For the first time in decades, the response to the global HIV epidemic is poised to achieve lasting progress in HIV prevention for young women and adolescent girls. This is buoyed by three key trends:
- a renewed HIV prevention platform — driven by breakthroughs in the development of novel prevention tools;
- political will at the highest levels of global development for intersectoral programming — as articulated in the aspirations of the Sustainable Development Goals (SDGs);
- an increase in investments for advancing gender equality acros all domains of health and well-being.
Across the most-affected regions, namely West and Central Africa and East and Southern Africa, national authorities are starting to see momentum in efforts to avert new HIV infections among young women and adolescent girls aged 15–24 years, the very demographic most central to the future sustainability of the entire HIV epidemic response. This progress is centred around the key epidemics of note, mainly in Southern Africa, which is encouraging. On a sobering note, although they were promising, recent documented declines in annual new HIV infections among young women and adolescent girls still fall far short of global commitments to reduce new HIV infections by over 75 per cent for the year 2020.
If recent history in the global HIV epidemic response is anything to go by, this opportunity will have a limited, if unknown, lifespan. Effective stewardship of both HIV-specific and broader health and development resources will be necessary to strengthen national systems and responses, with a clear eye towards a longer-term sustainable response once current funding levels recede. This will entail rational planning and decision-making, diligent resource management, savvy coordination of disparate actors and stakeholders across sectors, and disciplined use of data to drive programmatic decisions.
- The SDGs, with their emphasis on the interlinkage, mutuality and indivisibility of outcomes, perfectly frame the strategic planning processes needed to drive affirming programming for adolescent girls. At the national level, planning for adolescent girl- and woman-centred prevention programmes benefits from a firm grounding in the national health and development frameworks.
- The national response to the unique vulnerabilities that adolescent girls and young women face must be firmly anchored within the key national processes, starting from the national strategic plan/framework for health and HIV, and from similar documents in other sectors, ideally driven by clear longer-term investment cases, with linkage to both programmatic and national budget development.
- Subnational-level planning processes are critical to the success of national initiatives, but even more so in decentralized systems, and should include attention to coordination across partners and alignment of the efforts of subnational actors.
- The agency, leadership and engagement of young women and adolescent girls as experts on their own lives is essential to the national planning and review processes and must receive dedicated resources.
- Given the extensive nature of vulnerability and deprivation in many contexts, and the political pressures to meet the expectations of numerous constituencies, tough decisions must be made on who and what to prioritize within the prevention programming framework.
- Effective programming will require strong, visionary and courageous leadership, with a defined stewardship function to coordinate both the national actors and global or regional development initiatives within a clear national framework.
- Programme managers should take a long view towards the attainment of sustainable results, informed by clear-eyed understanding of their system and policy constraints, with the objective of developing systems that enable local ownership of prevention programmes for young women and adolescent girls.
Strategic contracting to strengthen stewardship and coordination. Strategic contracting of civil society and academic partners has been utilized to address gaps in national authorities’ capacity, monitor and track prevention investments, align prevention partners and operate accountability structures for planning and management of resources. This approach has tremendous promise, particularly in contexts where the local epidemic is mixed, where broad expanses of territory or large networks of service providers must be coordinated, and where private sector service provision is a mainstay of the health and social system.
Co-financing across sectors. Joint investment across sectors allows for an intersectoral approach when taking a programme to scale and is more reflective of the realities within communities where various sectors, including education, health, development, poverty reduction and technology, naturally merge. Co- financing enables various HIV, health and development objectives to be achieved simultaneously, but demands effective cross-sectoral coordination mechanisms for planning, implementation and financing.10 Governments and funders or investors should consider co-financing across sectors within their budget allocations, as it represents a cost-effective measure. This option could also represent a new funding pathway for high-impact interventions to be implemented and even scaled up. South Africa and Tanzania have identified co- financing as an innovative modality for implementation of national strategic plans for HIV and social protection. South Africa has incorporated co-financing in its HIV and tuberculosis investment case and subsequently in its national strategic plan for HIV/tuberculosis and sexually transmitted infections (2017–2022).
Resources
The Global Fund; 2016; English
https://www.theglobalfund.org/en/search/?q=Strategic+Investments+for+Ad… (available upon request)
This document highlights opportunities and requirements for addressing and involving adolescents in developing the concept note as part of the funding cycle. It also addresses issues related to adolescents in the context of resilient and sustainable health systems for three diseases: tuberculosis/HIV, tuberculosis and malaria, while emphasizing this population’s unique needs and challenges. The document provides: practical solutions for a range of adolescent-specic challenges; guiding questions for countries to use as they develop the funding model (through country dialogue, including review of national plans and concept note development); and key resources for designing and planning adolescent-focused interventions. Regarding HIV prevention, the note covers biomedical, behavioural and structural issues.
UNAIDS; 2014; English
https://www.unaids.org/sites/default/files/media_asset/JC2661_part1_en…
This tool aims to increase young people’s effective and meaningful participation in the Global Fund, with a specific emphasis on opportunities to participate at the national level. It has the following objectives: 1) provide practical guidance to youth activists at the country level on how they can participate in the Global Fund and ensure Global Fund grants are invested strategically to ensure programmes for young people have maximum impact; 2) provide guidance to Country Coordinating Mechanisms — the entities that coordinate the development and submission of funding requests to the Global Fund and that oversee the implementation of grants — so that they effectively and meaningfully engage young people.
UNAIDS; 2014; English
https://www.unaids.org/sites/default/files/media_asset/JC2661_part2_en…
This tool offers guidance to Country Coordinating Mechanism members and other Global Fund actors on how to involve young people in all Global Fund processes, including the development or review of national strategic plans (and/or investment cases), the management of the ongoing country dialogue, the creation of the concept note, the composition of Country Coordinating Mechanisms and the implementation of Global Fund-supported programmes.
Global Financing Facility; 2016; English
https://www.globalnancingfacility.org/guidance-note-investment-cases
This note aims to provide guidance to countries developing a reproductive, maternal, newborn, child and adolescent health (RMNCAH) investment case. The investment case is a description of the changes that a country wants to see with regard to RMNCAH, and a prioritized set of investments required achieve these results. It is not a comprehensive description of all of the activities underway on RMNCAH in the country. Instead, it presents a compelling case for how a limited number of priorities will put the country on the path to improving the health of women, children and adolescents over the long term and thereby contribute to the achievement of the SDGs.
The Lancet, Women Deliver; 2017; English
https://womendeliver.org/wp-content/uploads/2017/03/Deliver-for-Good-Bo…
Deliver for Good is a new global push that considers gender in the context of the SDGs and promotes 12 critical investments — political, nancial and programmatic — in girls and women which will bring high returns for women and for societies in decades to come. Deliver for Good will mobilize allies across sectors and issues, change the global narrative around girls and women, and help to fuel concrete action and SDG implementation at the global and country level. Deliver for Good will focus on solutions, action and the links between gender equality, health, education, economic empowerment, environment and access to resources.
Global Financing Facility; 2016; English
https://www.globalnancingfacility.org/guidance-note-investment-cases
This note aims to provide guidance to countries developing a reproductive, maternal, newborn, child and adolescent health (RMNCAH) investment case. The investment case is a description of the changes that a country wants to see with regard to RMNCAH, and a prioritized set of investments required achieve these results. It is not a comprehensive description of all of the activities underway on RMNCAH in the country. Instead, it presents a compelling case for how a limited number of priorities will put the country on the path to improving the health of women, children and adolescents over the long term and thereby contribute to the achievement of the SDGs.
The Lancet, Women Deliver; 2017; English
https://womendeliver.org/wp-content/uploads/2017/03/Deliver-for-Good-Bo…
Deliver for Good is a new global push that considers gender in the context of the SDGs and promotes 12 critical investments — political, nancial and programmatic — in girls and women which will bring high returns for women and for societies in decades to come. Deliver for Good will mobilize allies across sectors and issues, change the global narrative around girls and women, and help to fuel concrete action and SDG implementation at the global and country level. Deliver for Good will focus on solutions, action and the links between gender equality, health, education, economic empowerment, environment and access to resources.
Tanzania Ministry of Health, Community Development, Gender, Elderly and Children; 2019; English
http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_gro… Meeting_Documents_2019/NAIA__AHW_Presentation.pdf
The National Accelerated Investment Agenda for Adolescent Health and Wellbeing (NAIA_AHW) was developed with the objective of focusing the country on gaps in adolescent health and well-being that need to be addressed in the immediate term. This framework will enable key stakeholders to: 1) define the highest priority issues and key enablers; 2) set specific, measurable, assignable, realistic and time manageable (SMART) programme objectives; 3) determine the minimal (achievable) package of interventions required for each pillar; 4) describe the current landscape of activities by funder, implementer and geography; and 5) define the highest-priority actionable gaps and the funding required.
Government of the Republic of Uganda; 2018; English
https://www.unicef.org/uganda/media/3911/file
This multi-sectoral framework for adolescent girls in Uganda outlines the Government of Uganda’s commitments and efforts to invest in adolescence in the second decade of life. It outlines how government ministries will coordinate to deliver a package of services in order to achieve sustainable results for adolescent girls.
Zimbabwe Ministry of Women Affairs, Gender and Community Development; 2014; English
https://www.together forgirls.org/wp-content/uploads/2017/10/Final_Girls-and-Young-Womens-Empowerment-Framework-Oct- 2014-Zimbabwe.pdf
This framework articulates a national commitment to protecting and empowering girls and young women in Zimbabwe. It recognises that by empowering girls and young women it contributes to the transformation of the country’s economic future as well as the development of its peoples. The framework is anchored in the realisation that the most straightforward intervention to empower girls and young women is ensuring that they realise their rights as provided for by several international and regional human rights instruments.
Publisher: USAID; Year: 2018; Language: English
Website: https://youtu.be/8w9-E8wwDto
https://rise.ar ticulate.com/share/-xWeCMdb3GNTRuj-NI8AaQUsvMx6J6b4#/
As demand for health care rises, health system stakeholders in low- and middle-income countries are exploring ways to increase domestic resources for health. Using health resources more efficiently is one of the most promising strategies. Health system stakeholders in low- and middle-income countries are exploring ways to achieve more with available resources and realize savings that can be used to fill the gap in resources needed to expand effective health coverage to all. Where other guides and tools focus on improving allocative efficiency (’doing the right things’), this guide focuses on technical efficiency (’doing things right’). An interactive web-based guide, it is intended to help diagnose and address technical inefficiencies across health systems, as well as to help ministries of health look across the health system and prioritize areas of technical inefficiency that are likely to produce the greatest efficiency gains in the short term.
Stover, John, et al.; 2016 English
http://pubdocs.worldbank.org/en/519811454537584578/7-John-Stover-HIV-al…
This presentation introduces the Goals model, with particular attention on how it can be used to inform resource allocation in programme planning and optimization. Included throughout the document are examples from different countries that use Goals to develop an investment case. It also addresses the indicators and cost-effectiveness of various HIV preventions, as well as other considerations to assist countries in developing efficient and effective policy and programming.
Stephenson, Mary-Ann; Oxfam; 2018; English, French, Spanish
https://oxfamilibrary.openrepository.com/bitstream/10546/620429/13/gt-g…
Gender-responsive budgeting is essential both for gender justice and scal justice. It involves analysing government budgets for their effect on genders and the norms and roles associated with them. It also involves transforming these budgets to ensure that gender equality commitments are realized. These resources are designed to show how different actors can influence the budget cycle to promote gender-responsive budgeting at its different stages. It is intended to help groups developing strategies to think through the actions to take at each stage of the government budget process.
EVMS Network Center; English
https://www.dropbox.com/s/n0zyoppx8wwoxmm/Detailed%20cost%20estimator.x…
This set of spreadsheets provide key considerations for cost estimation, explained through an example using pre-exposure prophylaxis (PrEP) based on a South African implementation model. Although the estimator addresses PrEP, the calculator can be adapted by planners and programmers towards developing a costed operational plan across different sectors of programming.
UNDP; 2018; English
https://www.undp-capacitydevelopment-health.org/files/capacities/cd-pro…
CD-Assessment-Tool-Template-AGYW-07.03.18.xlsx This tool assesses the capacity of organizations to develop and implement HIV prevention programmes focusing on adolescent girls and young women.
World Bank/Global Financing Facility; 2017; English
https://www.globalfinancingfacility.org/sites/gff_new/files/Country%20P…
This paper aims to: 1) highlight how multi-stakeholder country platforms, built on development effectiveness principles; and, 2) lay out key considerations for new multi-stakeholder country platforms, along with the relevant mechanisms and a minimum set of standards to support the process of national coordination among actors engaged in RMNCAH. This guidance note is intended to serve as a resource for countries committed to implementing the Global Strategy.
Girls Not Brides; 2019; English, French
https://www.girlsnotbrides.org/resource-centre/national-partnerships-to…
This resource is designed to help set up partnerships effectively by identifying the challenges most partnerships face and solutions to those problems. This resource also helps partnerships identify where they are in the partnering cycle, map out where they may want to go, and assess whether they have all the necessary resources to advance the collective work.
FrameWorks Institute; 2017; English
http://www.frameworksinstitute.org/assets/files/PDF/inbrief-framing-imp…
This brief lays out an evidence-based approach to explaining improvement science and networked improvement communities so that more policymakers and practitioners understand and support these approaches. It touches on existing attitudes and conceptions that shape interpretations of these topics, a set of key concepts to advance across communications, specific communication techniques that have been shown to expand people’s thinking about improvement science and networked improvement communities, and communications themes that proponents of improvement science should avoid.
Lindland, Eric, et al.; 2015; English
http://www.frameworksinstitute.org/assets/les/evidence_implementation/NIRNreport_justdoit_2015.pdf
This report provides a set of key strategies for communicating implementation science and practice, grounded in a detailed understanding of how implementation is variously understood by experts, human service professionals and the public. The report outlines how to navigate the complex set of understandings and assumptions that arise when people think about topics such as the use of evidence, improving practice, effective implementation, and institutional change. This document is intended to help increase support for policies and programmes that promote investment of resources (such as time, funding, staff, infrastructure) in the science and practice of implementation. These recommendations can be used to effectively engage public ofcials, community leaders, practitioners and members of the public to understand and value the science and practice of implementation.