nfhk2011 ali arsalo_parallel5

Development of coordination and local

ownership for large international HIV

programmes in the framework of

Northern Dimension

The 10th Nordic Public Health Conference

Ali Arsalo, MD, 24.08.2011

Use of the Extended Logical Framework

Approach in the planning of a multinational

HIV Programme strategy within the NDPHS

Application of the experiences from the planning process of the

Barents HIV Programme to the work of the HIV & AIDS Expert Group

of the Northern Dimension Partnership for Health and Social Wellbeing

Ali Arsalo, MD, Kevi Consulting

The 10th Nordic Public Health Conference 24.08.2011

1. NDPHS and the EG HIV/AIDS & AI

2. Logical Framework Approach

3. Extension of the Logical Framework Approach

4. Barents HIV Programme

5. Steps in the development of the Barents HIV

Programme

6. Implications for the ownership and coordination

7. Planning process of the Expert Group activities for

future

8. Conclusions



1. NDPHS and the EG HIV/AIDS & AI

NDPHS is a multilateral collaboration mechanism

aiming at containing the spread of infectious diseases and developing healthy life styles

EGs (Expert Groups) are practical, international working groups of the NDPHS

EG HIV/AIDS & AI

provision of support to identification of project needs and project planning



2. Logical Framework Approach

Logical Framework Approach (LFA) is a holistic way of thinking and acting with essential key words:

Stakeholders, Beneficiaries, Participatory approach, Problem identification, Problem analysis, Orientation towards objectives and impacts

LFA is based on participatory analysis of the needs of beneficiaries, making complex phenomena more simple to manage

LFA aims at sustainable development impacts



3. Extension of the Logical Framework Approach Comprehensive planning of complex and multilateral approaches

Usually, the basic information about development needs is produced in planning seminars where selected representatives of different stakeholders are invited

However, when this is not relevant or possible, the identification of development needs can be carried out through extended LFA

Extension means different and extended approaches to collect the maximum of relevant information, to analyze, test, reformulate and visualize it



4. Barents HIV Programme I

The Programme was planned in 2003-2004 The situation was critical because HIV was rapidly spreading and it was indispensable to find new ways of collaboration and coordination

The challenge was complex and necessitated wide multilateral approach involving many regions and countries, different types of organisations, authorities and institutions

The planning was materialised so that essential principles of the LFA were made use of and applied through extensions beyond traditional arrangements



4. Barents HIV Programme II

Extension and modifications of the usual LFA Traditional, relatively limited planning seminars were not organised but, instead, the LFA was seen as a tool for comprehensive analysis of the context and for creating a strategy for combating the spread of HIV and its harmful consequences

In fact, along the planning process, a new way of making use of the LFA principles in planning of a wide development strategy was developed and tested

The process produced also tools for improving the coordination during the implementation



5. Steps in the development of the

Barents HIV Programme I

Three phases of consultations Relevant information was collected by a very wide series of consultations with different stakeholders. The information was analysed by using Logical Framework tools, like Problem and Objective Trees

Then, as the second step, a meeting for almost 100 participants was organised where the conclusions from the first round of consultations were tested and more information was collected.



Subsequently, the second versions of Problem and Objective Trees were formed.

In the third phase, the new versions were presented to stakeholders during another round of consultations, after which the final proposals were prepared and presented to decision makers.


Barents HIV Programme II



It is essential that no ready-made, outside or blueprinted solutions were imposed but

all the information on which the Programme was developed was collected from a wide range of different stakeholders


Barents HIV Programme III



Problem Tree

reveals and clarifies the core problem and the

expected consequences of the problems

based on information from the wide range of

partners and different stakeholders

shows different problem areas to be tackled

describes various needs for projects and

activities to improve the prevailing situation


The 10th Nordic Public Health Conference 24.08.2011 The HIV/AIDS Epidemic is spreading

in Barents region,

leading to threat of National Security.

There is lack of expanded and

comprehensive response towards

HIV/AIDS situation. Several socioeconomic, cultural, legal and

health factors contribute to

vulnerability to HIV infection

Interventions to influence individual

and societal norms, improve the health

infrastructure and alleviate structural

and economical constraints to HIV

prevention and care still are not

effective and efficient

Current HIV/AIDS National program

coverage levels are insufficient

1. Existing

Legislation for

effective

national

policies to

control the

HIV epidemic

needs

strengthening

3. Prevention and

Surveillance

activities needs

to be widened,

deepened and

supported

2. Technical,

partner and

response

capacity for

program or

project

planning and

implementation

needs to be

improved

5. Programs

ensuring

respect towards

human rights,

including

persons living

with HIV/AIDS

(PLWHAs) are

insufficient

4. ARV treatment

affordability and

accessibility within

the Public Health

Care system need to

be improved

6. Integration and

coordination

between Primary

Health care and

HIV/AIDS services,

Social and

Educational

Services and

Sectors are

insufficient

Barents HIV

Programme

PROBLEM TREE

Barents HIV

Programme

2005->



The HIV/AIDS Epidemic is spreading in Barents region, leading to treat of National Security.

There is lack of Expanded and Comprehensive

response towards HIV/AIDS situation. Several socioeconomic, cultural, legal and health factors

contribute to vulnerability to HIV infection

Interventions to influence individual and societal norms,

improve the health infrastructure and alleviate structural

and economical constraints to HIV prevention and care

still are not effective and efficient

Current HIV/AIDS National program coverage levels are insufficient

1. Existing

Legislation for

effective national

policies to control the

HIV epidemic needs

strengthening

3. Prevention and Surveillance

activities needs to be widened,

deepened and supported

2. Technical, partner and

response capacity for

program or project

planning and

implementation needs to

be improved

5. Programs ensuring

respect towards human

rights, including persons

living with HIV/AIDS

(PLWHAs) are insufficient

4. ARV treatment affordability and

accessibility within the Public

Health Care system need to be

improved

6. Integration and

coordination between Primary

Health care and HIV/AIDS

services, Social and

Educational Services and

Sectors are insufficient

The laws and regulations

in Federal and Regional

level are not in

compliance

Policies and regulations to

ensure universal, non-

discriminating access to

anti-retroviral drug

treatment to all infected

people are not in place

Legal status of Harm

reduction programs is

unclear

The lack of legislative acts

ensuring implementation

prevention strategies

among vulnerable groups

Inappropriate legislation

to protect orphans and

other vulnerable children

and their families

Lack of legislation to

promote partnership

among key stakeholders

The laws and regulations

which define roles and

responsibilities of different

institutions in the context

of HIV/AIDS preventions

are not clear

Training strategies that are

responsive to the needs of

the target audience are not

well established

In-service/field supervision

for continued skills transfer

is absent

Poor cooperation between

different institutions: STI,

Penitentiary and TB in

dealing with HIV/AIDS

Political acknowledgement

and support for HIV/AIDS

activities are week

Inadequate collaboration

among key stakeholders in

all sectors (cooperation

between NGO’s, civil

societies, private business

and governmental

agencies)

LLack of advocacy activities

towards policy and decision

makers

NGOs in small cities and

rural areas are not

developed

Budgeting system is unclear

and does not promote

effectiveness

Networks of low-threshold centres for hard-to-reach

target groups are week

Links between drug treatment, HIV counselling and

testing programs and primary health care services

are not established.

Current programs towards increasing knowledge,

encouraging healthy attitudes, developing skills or

changing behaviour among youth are insufficient

Young peoples access to user-friendly STI services,

voluntary counselling and testing (VCT), condoms

and other resources for sexual health are limited

Lack of counselling attitude among health care

workers

Information on methods of Second generation HIV

surveillance system among health care workers is

insufficient

Monitoring of changes in the risk behavior patterns

that are associated with HIV, and monitoring of

sexual behavior, especially among the vulnerable

groups is week

Lack of general awareness on current trends of

care, prevention and infection safety, among health

care workers indirectly involved with HIV/AIDS

Communication strategies to promote services,

improve symptom awareness and STI treatment

seeking behaviour are insufficient

Insufficient participation of mass-media in

information dissemination on HIV/AIDS

Insufficient MTCT prevention activities for pregnant

women with drug dependence or in prison

General awareness

about the impact of

the emerging threat,

economical impact

and measures to

control is weak

Insufficient

participation of

mass-media in

information

dissemination for

protection of

PLWHAs

Shortage of

vulnerability and

stigma reduction

strategies

Support services

and support groups

for PLWHAs are

week and insufficient

Societal factors are

not sufficiently

considered in

HIV/AIDS preventive

interventions

Psychological,

socioeconomic and

legal needs for

PLWHA are met

inadequately

ARV treatment is not available for

all

Insufficient counselling about the

need to continue protective action

and information on the effects of

ARV for clients and their sexual

partners

Information and education for

communities and society on the

possibilities of ARV use are not in

place

Training health teams (doctor,

nurse, counsellor, laboratory staff)

in both the public and private

sectors, with regular updates on

treatment and care options are

insufficient

Lack of universal and no

discriminative access to treatment

Poor development of systems to

integrate HIV care in outpatient

departments and at health centres

Insufficient development of system

of medical care for TB/HIV patients

TB education and training

wherever HIV services are

delivered is insufficient

Laboratory facilities needs

strengthening and upgrading

Absent of special system of ARV

treatment for IDUs

Services at primary care level

to assure broadest access to

effective care and prevention of

HIV/AIDS are weak

Knowledge among providers to

manage counselling and testing

and prophylaxis against

opportunistic infections at the

primary care level is insufficient.

Communication and referral

systems to link closely primary

providers to more specialised

HIV services are inadequate.

School curriculums are lacking

information on HIV/AIDS

prevention

Programmes and courses to

respond to new needs arising

from an AIDS-affected society

within Colleges and universities

are abscent

Lack of teaching capacity to

deliver HIV/AIDS education

Absence of strategic planning

for HIV/AIDS in the education

sector

Weak social safety supporting

orphans and vulnerable

children

HIV prevention programs in

Prisons are insufficient

Barents HIV Programme

PROBLEM TREE


2005->



Objective Tree

defines the PURPOSE for the development activities

shows why it is important to implement active measures based on the information given by the Problem Tree

shows different working areas to tackle

describes various topics for projects and activities for detailed planning and implementation


The 10th Nordic Public Health Conference 24.08.2011 The spread of HIV/AIDS epidemic

in Barents region and its impact is under control

Expanded and Comprehensive

actions against HIV/AIDS

implemented. Socioeconomic,

cultural, legal and health

factors are respected in the

prevention of HIV infection

Relevance, efficiency and effectiveness of

the interventions, influencing individual

and societal norms are improved. Health

infrastructure strengthened and structural

and environmental constraints for HIV

prevention and care alleviated.

Current HIV/AIDS National program coverage levels

are sufficient for responding to prevailing realities

1. Existing

Legislation for

effective

national policies

to control the

HIV epidemic

updated

3.

Comprehensive

and realistic

Prevention and

Surveillance

activities are

implemented

2. Technical,

partner and

response

capacity for

program or

project

planning and

implementation

improved

5. Programs

ensuring respect

towards human

human rights,

including persons

living with

HIV/AIDS

(PLWHAs) are

implemented

4. ARV treatment

Affordability and

accessibility

within the Public

Health system

correlate to

individual needs

6. Coordination

between HIV/AIDS

services and

Primary Health

care, Educational,

Penitentiary and

Social Services

and Sectors is

established

Barents HIV

Programme

OBJECTIVE TREE

Barents HIV

Programme

2005->



The spread of HIV/AIDS epidemic in Barents region and its impact is under control

Expanded and Comprehensive actions against

HIV/AIDS implemented. Socioeconomic,

cultural, legal and health factors are respected

in the prevention of HIV infection

Relevance, efficiency and effectiveness of the interventions,

influencing individual and societal norms are improved. Health

infrastructure strengthened and structural and environmental

constraints for HIV prevention and care alleviated.

Current HIV/AIDS National program coverage levels are sufficient for responding to prevailing realities

1. Existing Legislation

for effective national

policies to control the

HIV epidemic updated

3. Comprehensive and

realistic Prevention

and Surveillance

activities are

implemented

2. Technical, partner

and response

capacity for program

or project planning

and implementation

improved

5.Programs ensuring

respect towards human

human rights, including

persons living with

HIV/AIDS (PLWHAs) are

implemented

4. ARV treatment

Affordability and

accessibility within the

Public Health system

correlate to individual

needs

6. Coordination between

HIV/AIDS services and

Primary Health care,

Educational, Penitentiary

and Social Services and

Sectors is established

• The laws and regulations

in Federal and Regional

level are in compliance

• Policies and regulations

ensuring universal, non-

discriminating access to

anti-retroviral drug

treatment to all infected

people are founded

• Legal status of Harm

reduction programs

established

• Legislative acts providing

information on

implementation of

prevention strategies

among vulnerable groups

created

• Appropriate legislation to

protect orphans and other

vulnerable children and

their families developed

• Partnership among key

stakeholders is supported

by legislation

• The lows and regulations

defining roles and

responsibilities of different

institutions in the context of

HIV/AIDS preventions

established

• Training strategies that

are responsive to the needs

of the target audience are

developed and

implemented

• In-service/field supervision

for continued skills transfer

established

• Cooperation and

coordination between

different institutions: STI,

Penitentiary and TB in

dealing with HIV/AIDS

created

• Needs for support of

HIV/AIDS Politically

acknowledged.

• Coordination structured

among key stakeholders in

all sectors (cooperation

between NGO’s, civil

societies, private business

and governmental

agencies) established

• Advocacy activities

towards policy and decision

makers are set up.

• NGOs in small cities and

rural areas established and

developed

• Increased use of

Budgeting system for

promotion of program and

project effectiveness

• Networks of low-threshold centres for hard-to-

reach target groups strengthened.

• Links between drug treatment, HIV

counselling and testing programs and primary

health care services established.

• Programs, towards increased knowledge,

encouraging healthy attitudes, developing skills

or changing behaviour among youth, instituted.

• Accessibility for young peoples to user-friendly

STI services, voluntary counselling and testing

(VCT), condoms and other resources for sexual

health improved

• Health care workers counselling skills

development programs established.

• Information on methods of Second generation

HIV surveillance system among health care

workers is easily accessible.

• Monitoring of changes in the risk behaviour

patterns that are associated with HIV, and

monitoring of sexual behaviour, especially

among the vulnerable groups is established

• General awareness on current trends of care,

prevention and infection safety, among health

care workers indirectly involved with HIV/AIDS

increased

• Communication strategies to promote

services, improve symptom awareness and STI

treatment seeking behaviour are established

and operational.

• Mass-media participation in information

dissemination on HIV/AIDS ensured

• MTCT prevention activities for pregnant

women with drug dependence or placed in

prisons are established and operational.

• General awareness

about the impact of

the emerging threat,

economical impact

and measures to

control increased

• Sufficient

participation of mass-

media in information

dissemination for

protection of PLWHAs

ensured

• Vulnerability and

stigma reduction

strategies created and

implemented

• Support services and

support groups for

PLWHAs are

established and

operational

• Societal factors are

elaborated and

integrated in HIV/AIDS

preventive

interventions

• Institutions to meet

psychological,

socioeconomic and

legal needs for

PLWHA are set up.

• ARV treatment is available for all

in need

• Ongoing counselling about the

need to continue protective action

and information on the effects of

ARV for clients and their sexual

partners is established and

operational.

• Programs for information and

education of communities and

society on the possibilities of ARV

use are created and implemented

• Training programs for health

workers in both the public and

private sectors, with regular

updates on treatment and care

options instituted

• Systems to integrate HIV care in

outpatient departments and at

health centres developed

• Systems of medical care for

TB/HIV patients are updated and

operational

• Programs for TB education and

training whithin HIV services are

established

• Laboratory facilities are

upgraded, equipped, staffed

and operational • Special system of ARV treatment

for IDUs are established

• Broadest access to effective

care and prevention of HIV/AID

at primary care level is assured

• Training programs to manage

counselling , testing and

prophylaxis against opportunistic

infections among providers at

the primary care level are

created

• Communication and referral

systems to link closely primary

providers to more specialised

HIV services are established.

Information on HIV/AIDS

prevention is included in School

curriculums.

• Programmes and courses to

respond to new needs arising

from an AIDS-affected society

within Colleges and universities

are established and operational.

• Teachers capacity to deliver

relevant HIV/AIDS education

increased .

• Strategic planning for

HIV/AIDS is included in the

education sector.

• Social support

program/projects of orphans

and vulnerable children are

developed and implemented

• HIV/AIDS prevention programs

within Penitentiary system

created and implemented


OBJECTIVE TREE


2005->



6. Implications of the Extended LFA

for the ownership and coordination I

In-built basic factors to influence sustainability

High relevance, connected to realistic and

comprehensive contents through wide consultations of

various stakeholders, those who are the best experts

and who are directly concerned

Different actors will find their voice in the Programme

plan which supports feeling of realism and the

development of ownership



6. Implications of the Extended LFA

for the ownership and coordination II

Improving strategic orientation and coordination

Comprehensive strategy can be developed through the

extended LFA process

All the main elements become visible and transparent,

allowing and improving long-term planning and

concentration to priority issues

Provision of tools and mechanisms for local authorities

to coordinated actions instead of short term fragments



7. Planning Process of the NDPHS HIV

Expert Group activities for the future

The wide range of Barents experiences, conclusions and suggestions can be used in developing strategies and coordination for new international approaches

The NDPHS EG on HIV, AIDS & AI is currently developing an action plan and mechanisms for supporting project planning internationally and for partner countries

In this task, the experiences, conclusions and suggestions from the Barents HIV Programme planning and implementation are made use of



8. Conclusions I

Extended LFA can be used for any multilateral programme planning process internationally or regionally

The use of extended LFA planning needs resources, effective management, transparency, long term visions and willingness for collaboration

The process produces and provides easy and effective tools for coordination and management if sustainable results are to be achieved

Improvement of effectiveness of projects can be achieved



8. Conclusions II

Structuring of the Programme to understandable

purpose, realistic components and relevant

assumptions

Extension of LFA based planning provides simple

tools for programme managers

Simple coordination tools will also be available for

implementing and financing agencies

Through extended planning and long-term

commitment to the implementation directing

towards improvement of effectiveness of projects



Effective projects! Steps for tomorrow’s development impacts

Ali Arsalo, M.D. Managing Director

Kevi Consulting Pvt.Ltd gsm 050 537 6265

[email protected] www.kevicon.fi

nfhk2011 ali arsalo_parallel5

Health & Medicine

kevi consulting

spread of hiv

development of coordination

logical framework tools

barents hiv programme6

barents hiv programme5

implementationali arsalo

conclusionsali arsalo