Transcript Slide 1

Toward a Multi-sectoral Approach to
HIV/AIDS Response in the Caribbean
Kevin Fenton, M.D., Ph.D., F.F.P.H.
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Pan Caribbean Partnership Against HIV and AIDS
October 28, 2009
Overview
• Multi-sectoral collaboration
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What do we mean? What are we trying to achieve?
Examples of best and promising practice
• Strategies for effective multi-sectoral
collaboration
• From theory to action:
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Accelerating multi-sectoral collaboration
• Strengthening multi-sectoral collaborations
• Summary
Multi-sectoral
collaboration
What do we mean?
What are we trying to achieve?
Collaboration
• Collaboration is a mutually beneficial and welldefined relationship entered into by two or more
programs, organizations or organizational units to
achieve common goals
• The collaborative relationship usually includes a
commitment to mutual relationships and goals, a
jointly developed structure and shared responsibility,
mutual authority and accountability for success,
and sharing of resources and rewards
Multi-sectoral Collaboration
Multi-sectoral collaboration means involving
all sectors of society - government,
business, communities and people living
with HIV at all levels - regional, national
and local, in addressing the causes and
impacts of the epidemic and required
response.
Commitment at highest levels to
multi-sectoral collaboration
• The Declaration of Commitment by governments at the
United Nations General Assembly Special Session on
HIV/AIDS in June 2001 commits national leaders:
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“…to ensure the development and implementation of multi-sectoral
national strategies and financing plans for combating HIV/AIDS.”
• Following this, Commonwealth Heads of Government
made another strong commitment to HIV/AIDS in the
Coolum Declaration issued from their 2002 Meeting,
stating:
– ” … We urge both the public and private sector, and international
organisations, to join with us in a renewed effort to tackle the challenge
HIV/AIDS presents to our countries and their people, and to humanity
itself.”
Why is a Multi-sectoral approach
needed for our HIV/AIDS response?
• HIV/AIDS epidemic is cross-sectoral and multisectoral in nature
• No one organization has ability to mount a
multifaceted approach
• No single group has needed financial
resources, capacity, reach, expertise, experience,
understanding, and credibility to respond to the
epidemic
Benefits of multi-sectoral
collaborations
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Broaden the mission of member organizations
Help develop more comprehensive strategies
Help develop wider public support for issues
Minimize duplication and increase efficiency of
services
• Increase participation from, and respond to the
needs of, diverse sectors
• Help exploit new resources in a changing
environment
• Increase program accountability and planning and
evaluation capacity
Benefits of multi-sectoral
collaborations
• Multi-sector collaboration is an important means
of achieving strategic, cross-sectoral
change. However, it also presents significant
managerial challenges.
• Identifies and leverages critical brainpower
and resources for response
• Promotes effective partnerships and
coordination
• Useful for design, resourcing, implementation,
monitoring, evaluation and sustainability of
national response to HIV/AIDS epidemic
Example of Multi-sectoral Success:
Thailand
• Key to Thailand’s success in reducing new HIV
infections from 140,000 a year to 20,000 in a
decade has been broad-based multi-sectoral
action
• Objective:
– Lower HIV transmission via commercial sex and make
condom use socially acceptable
• Key agencies that collaborated
– Thai Ministry of Public Health
– Ministry of Interior
– Office of the Prime Minister
Source: Guidelines for Implementing a Multi-Sectoral Approach to HIV/AIDS in
Commonwealth Countries, 2003
Example of Multi-sectoral Success:
Jamaica
• Jamaica Multi-sectoral response includes
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Government
Civil society
People living with HIV/AIDs
Vulnerable groups
National HIV/STI Programme
National AIDS Committee
Education, health, and labor sectors
Finance and Planning sector
Ministry of Tourism
Ministry of National Security
Business sector, NGOs,
Faith-based organizations, social agencies, media
Regional and international partners, such as PAHO
Example of Multi-sectoral Success:
Trinidad and Tobago
• Expanding the multisectoral response:
– Eight HIV/AIDS Coordinators were recruited in the Ministries of
National Security; Education; Sports and Youth Affairs;
Community Development, Culture and Gender Affairs; Tourism;
Local Government; Health; Labour, Cooperatives and Small and
micro-Enterprise Development.
• NGOs are important partners of the NACC and have
facilitated access to most at risk and hard to reach
population groups, including CSW,MSM,PLWHA,
Orphans and Vulnerable Children
Example of Multi-sectoral Success:
The Bahamas
• Lasting and productive partnerships have been
forged between the health system and the business
community, Civil Society and Religious
Organisations.
– The Samaritan Ministries, organised by the Bahamas Catholic
Diocese trains volunteers from all faiths, and equips them for
outreach services in treatment, care and support.
• Imperial Life Financial, a leading business
organisation is a sponsor of the AIDS Foundation of
Bahamas which organises a successful annual
fundraiser – The Red Ribbon Ball
Example of Multi-sectoral Success:
Haiti
• Impact of Haiti’s commitment to a sustainable
national multisectoral response
– Successful in scaling up the number of persons
receiving ARV treatment from 2000 patients in 2001
to 25,000 patients in 2008.
– Strengthened partnership between the private and
public sector
– Strengthened country coordinating mechanism (CCM)
in the implementation of the National Strategic Plan
– Resulted in resource mobilization to support the
national response
– All stakeholders shared common goal
Source: Ministry of Health of Haiti/MESI Haiti
Example of Multi-sectoral Success:
Haiti
• Key Actors
– Ministries
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Education
Youth and Sport
Women
Social Affairs
Justice and Public
Security
– Civil Society Participation
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NGOs
Faith-based organization
Women’s organizations
Religious sector, including
Voodoo
• People Living with HIV/AIDS
– with 2 persons at highest level
represented on the National
CCM
• Representation by
vulnerable groups
– Women
– Sex Workers
– Youth (with representation at
the CCM)
– Police Force
• Other key variables
– Integration of HIV/AIDS in
each health department
– Participation of international
partners
Barbados
• Long track-record in working multisectorally to
achieve a coordinated partner response.
• HIV/AIDS elevated to a national priority by the
Office of the Prime Minister
• Key partners in the Barbados HIV/AIDS Response
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National HIV/AIDS Commission
Ministry of Health
Ministry of Social Transformation
Ministry of Education
Barbados Defence Force
Other line ministries
Civil Society (including NGOs and Faith-based Organizations)
Multi-sectoral collaboration:
Emerging lessons and Best Practices
Where are we now?
The Caribbean Experience
• An analysis of the Caribbean NSP’s and UNGASS
Reports Best Practices suggests that most national
programs have included some version of a multisectoral approach to planning and implementing
their HIV/AIDS response
• The national organizations that most often lead
these efforts are the MOH or the NAC’s
• The number and type of different organizations
involved also varies widely across the region
Where are we now?
The Caribbean Experience
• Some countries engage only a small number of
organizations in a very limited and unclear way
while others involve a large multi-sectoral cross
section of their country in a very central way and
have very clear roles and responsibilities.
• Most countries engagement with other organizations
appears to have begun as a requirement of the
donor award process so only a few countries have
articulated a compelling rational for this approach.
Where are we now?
The Caribbean Experience
• These relationships all seem to be held together by a
shared vision or goal and a commitment that each
party contributes a unique and indispensible
resource to achieving the goal. This contribution is
not always financial.
• The most successful multi-sectoral relationships
seem to thrive on shared credit for the
accomplishment and energy is spent assuring that all
parties visibly benefit in some way.
Best practices for effective multisectoral collaboration
• Be dynamic, flexible, strategic and coordinated
• Take account of the size of the problem,
identifying the vulnerable, high-risk groups;
• Provide effective leadership which is critical for
policy development; strategic planning;
• Involve national leaders, all government ministries
and departments, with each taking responsibility for
pre-determined aspects of the overall response
• Include sectors outside government - business,
civil society organisations, communities, PLWHAs
and others affected by the epidemic
Best practices for effective multisectoral collaboration
• Define roles and responsibilities, based on the
comparative advantage of each
player/stakeholder.
– It is not always necessary or appropriate for every sector to be
involved in every area of activity
• Should occur at all levels in the country and be
linked to action at the international level.
• Ensure good communication and clear
accountability among all partners
• Each sector should develop sectoral plans of
action that accord with national strategic plans.
From theory to action:
Accelerating multi-sectoral
collaboration
Initiating a Multi-sectoral Approach
1. Preparation
– Identify the gaps in your HIV response and search
for organizations that might have similar goals
2. Negotiation
– Meet with the leadership of these organizations
and make balanced plan
3. Action
– Follow plan, monitor progress and solve problems.
Potential Partners
• Public sector
– Ministries of Health, Planning, Finance, Labor, Women’s Affairs,
Education, Agriculture, Your, Uniformed Services, Housing, Justice and
Human Rights, Community Development, Social Services
• Private sector
– Organized private sector coalitions for HIV/AIDS
– Workplace HIV/AIDS programs
– Business clubs and organizations
• NGO/Civil Society Sector
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People living with HIV/AIDS
Political, religious and traditional leaders, Unions
Professional associations
NGOs and networking associations, Faith-based organizations
• Bilateral and Multi-lateral Organizations/ Partners
1. Create a more solid foundation for
multi-sectoral collaboration
• Multisectoral responses in place but quality and
implementation vary.
• Variable success across sectors in
mainstreaming HIV/AIDS response
– Health ministries most active with their constituencies
– Other ministries may have policies but no action plans
– UNAIDS survey in 63 countries found only 13% had
made progress in implementing sectoral plans
2. Motivate genuine private sector
involvement
• Involvement by the businesses community in many
countries appears to be fairly modest
• Involvement relatively low given the concern
about HIV impacts expressed by business managers.
Reasons vary:
– Few incentives; Funding often goes to govts. and NGOs
– Not all companies have the skills to do their own programs
– High transaction costs with dealing with governments or NACs
• Success will require radical thinking on how to
improve incentives for partnership
3. Strengthen governance for multisectoral collaboration
• The Three Ones calls for one national AIDS
coordinating authority with a broad multisectoral
mandate
• The World Bank (2001) recommends that NACs stick
to facilitation rather than control, and avoid
competing with or duplicating the key role of
the health sector in responding to the epidemic
• Over time, there must be a commitment to
evaluate and learn from the successes of
multisectoral NACS
Summary
• A multi-sectoral approach involves all sectors of
society—governments, business, communities,
people living with HIV and others in addressing the
causes and impact of the HIV epidemic and response
• An analysis of the Caribbean’s national strategic
plans and the UNGASS reports best practices
suggests that most national programs have included
some version of a multi-sectoral approach to
planning and implementing their HIV response
Summary
• Most national programs have included some version
of a multi-sectoral approach to planning and
implementing their HIV/AIDS response
• Leadership and engagement at the highest level
(MoH or NAC) is key
• Multi-sectoral approaches that work best and lasted
longest have been very strategic and have had a
history of top level leadership support and
personal commitment
Toward a Multi-sectoral Approach to
HIV/AIDS Response in the Caribbean
Kevin Fenton, M.D., Ph.D., F.F.P.H.
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Pan Caribbean Partnership Against HIV and AIDS
October 28, 2009