frameworks should set measurable goals, objectives, and concrete commitments, not only for the USG but for all partners in the Partnership Framework. The Partnership Framework should identify indicators to assess partners’ progress towards achieving these goals and objectives, and meeting these commitments. In general, the scope of the targets should be national and not just reflect PEPFAR-supported accomplishments. The Partnership process should emphasize national target-setting and transitioning PEPFAR-specific reporting systems to national, country-owned systems in full support of the “Third One.” As a multi-party partnership, the reporting needs of all parties (including the host government and PEPFAR) should be considered, as should the need for international harmonization of indicators used to monitor the program carried out under the Partnership.

Collaborative but not contractual: Partnership Frameworks are not intended to be legally binding. Rather, they are intended as non-binding joint strategic planning documents that outline the goals and objectives to be achieved and the commitments and contributions of all participating Framework members. Partnership Frameworks are intended to facilitate communication and collaboration among partners, including ensuring through action that programs are more stable and integrated over the five-year time frame. Partnership Frameworks do not alter existing USG or host country rules, regulations, cooperative agreements or contracts.

Transparency: To inform key stakeholders, every Partnership Framework will be submitted to the U.S. Congress, published in the U.S. Federal Register, posted on PEPFAR’s public internet website, and should likewise be widely disseminated and made publicly available in host countries.

C. PROCESS AND CONTENT

As detailed in Parts II and III of this guidance document, Partnership Framework documents consist of two inter-related sections which may be developed either simultaneously or in two sequential stages, depending on the country context. The decision of whether to simultaneously or sequentially develop the two sections and whether to formulate one or two documents should be made by the USG PEPFAR country team in consultation with the other country partners, including the host government.

Development of the first section of a Partnership Framework focuses on establishing a collaborative relationship, negotiating the overarching 5-year goals of the Framework and commitments of each party, and setting forth these agreements in a concise signed document called the “Partnership Framework.”

The second, more detailed section, the “Partnership Framework Implementation Plan,” may take longer to develop and includes baseline data, specific strategies for achieving the 5-year goals and objectives, and a monitoring and evaluation plan. Some countries may choose to rapidly develop sections of the Implementation Plan where agreement can easily be reached, and to develop other sections over a longer period of time. Whether developed simultaneously or sequentially, the Implementation Plan must flow from the Partnership Framework.

Both sections of the Partnership Framework will need to be reviewed, negotiated and signed. Part IV of this guidance document discusses those processes.

Over the life of the Partnership Framework, PEPFAR and other partners will jointly:

• Develop a document outlining a strategic five year framework of collaboration that includes two sections: a Partnership Framework and a Partnership Framework Implementation Plan. As noted, these can be developed concurrently as one combined document or sequentially as two separate documents.
• Sign the Partnership Framework document(s).
• Conduct annual reviews of the Partnership Framework and Implementation Plan.
• Develop annual work plans for the Partnership Framework through the Country Operational Plan (COP) planning process.
• Report annually on Framework achievements through the Annual Program Results report (APR).

Questions concerning this guidance and its application should be directed to PEPFAR headquarters Country Support Teams. Technical assistance (TA) for development of the Partnership Framework Implementation Plan may be required, particularly in areas such as finance and policy. Country partners developing the Framework should identify such needs and engage appropriate TA from headquarters, the host country, or regional technical experts.