Changing the World through Local-to-Global Advocacy

Scaling and Assessing Impact from the Campaign to End Pediatric HIV/AIDS (CEPA)

by Dr. Paul S. Zeitz, Executive Director& Professor Sanjeev Khagram, iScale

Advocacy Breakfast SeriesAspen Institute

Washington, D.C.15 January 2011

“Waging Justice”– A Performance-based Advocacy Approach

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Pressure

Decision-Makers

Accountability Advocacy

Conception

Issue I

dentifi

catio

nPolicy Analysis

Agenda Setting

Mobilize Public

Generate Media

Target Accountability

Advocacy

Accountability

Results

& Outcomes

Accountab

ility

NOTE: GPAN’s advocacy approach was developed utilizing the Annie E. Casey Foundation’s “Guide to Measuring Advocacy and Policy,” conversations with interviewees, and analysis by Dalberg Global Development Advisors.

Build

Partnerships

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1. Develop clearly defined, campaign-specific Theory of Change and Theories of Action to achieve

strategic political advocacy outcomes that align with GPAN’s overall Theory of Change.

2. Utilize criteria for prioritizing among network models and targeted advocacy outcomes in order

to successfully advance GPAN’s priority initiatives or campaigns.

3. Develop a clear approach to achieving impact based on experience, environmental mapping, and

an understanding of key gaps in the advocacy landscape.

4. Utilize a networked advocacy approach to pressure decision-makers, mobilize constituencies,

and build partnerships.

5. Create or support campaign networks to design and implement advocacy action plans that

prioritize specific outcomes and reflect the needs and priorities of affected communities.

6. Engage in strategic political communications that speak truth to power, help frame the advocacy

debate, and ensure rapid response to emerging advocacy opportunities.

7. Support watchdog mechanisms and networks to hold political leaders and other stakeholders

accountable for their commitments.

8. Conduct performance-based advocacy through robust systems that facilitate monitoring,

evaluation, and continuous learning, e.g., Impact Planning, Assessment, Reporting and Learning

(IPARL) system.

Agenda SettingIss

ue Id

entifi

catio

n

Policy Analysis

Conception

Target Accountability

Resu

lts &

Out

com

es

Acco

unta

bilit

y

Advocacy

Accountability

Account-ability

Advocacy

Mobilize Public

Build

Partnersh

ips

Generate

Media

Pressure

Decision Makers

Overview of the “Waging Justice” Advocacy Approach

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“Waging Justice”

Performance based

Approach

ADVOCACY OUTCOMES

Paradigm-busting POLICIESSecure evidence-based policies that achieve ground-breaking progress,

rather than small-scale incremental change

Increased and improved needs-based FUNDINGMobilize significant, sufficient, and sustained funding from diverse sources, e.g., public

and private, and ensure efficient disbursement and implementation mechanisms

ACCOUNTABILITY for people-level impactsStrengthen and create watchdog and enforcement mechanisms to ensure improved

implementation of global, regional, and national commitments

CIVIL SOCIETY inclusion in decision-making and implementationIncrease civil-society participation and engagement with global, regional, and national

institutions, and ensure local ownership of program design and implementation

New and transformed INSTITUTIONSStrengthen the performance and impact of existing institutions through policy,

procedural, and governance reforms, and create new institutions as needed

Inter-ConnectedStrategic

Objectives

Strategic Focus on Five Priority Advocacy Outcomes

Campaign to End Pediatric HIV/AIDS (CEPA) GOALS: Going to Scale with PPTCT+ and Pediatric Treatment

80% coverage for pediatric HIV/AIDS

treatment and

80% coverage for PPTCT+ services

by December 31, 2015

• Current CIFF Support: May 2009 –April 2012• GPAN/GAA Committed to CEPA(+), 2011-2015

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CEPA Local-to-Global PartnersInitiating Countries

Kenya, Mozambique, Zambia, Nigeria, Tanzania, Uganda: indigenous civil-society networks

Sub-Saharan Africa RegionANECCA, PATAM, HAI Stock Outs Campaign, Health GAP, OSISA, Graça Machel Trust

Global PartnersGAA, Health GAPEvaluation & Learning Partner: iScaleFunding Partners: Children’s Investment Fund Foundation (CIFF), UNICEF, others

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CEPA IPARL COMPONENTS Link IE and M&E activities with Strategy

• Clearly articulated CEPA-wide Theory of Change

• Clearly articulated global and national, regional, and global level “Theories of Action” for CEPA partners

• An integrated assessment framework aligned with global, regional and national level strategies – includes: baseline data, score card of indicators, evidence of change journals, and periodic assessments (review and evaluation)

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CEPA IPARL COMPONENTS Link IE and M&E activities with Strategy

• Learning and improvement activities

• Constituency voice and feedback

• Public and donor reporting

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CEPA’s Advocacy Objectives

End 2015 Goal: 80% Coverage for

Comprehensive PPTCT+ and

Pediatric HIV/AIDS Treatment

Objective 1: Comprehensive Family Centered

Care and Nutrition

Objective 2: Early Infant

Diagnosis and Treatment

Objective 3: Access to

Appropriate Medicines and Commodities

Objective 4: Full Funding

Objective 5: Reprogramming to Achieve CEPA

Impact

Objective 6: Overcoming

Human Resources Crisis

Objective 7: Overcoming Stigma and

Discrimination

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Theories of Action that Include Evidence/KPIs to Monitor Progress Towards

Advocacy Outcomes and Advocacy Outputs

Advocacy OutcomeNational policy strengthened to prevent

discrimination against HIV positive mothers and children.

Advocacy OutcomeAn accredited set of National Training curricula for

task shifting is established.

Advocacy OutcomeComprehensive and harmonized pediatric care

policies, guidelines, and standard operating procedures are adopted by National Government,

donors, and providers.

BottleneckStigma

BottleneckLack of coordinated

care

BottleneckLimited number and capacity of trained

health care professionals

Advocacy Output

Pediatric care policy guidelines drafted by

Ministry of Health

Advocacy OutputReport on national

stigma index is published

Advocacy OutputNational Training

curricula is drafted by relevant actors

Evidence/KPIs: Punishments for discrimination in National policy are made more severe

Evidence/KPIs: National Training curricula document

Evidence/KPIs: Relevant legislationEvidence/KPIs: Draft of Pediatric care policy

guidelines

Evidence/KPIs: Draft of Training Curricula

Evidence/KPIs: Stigma Report

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“Robot” Traffic Light SystemColor Code for Monitoring Progress

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Outcome/Output STATUSAchievement of outcome/output

Progress towards outcome/outputSome progress towards outcome/output, but significant challenges existNo progress to date (or) no achievement of outcome/output

Insufficient data for status assessment* This describes the status of outcomes irrespective of CEPA

contributionCEPA CONTRIBUTION Towards Outcomes/OutputsSignificant CEPA contribution

Some CEPA contribution

No CEPA contributionInsufficient data, un-validated data, or contested data which makes contribution assessment difficult

By end of 2010 MoH implements more effective PPTCT interventions, based on phased implementation of the new WHO PPTCT Guidelines

By Dec 2010 MoH implements task shifting to allow non-physician clinicians to prescribe Ped

ART and PPTCT

Within the next 12 months, supply chain management systems decentralized and better

coordinated by MoH

15% of the 2011 annual national budget (internal resources) is allocated to health sector (Abuja Declaration) (and within this 15%, adequate resources to MCH including

PPTCT, and paediatric ART

80% targets for supplying PPTCT+ and paediatric treatment services to be achieved by Dec. 31, 2012 set by government

Core Objective 1: Family centred care and nutrition

Priority 1.1 Rapid adaptation and implementation of new WHO guidelines on ART, PPTCT+ and infant feeding by 2011

Core Objective 2: Early infant diagnosis and treatment (EID+T)

Priority 2.1 Development and implementation of EID+T guidelines to increase testing of children within two months of birth by 2011

Core Objective 3: Access to appropriate medicines

Priority 3.1 Effective policy and monitoring mechanisms in place to reduce point of care stock-outs of ART for adults and children, OI drugs, EDI and family planning commodities by 2012

Core Objective 4: Full fundingPriority 4.1 Increased national budget for PPTCT+ Ped treat, and services by 2012

Priority 4.3 Achieve the Abuja declaration commitment by 2012

Cross-Cutting Objective 5: Reprogramming to Achieve CEPA Impact

Priority 5.1 Political commitments and nat plans/frameworks adopt CEPA goals and priorities by 2012

Cross-Cutting Objective 6: Overcoming Human Resource Crisis

Priority 6.1 Effective policies and guidelines to expand and improve HR capacity to support scale up of PPTCT+ and Ped treat services by 2012

CS engaged by MoH and Development partners in 12 meetings of thematic wk groups

Com/tradit religious lead, healers, activists are trained about PPTCT and Ped HIV/AIDs treatment by end of 2010, by CEPA partners and endorsed by MoH

5 training wksps by CEPA partners on Ped HIV/AIDS and PPTCT for Com/tradit religious lead, healers, activists

MoH adopts Opt A of new WHO Guidelines by Aug 2010

CEPA identify/participate in 5 thematic wk groups open for CS

participation by Jun 2010

Training plans and guidelines to authorize non-physician clinicians on PPTCT clinical manage include provis of HAART and to provide

ART

MoH approv new strat plan for pharm logistics by Jun 2010

Gov+Multi-lat/Bi-lat donors commit to increase funding for Ped

HIV /AIDs and PPTCT

No Output identified in NAAP

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Advantages of CEPA’s IPARL • “Agenda-setting” effect of extensive advocacy action

planning• Aligned Campaign-wide theory of change, partner theories of

action and KPIs• Shift in focus from activities to measurable advocacy

outcomes and outputs• Real-time learning to inform strategy and course correction• Integration and triangulation of multiple types of evaluation

data• Enhances capacity in all partners, improving non-CEPA

related advocacy• Enhances a “global action network (GAN)” approach to

transnational advocacy

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Risks/Challenges of CEPA’s IPARL

• Requires authentic ownership and trust amongst partners

• Low capacity of advocacy organizations to implement reduces potential learning and course correction benefits

• Overcoming KPI-fatigue• Attribution of contribution remains elusive• Donor-driven monitoring and evaluation can shift

focus from strategic advocacy• Risk that funders will rigidly link performance-

based advocacy to funding

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Lessons: Performance-based Advocacy (PBA) • Should be an integral part of the early stage

planning process, incorporating regular monitoring reviews and periodic impact evaluation

• Requires a cultural shift among advocates

• Requires intensive capacity building and robust peer mentoring systems

• Must be fit-for-purpose, with sustained financial support by funding partners

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"True peace is not merely the absence of tension:

it is the presence of justice."

--Reverend Martin Luther King Jr.

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