III. Partnership Framework Implementation Plans


A. PROCESS FOR DEVELOPMENT

The Partnership Framework Implementation Plan spells out in more detail the 5-year objectives, contributions and targets for the Partnership Framework. As a more specific document than the Partnership Framework, the Implementation Plan can be updated in writing during the five year period to reflect changing conditions or priorities without altering the Partnership Framework. While signatories to the Partnership Framework should be aware of the content of the Implementation Plan, the Implementation Plan itself may be signed by lower-level signatories or by multiple partners, as in the case of Regional Frameworks.

1. Establishing baselines

Given the need for strong evidence-based strategies, either actual baseline data or a timeline and plan for conducting situation assessments and establishing baselines should be included in the Partnership Framework Implementation Plan. Partnership Framework design teams should use existing assessments, when available, to save time and strengthen harmonization, complemented with new situation assessments only as needed. In many countries, data are limited. In such cases, it is possible that establishing systems to obtain quality data may be one of the Partnership Framework objectives.

HIV/AIDS epidemic, response, and health systems situation assessment: In many cases, recent national planning exercises may have included an assessment of the HIV/AIDS epidemic and response, which can be used as a baseline. If this is not the case, design teams will need to develop a baseline situation assessment of the current state of the epidemic and the response by all partners. In conducting an HIV/AIDS situation assessment, consider reviewing national monitoring indicators, including United Nations General Assembly Special Session on HIV/AIDS (UNGASS) National Program Indicators, and recent survey and surveillance, program evaluation, data triangulation, and/or cohort study information. The HIV situation assessment should be country government-owned and informed by consultations with key stakeholders, including the government, civil society, non-governmental organizations, other donors, international organizations, and the private sector. The assessment should include a discussion of the overall strengths and weaknesses of the health system as they affect prospects for achieving national and PEPFAR prevention, care, and treatment objectives, including, for example, analysis of service delivery or health workforce. It should describe the governmental and non-governmental health system and any other relevant sectors that are engaged in HIV/AIDS prevention, care and treatment, and how HIV/AIDS services fit into and/or relate to the overall governmental and non-governmental health system. It should particularly highlight areas or key gaps for technical assistance, and it should address in detail the geographic relationship between the target populations and health system resources. For each target population, define the necessary continuum of prevention, treatment and care services. Define necessary OVC services. Include the status and timeframe of the national strategy and whether it contains cost information, as well as information on health systems, and how it coordinates with NGOs, private sector, other civil society organizations, international organizations, PEPFAR, and other donors. Describe all GFATM grants (which essentially represent a country-owned model of support), any technical assistance to facilitate their effective use, and the relationship of USG resources to the GFATM grants. The assessment should identify areas for potential emphasis in the Implementation Plan. See Annex V for additional suggestions for assessing health system strengths and weaknesses, including questions that will help to guide country teams through this discussion.

HIV/AIDS policy reform situation assessment: A policy reform situation assessment can be a stand-alone exercise or can be integrated into the HIV/AIDS situation assessment described above. In either case, all policy areas from Annex I - “List of Policy Areas to be addressed in the Partnership Framework” should be explicitly addressed. Create a table listing key policies (see Table 5) in existence that impact HIV/AIDS prevention, care, and treatment, and their respective completed stages within the 6 stages of policy reform listed in the Next Generation Indicators Reference Guide, version 1.1, annex 4, table 1. Address all policy areas in Annex I including the existence of policies and the degree to which they are implemented. The baseline should include the specific policies targeted for reform by the Partnership Framework partners and participating stakeholders with a notation explaining why other critical policy areas are not addressed. While it may not be appropriate or necessary to work in all policy areas, a joint collaborative analysis with government of all areas and their implementation should be completed. In addition, policy areas that are important and relevant in the country context but are not explicitly listed in Annex 1 also should be included in the assessment (such as policy issues around maternal and child health). Policy reform promotes country leadership and ownership by ensuring that evidence-based policies are in place and implemented at the national, provincial/state, district, and local levels (Annex 1). Consider reviewing the 2008 UNAIDS National Composite Policy Index data from government and civil society at http://www.unaids.org/en/KnowledgeCentre/HIVData/CountryProgress/2008_NCPI_reports.asp to note policy areas identified by government and civil society as requiring increased attention. The National Composite Policy Index and the Partnership Framework Policy Reform Monitoring Table (see Table 5) are complementary in that the former assesses the 'overall policy, strategy, legal and program implementation environment of the HIV response' and the latter assesses specific policies to be reformed over the next five years. Also, evaluate the degree to which an enabling policy framework exists in the country, assessing governance and policy-making processes such as: (a) relevant Constitutional provisions; (b) important influences on policy processes; and (c) effectiveness of tools to implement policies. Identify relevant policy-making bodies (e.g., Ministries), authorities, and procedures as well as the effectiveness of available tools to implement policies. There may be differences of opinion between the USG and the government on certain policies. In such cases, the Partnership Framework may work toward a reform agenda around that policy and/or focus on other policy reform areas where consensus exists.

HIV/AIDS financing situation assessment: The purpose of this assessment is to better understand program costs, available resources and projected gaps and trends over time, using existing data sources where possible. Design teams should review trends of financial commitments to health and tabulate funding from different sources, taking advantage of resources such as National Health Accounts bi-annual data available online at https://www.who.int/nha/ and at http://www.unaids.org/en/KnowledgeCentre/HIVData/CountryProgress/Default.asp, including percentage of total government expenditure budgeted to health as well as National AIDS Spending Assessment data, if available. Evaluation of data from GFATM’s enhanced financial reporting system may also be useful, along with other data produced from other financial monitoring and reporting systems. Data on program costs and financing may also exist from completed evaluations. Describe what has been done to address sustainable ARV financing, and note the status of any ARV cost negotiations and cost modeling, as well as prevention and care cost issues. Identify any technical support the government needs to promote cost efficiencies and sustainability.

2. Setting targets, monitoring, and evaluation

The USG, the government, and other parties involved in the Partnership should consider program response to date, available resources, unmet needs, priorities of the national HIV/AIDS control plan, and other factors, to determine the scope of the activities to be carried out through the Partnership Framework to meet the 5-year goals of the Framework. This scope should include program areas (e.g., PMTCT service provision, OVC support, lab strengthening, healthcare worker training) and policy reforms (e.g., male circumcision, opt-out testing) that will be addressed through the Partnership and cover all PEPFAR-supported HIV/AIDS activities in the country. Objectives and essential interventions for each program area should be defined.

Once the scope of activities and objectives are agreed on, the Partnership should select indicators that will be used to set 5-year targets and monitor progress on the goals and objectives. Indicators for goals should be higher level, typically measured by means of outcome and impact indicators. Key indicators for objectives will measure services provided, coverage of services, status of health systems and infrastructure, and other parameters. All indicators used for monitoring Partnership Framework progress should be the result of a country harmonization process with the national government and other major donors, including the GFATM. In general, indicators should have a national perspective (e.g., percent of pregnant women who were tested for HIV and who know their results). These should be supplemented by a PEPFAR-specific perspective (e.g., number of new healthcare workers who graduated from a pre-service training institute with PEPFAR support) only as needed for USG-specific reporting. Other Framework partners may also have specific requirements for indicators that should be considered.

The Partnership should then set 5-year targets, to be measured using these indicators. These targets should be based on baseline data, status of the program, available resources (assuming availability of funds), and other factors. In general, these targets should also have a national perspective and account for all accomplishments in the country by all contributors to the response. Reporting against these targets will take place through PEPFAR’s APR process.

Based on these targets, the Partnership should agree on specific commitments by the USG, country, and other partners during the 5 years of the Partnership. These commitments will be financial (i.e., anticipated funding to be provided to the program) and programmatic (e.g., carrying out specific activities in support of blood safety, implementing policy change in gender, capacity-building, etc.). As described above, technical assistance and mentoring to the government should be among the key USG commitments, so that programs are increasingly coordinated and managed by, and where feasible funded and implemented by, the government, with the participation of civil society and the private sector. Identifying process and program outcomes will be critical to allowing the partners to track the evolution of country ownership.

Finally, the Partnership should establish a plan for monitoring progress towards achieving the Partnership’s targets, meeting expected partner contributions, and measuring its impact. It is critical to track financial flows over the course of the Partnership Framework Implementation Plan to show progress toward country investment in its national response. Conducting or regularly updating existing National AIDS Spending Assessments should be considered as part of the monitoring plan to achieve these goals.

B. REQUIRED CONTENT OF THE PARTNERSHIP FRAMEWORK IMPLEMENTATION PLAN [~30 PAGES]

The 5-year Partnership Framework Implementation Plan flows from the Partnership Framework, and may be developed subsequent to the signing of the Partnership Framework. Together with the more succinct Framework, it represents the 5-year strategic framework for USG PEPFAR collaboration with the government and other partners. Therefore, once signed, it is the basis for COP development, and COP activities should follow from this strategy. PEPFAR country teams may renegotiate the Implementation Plan periodically as circumstances change.

1. Supporting country ownership [1-2 pages]

Relate the Implementation Plan to the Partnership Framework. Describe how the Partnership Framework and Implementation Plan strengthen the ability of the country government to plan, oversee, manage, and ultimately deliver and finance, HIV/AIDS programs by emphasizing capacity-building and support of country-driven programs.

Describe how the existing portfolio of USG-supported, NGO-implemented programs will transition to the partner government (at national, provincial, district, and village levels), remain NGO-based, or be terminated within the 5-year timeframe. Please also describe any plans and approaches for developing the capacity of local private non-profit and for-profit implementing partners which may be integral components of the government-led national HIV/AIDS response.

For countries where technical assistance is already the focus, describe how technical assistance and support will be used to strengthen sustainable government systems. For countries with relatively small PEPFAR programs, describe how the Partnership Framework and Implementation Plan will contribute to national goals and a sustainable scale-up through existing government systems, rather than through direct service delivery. Describe the particular niches that the USG will support within the context of the national plan, and in relation to other assistance efforts such as GFATM grants. Describe how technical assistance will build the capacity of the government to manage and oversee the program. For countries with larger PEPFAR programs (e.g., former “focus” countries), describe plans to transition service delivery by external partners into government–coordinated health systems, and to maximize USG investments by providing increased capacity-building and technical assistance directly to the government to improve efficiencies and quality in existing programs.

Please reflect support for country ownership in all goals and objectives.

2. Country HIV/AIDS profile and baselines [3-5 pages]

Summarize the results of the three situation assessments conducted under section III.A.1 above.

3. Strategy and commitments [10-15 pages]

Describe the overall strategy employed for the Partnership that will lead to expanded government capacity to plan, oversee, manage, and ultimately finance their national HIV/AIDS strategy. In this context, summarize how the Partnership Framework will address key weaknesses in the health sector to enable the sustainability of the partner country’s response to HIV/AIDS, and identify who will play key roles in the partnership and in the HIV/AIDS response. Detail goals, objectives and commitments of the USG, the partner government, and any other partners.

  1. National Strategy: Summarize the programmatic approaches as represented in the National Strategic Plan on HIV/AIDS in the country, addressing, for each target population, HIV prevention, care, and treatment through service delivery, health systems strengthening, policy reform, and financial commitment. Describe how the Partnership Framework Implementation Plan contributes to the National Strategy.
     
  2. Partnership Framework Strategy: Institutional and Human Capacity Building: Describe the Partnership Framework’s strategy to build the institutional and human capacity of the partner government to lead and sustain the national response to HIV/AIDS. Relating to information described in the baseline assessments above, identify key strengths and weaknesses in institutional and human capacity that the Partnership Framework will focus on, and the anticipated five-year results of planned capacity-building efforts. Describe any plans for institutional and human capacity development in the public and private sectors to support the national strategy, and any plans for promoting productive partnerships between various levels of government and other sectors (civil society, the private sector (non-profit and for-profit), and communities).
     
  3. Partnership Framework Service Delivery and Policy Reform: Describe how the Partnership Framework’s 5-year goals, objectives and contributions will contribute to the realization of the country’s National Strategic Plan on HIV/AIDS, and promote country ownership, including effective use of all available resources, including GFATM grants. Other donor activities must be mapped out in the Partnership Framework Implementation Plan in order for it to effectively communicate opportunities to realize efficiencies, ensure quality services, and promote sustainability. Describe how the contributions to various components of the HIV/AIDS response reflect the comparative advantage of the country, the USG, and other partners to achieve maximum impact. Include, in tabular form, (see illustrative Table 3) the specific goals, objectives and contributions for your Partnership, including agreed targets for policy reform for each relevant objective. This table should build on the table developed for the Partnership Framework, providing more specific detail and information.
     
  4. Financial Accountability: Establish a timeline of increasing partner government commitment to add financial support, and include criteria to allow tracking of the amount of partner country support. Describe the government’s ability to provide and make publicly available timely and accurate cost and financing information, and its ability to increase public financing for HIV/AIDS and health (e.g., whether meeting Abuja Declaration target of 15% of national budget for health is feasible). Describe efforts to support transparency and combat corruption. Under the PEPFAR reauthorization legislation, Partnership Frameworks must include "cost sharing assurances" from the government that demonstrate a 25% contribution (in cash or in kind) by the government to programs in which the USG directly funds the government (i.e., assurances meeting the requirements of section 110 of the Foreign Assistance Act). The PFIP should acknowledge the government’s intention to meet cost-sharing requirements for such programs. If the government is financially unable to provide cost-sharing assurances, the PFIP should briefly outline the country’s financial condition and indicate that a waiver will be requested. The PFIP should also describe expected commitments and timing of other donors, including the GFATM and the IHP+ as applicable, describe cost-sharing from PVOs and NGOs, and describe how cost-efficiencies will be increased over the course of the Partnership through coordinated financing and other strategies. Please describe how the availability of PEPFAR funds and those of the government and other donors will be based on a review of the Partnership Framework performance against the annual targets and on the availability of funds.

    Complete, in tabular form (see illustrative Table 2) the projected funding for the HIV/AIDS response in the country from various funding sources. This table should include all funding sources, not just those of Partnership signatories. These projections will be used to track financial commitments of the signatories over the course of the Partnership.
     

  5. Implementation modality and budget:
    • Provide a brief description of each goal area and describe the primary strategies and mechanisms by which goals will be achieved. Identify: 1) population coverage linked to goals and objectives; 2) approaches and methods which have increased effectiveness or decreased costs in order to maximize efficiencies (among partners, programs, etc); 3) highlights of implementation approaches based on lessons learned about what has worked and not worked; 4) major/innovative mechanisms to be used over the next five years for achievement of goals and objectives; 5) focus areas for targeted technical assistance (Annex 7 provides an example of Malawi’s table format describing goals and implementation modalities).
    • Provide basic funding trends for Partnership Framework Goal Areas. Describe USG contributions and estimated funding trends over the Partnership Framework period for each goal area. Funding trends should be consistent with implementation modalities, approaches and methods and thus should demonstrate movement towards achievement of goals and country ownership. (An illustrative example of a tabular format used by the Caribbean region is provided in Annex VIII).

Table 2: Projected financial contributions (illustrative only)

Funding Partner

Approximate Funding Level

Areas of Focus

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

 Government

$18M

$18M

$20M

$20M

$22M

HIV prevention, care and treatment

PEPFAR

$48M

$48M

$45M

$45M

$45M

HIV prevention, care, treatment

GFATM

$43M

$43M

$43M

?

?

HIV and TB grants

·   Drug procurement

·   OVC services

·   HIV prevention

·   HCD

MCC

$23M

$23M

$23M

$23M

$23M

Health infrastructure

European Community

$6M

$6M

$5M

?

?

OVC

Clinton Foundation

$8M

$5M

?

?

?

HCD

Irish Aid

$4M

$4M

?

?

?

HR management

Drug procurement

DFID

$2.5M

$2.5M

?

?

?

Workplace programs

Total Projected

$152.5 M

$152.5 M

$136 M

 

 

 

Est. Requirement*

$160 M

$160 M

$160 M

 

 

 

Gap*

$7.5 M

$7.5

$24 M

 

 

 

*When a costed HIV/AIDS strategy exists

Table 3. Example of tabular format depicting relationship among goal, objectives, and commitments.

Five-Year Goal

Prevention: Reduce HIV Incidence by 50%

 

Objectives

 

Expected Commitments

 

National

USG

 

Other

5-Yr

Year 1

5-Yr                                                Year 1

5-Yr

Ensure provision of HIV prophylactic treatment of 85% of pregnant women who require this intervention

·         GOV procures xx% of prophylactic drugs

·         GOV procures xx% of HIV test kits

·         GOV provides leadership in strategic planning and review of PMTCT effort

·         GOV fully implements ‘opt out testing”

·         GOV procures (xx-4n)% of prophylactic drugs

·         GOV procures (xx-4n)% of HIV test kits

·         GOV provides leadership in strategic planning and review of PMTCT effort

·         GOV includes assessment of “opt out testing” in its supervision system

·         USG funds training xx% of PMTCT providers working in country government facilities incorporating a comprehensive approach that includes Emergency Obstetric Care, Neonatal Resuscitation and Family Planning as appropriate.

·         USG provides long-term consultants to work at the national MOH to build planning and management capacity including a strategy for building similar capacity at the provincial levels

·         USG (using other resources) strengthens ANC, labor and delivery, and postpartum services for women and children

 

·         USG funds training (xx%-4n) of PMTCT providers working in country government facilities incorporating a comprehensive approach that includes Emergency Obstetric Care, Neonatal Resuscitation and Family Planning as appropriate.

·         USG recruits and identify consultants to work at the national MOH.

·         USG (using other resources) assesses strategic areas in which to strengthen ANC, labor and delivery, and postpartum services including voluntary family planning

·         GF procures xx% of prophylactic drugs

·         WHO supports 3 regional and 1 national meeting  for planning and review processes

·         NGOs support community mobilization in all USG-funded sites

Ensure all relevant target populations receive appropriate prevention interventions associated with HIV risk behaviors

·         GOV incorporates life-skills training curricula in xx% of all primary and secondary schools

·         GOV prints xxx copies of life-skills curricula annually

·         GOV collects data on MARPs and use its resources to target interventions towards MARPs

·         MOE updates teacher training college curricula to include prevention skills

·          GOV incorporates life-skills training curricula in (xx-4n)% of all primary and secondary schools

·         GOV prints (xxx-4n) copies of life-skills curricula annually

·         GOV implements MARPS survey in year 1

·         MOE reviews current curricula and develop plan to update

·         USG supports development of combination prevention pilot, and scale up to 3 provinces

·         USG supports development of quality standards for prevention programs

·         USG supports review of policy barriers to service access for MARPS 

·         USG (using other resources) supports MOE in dissemination and quality improvement of HIV prevention and life skills curricula through teacher training colleges.

·         USG implements development of combination prevention pilot

·         USG implements quality assessment of prevention programs

·         USG initiates review of policy barriers to service access for MARPS 

·         USG identifies other resources and support MOE to review current curricula and develop plan to update

·         GF supports xx% of model expansion

·         UNAIDS supports printing and dissemination of prevention quality standards

·         PLHA umbrella org ensures all member org. have trained PwP counselors

·         Country Business Coalition ensures to xx% of members having workplace programs

Provide male circumcision services in xx% of country health facilities

·         GOV develops guidelines to support expansion of MC

·         GOV funds training of xx% of MC providers

·         GOV develops guidelines to support expansion of MC

·         GOV identifies and/or develop health cadre to implement MC

 

·         USG provides TA to MOH to develop a national strategy for MC rollout

·         Upon establishment of GOV policy and guidelines, USG funds xx% of new MC sites in accordance with the rollout strategy

·         USG procures xx% of MC-related surgical equipment

·         USG identifies TA needs for MOH to develop a national strategy for MC rollout

·         Upon establishment of GOV d guidelines, USG will funds (xx%-4n)  of new MC sites in accordance with the rollout strategy

·         USG procures (xx%-4n) of MC-related surgical equipment

·         WHO supports monitoring of MC quality, adverse events

 

Ensure quality diagnostic services with appropriate use of laboratory facilities and testing

·         GOV supports xx% of National Reference Laboratory functions

·         GOV supports development of QA/QC standards and protocols

·         GOV supports (xx-4n)% of National Reference Laboratory functions

 

·         USG supports training of xx% of new lab technicians

·         USG (through PEPFAR, TB, and other leveraged resources) funds xx% of construction costs for xx new laboratories

·         USG supports training of (xx%-4n) of new lab technicians

·         USG (through PEPFAR, TB, and other leveraged resources) funds (xx%-4n) of construction costs for (xx-4n) new laboratories

 

Note. ‘4n’ represents a first-year decrement from the total planned achievement (‘xx’) over the course of the five years.

4. Monitoring and evaluation [5-10 pages]

Describe how the Partnership Framework Implementation Plan will be monitored, and how such monitoring will support national data collection systems, moving away from PEPFAR-specific reporting systems. In this description, include how partners (such as GFATM, DFID, etc.) plan to be involved in jointly monitoring the Framework, including an annual joint review that assesses progress toward: targets; projected financial contributions; cost efficiencies through coordinated financing; increasing program ownership by the government; and any steps to allow for mid-course corrections, as needed, to ensure achievement of goals. The following suggests a framework for this joint monitoring.

Describe plans to collect data to monitor Framework goals. These data should derive from surveillance, population-based surveys, facility surveys, program evaluation, public health evaluation, and other means to describe the impact of the program on key measures of HIV prevalence and incidence, behaviors, morbidity, mortality, population well-being, and health system strengthening. These surveys and surveillance activities do not occur annually, so planning should identify when this work is scheduled and when results will be available for reporting.

Describe plans to monitor progress toward Partnership objectives in scaling up services, advancing enabling policies, and meeting anticipated financial and activity contributions. Below are two example table templates that can be used for this description. The first (illustrative Table 4) includes programmatic objectives, indicators, baseline, and 5-year targets, while the second (illustrative Table 6) includes objectives, expected contributions and contributions indicators.

Table 4. Example of table depicting objectives, indicators, and baseline and 5-year target data.

Five-Year Goal

Prevention: Reduce HIV Incidence by 50%

 

Objectives

Indicators

 

National (All programs) and

Baseline

5-Year Target

USG (PEPFAR programs)

 

 

 

Ensure provision of HIV prophylactic treatment of 85% of pregnant women who require this intervention

·         Percent of pregnant women who were tested for HIV and know their results

·         Percent of HIV-infected pregnant women who received antiretrovirals to reduce the risk of mother-to-child transmission

·         42% of pregnant women were tested for HIV and know their results

·         61% of HIV-infected pregnant women received antiretrovirals to reduce the risk of MTCT

·         85% of pregnant women tested for HIV and know their results

·         85% of HIV-infected pregnant women receive antiretrovirals to reduce the risk of MTCT

Ensure all relevant target populations receive appropriate prevention interventions associated with HIV risk behaviors

·         Number of PLHA reached with individual/small group comprehensive prevention intervention

·         Number of MARPS reached with intended number of sessions for individual and small group interventions

·         Number of schools with PEPFAR-supported life-skills program

·         10,000 of PLHA were reached with individual/small group comprehensive prevention interventions

·         2,790 MARPs were reached with intended number of sessions for individual and small group interventions

·         140 schools had life-skills programs supported by PEPFAR

·         80,000 of PLHA reached with individual/small group comprehensive prevention interventions

·         10, 000 MARPs reached with intended number of sessions for individual and small group interventions

·         750 schools have life-skills programs supported by PEPFAR

Provide male circumcision services in xx% of country health facilities

·         Number of male circumcisions performed according to national or international standards

·         250 male circumcisions were performed in 2008

·         450,000 male circumcisions performed over 5 years

Ensure quality diagnostic services with appropriate use of laboratory facilities and testing

·         Percent of HIV rapid test facilities with satisfactory performance in external quality assurance / proficiency testing program for HIV rapid test

·         22% of HIV rapid test facilities perform satisfactorily in external QA / proficiency testing for HIV rapid tests

·         80% of HIV rapid test facilities perform satisfactorily in external QA / proficiency testing for HIV rapid tests

The programmatic table should include all of the indicators and targets that will be tracked through the Partnership, including all those required by PEPFAR (see Next Generation Indicators Reference Guide, version 1.1) and any others agreed upon as part of the Partnership. These indicators will be used to track the progress of the Partnership in achieving its goals. Indicators are not needed for program areas not addressed through the Partnership Framework and COP.

Annual reporting on these indicators will be through the PEPFAR semi-annual and annual reporting process. In the Partnership Framework, PEPFAR ‘downstream’ and ‘upstream’ targets and results will be replaced by ‘direct’ (USG direct delivery of services) and ‘national’ counts. Therefore, measurement of the 5-year targets should be based on national-level and PEPFAR direct results. Specific guidance for appropriate PEPFAR accounting in program areas lacking ‘direct’ support is available in the Next Generation Indicators Reverence Guide version 1.1. Financial contributions will be monitored on the basis of National AIDS Spending Assessments and National Health Accounts (see Annex III); reporting will occur bi-annually.

It is essential to engage partner governments in taking ownership of policy reform and monitoring its progress. To support this, measuring policy reform should be kept relatively simple and may follow a standard template per Annexes 3 and 4 of the Next Generation Indicators Reference Guide Version 1.1 (August 2009). The baseline stage of policy reform and the target stage for the 5-year Partnership for all policies targeted by the Partnership will need to be agreed with the government. The government and partners will then be able to use these targets to track the progress of the Partnership in achieving its goals of policy reform. An illustrative policy reform monitoring table is included on the next page (Table 5) as an example of how to report on this essential reported Health System Strengthening indicator. The seven policy areas from Annex I are included, followed by an example of a policy reform not included in Annex I but which has been targeted in the hypothetical Partnership Framework. The specific targeted policy reforms in this table are only meant to be illustrative.

Table 5. Illustrative Policy Reform Monitoring Table

  1. Create a column for each specific policy reform targeted in the Partnership Framework (multiple pages may be required).
  2. For each specific policy reform, check applicable boxes to indicate baseline (i.e., completed) stages of policy reform.
  3. For each specific policy reform, use an ‘x’ to indicate the target stage for the end of the Partnership Framework.

                           Specific Policy Reforms Targeted in Partnership Framework

Country X

Policy Reform Monitoring Table

 

Human Resources for Health (e.g., HRH policy)

 

Gender (e.g., violence against women)

Children (e.g., OVC protection policy)

 

CT uptake

(e.g., HIV PITC guidelines)

 

Access to high-quality, low-cost medications (e.g., drug registration policy)

Stigma and Discrimination (e.g., enforcement of legislative provisions) 

 

Multisectoral response to health and development

(e.g., TB/HIV testing policy)

Male Circumcision (e.g., national policy)

*optional

Maternal and Child Health (e.g., infant nutrition)

*optional

Stage of Policy Reform

 

1.  Identify baseline policy issues by conducting situation assessment

 

ü

ü

ü

ü

ü

ü

ü

ü

ü

2. Engagement of stakeholders in developing common policy agenda

 

ü

 

 

 

 

 

 

ü

 

ü

 

ü

 

* 3. Develop policy

 

ü

 

x

 

ü

ü

 

ü

 

* 4. Official Government endorsement of policy

 

 

x

 

 

x

ü

 

ü

x

5. Implementation of policy

 

x

 

 

x

 

x

x

ü

 

6. Evaluation of policy implementation

 

 

 

 

 

 

x

 

x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Only required if making a change in existing written policy (e.g., amending, repealing, or drafting new). Note: the first seven columns represent policy reform areas that are required to be included in the policy situation assessment, and may be included in the agenda. In addition, if other actors or donors are already working in a specific policy reform area, the U.S.G. does not necessarily need to work in that area unless there is value added

Monitoring specific contribution activities will be based on narrative reporting among the Partnership members. Simple, nominal categories will be used, along with additional explanatory text appropriate to the discussion. Activities will not be monitored individually, but rather as clusters associated with the objectives. Table 6 provides an illustration of how this matrix might appear. A version of this table will be used by the partners and other stakeholders to track the progress of the partnership in achieving its goals of coordinating activities and transitioning programs to local ownership. These results will be reported annually to headquarters.

Table 6. Example of table depicting objectives, commitments, and commitment indicators.

Five-Year Goal

Prevention: Reduce HIV Incidence by 50%

 

Objectives

Expected Contributions

Indicators

 

National

USG

National

USG

 

 

 

 

 

Ensure provision of HIV prophylactic treatment of 85% of pregnant women who require this intervention

·         GOV  procures xx% of prophylactic drugs

·         GOV procures xx% of HIV testing kits

·         GOV provides leadership in strategic planning and review of PMTCT effort

·         USG trains xx% of PMTCT providers

·         USG funds xx% of PMTCT sites

Yes / Partial / No

Yes / Partial / No

Ensure all relevant target populations receive appropriate prevention interventions associated with HIV risk behaviors

·         GOV incorporates life-skills training curricula in xx% of all primary and secondary schools

·         GOV supports development of NGOs for community mobilization

·         USG supports development of combination prevention pilot, and xx% of model expansion

·         USG supports development of quality standards for prevention programs

Yes / Partial / No

Yes / Partial / No

Provide male circumcision services in xx% of country health facilities

·         GOV ensures favorable policy environment to support expansion of MC

·         GOV funds training of xx% of MC providers

·         USG funds xx% of new MC sites

·         USG procures xx% of MC-related surgical equipment

Yes / Partial / No

Yes / Partial / No

Ensure quality diagnostic services with appropriate use of laboratory facilities and testing

·         GOV supports xx% of National Reference Laboratory functions

·         GOV supports development of QA/QC standards and protocols

·         USG supports training of xx% of new lab technicians

·         USG funds xx% of construction costs for xx new laboratories

Yes / Partial / No

Yes / Partial / No

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