Policy Environment Analysis

Transcription

1 Central American Course Monitoring and Evaluation for HIV/AIDS Policy and Program Management Module 1 Unit 2 Policy Environment Analysis National Commitment and Policy Instrument 2012 Stigma and Discrimination Gallup Poll Belize 2012 Policy Implementation Monitoring Processes Tool 2011 Martha Angelica Carrillo, MSc. USAID/PASCA Country Representative

2 Policy Environment Analysis Tools/Reports: 1. National Commitment and Policy Instrument Stigma and Discrimination Gallup Poll Belize Policy Implementation Monitoring Processes Tool Analysis of the Situation and Response Policy Inventory 2011

3 Stigma and Discrimination Gallup Poll USAID/PASCA through the technical support of the Interdisciplinary Consultancy for Development (CID) conducted a survey by gallup poll on opinions and knowledge on HIV and AIDS among the adult population in all the Central American Countries. The Belize report includes the results from a sample taken in January A total of 433 adults, one per household, across the country which is representative of the total adult population in Belize were interviewed.

4 Stigma and Discrimination Gallup Poll Findings: The majority of Belizeans know or at least have heard of HIV/AIDS The knowledge level is primarily based on educational level The majority of those interviewed believe that the government has a responsibility to provide prevention education as well as to provide support to persons living with HIV and suffering from AIDS. The majority of respondents agree that prevention campaigns at the general as well as the most at risk population are needed and that its important to ensure that condoms are readily available to all sexually active persons.

5 Stigma and Discrimination Gallup Poll Findings: The majority of citizens do not believe that transgendered persons should be harmed because of who they are, however, their was disagreement regarding their right to have identification cards which identify them as women. Its interesting to note that persons with a higher educational level and more knowledge of the HIV topic were more critical of the government s response to HIV and they are also less likely to be discriminatory towards PLHIV, SWs and transgendereds.

6 Policy Implementation Assessment: Step-by-Step Approach Select a policy Form a core country team Make decisions about expectations Adapt the interview guides Identify key informants Conduct in-depth interviews Analize data Share findings and discuss next steps

7 Methodology: Sample Sample, planned Sample, obtained 34 cases 31 cases Types of interviewees Policymakers 11 cases (35%) Implementers / Other stakeholders 20 cases (65%) Sectors Public sector 13 cases (42%) Civil society 14 cases (45%) Intnl. Cooperation 4 cases (13%)

8 Findings related to the implementation mechanism ADOPTION OF THE PLAN

9 Porcentaje To what extent the NSP goals and objectives address the key issues in the country regarding HIV and aids? 100 It has been a process. It has to be dynamic to be able to address the issues, but with consistent reviews to see if you are on target It is a good plan basically but needs to be revised. Mainly it needs to be updated and some things have changed since Whilst they try and make the process inclusive they have not done enough research in Belize to analyze the HIV situation. it does not have a strong human rights focus, [nor] emerging issues such as gender and vulnerable populations It could do better with gender, does not include finance - how will it be funded our contribution to the national response. 0 3 DK/NA 0 Do not address important issues Address some key issues, but many missing Address most of the key issues, but some missing 6 Address all key issues Does not address the issues of housing, income generation and vulnerable population. not much about private sector involvement is addressed in the plan. Policymakers and Implementers

10 The National Strategic Plan timeframe is In your opinion, are its goals and objectives achievable within this timeframe? From the perspective of not having an operational plan and an assessment of the plan, I would have to say no. No clear way of assessing outcomes. How can we say we are achieving the goals when we don't have anything in place to measure them 23% 6% 71% We have to make sure an strong M&E Plan is in place. we have not make much progress to date, goals are too broad and ambitious and require more time. I do not think it is achievable, especially in the area of behavior change. It will take a while but it will not happen within the timeframe. Financial and human resources are not there. Prevention efforts, stigma and discrimination will not change over a five-year period. Clinical management is not in place to facilitate it, could be enough if we had a robust response Yes No DK/NA I think it s heavily dependent on services; that is what we have not been able to do: we lack capacity, lack baseline data, an effective communication system, lack of resources and some technical capacity and ( ) commitment. Policymakers and Implementers

11 Porcentaje What is the level of consensus among the different stakeholders about the importance of implementing the NSP ? 100 there has been limited effort ( ) to achieve the consensus and to ensure that there is a mechanism in place to make sure people are implementing the plan. 80 a lot of the CCM members are involved but not really involved. Also it has to do with how the NAC positions the CCM, as they have not let them know their role Consensus building has been a good thing for the NAC, as everybody knows the importance of implementing the plan but have not translated it into implementation. Lots of people involved in consultations have agreed that it needs to be done but when it comes to implementation it is another story DK/NA No consensus Limited consensus, few groups participating Good consensus, many groups participating Ample consensus among government, NGO and other stakeholders I still don't think the meetings are inclusive of all the actors. Government and NGO have their mandates and everybody is not actively involved in the processes. we know what needs to be done to decrease the problem and we all agree from a team perspective. Policymakers and Implementers

12 NATIONAL COMMITMENT POLICY INDEX PURPOSE: To assess progress in the development and implementation of national level HIV and AIDS policies, laws and strategies in

13 Stigma and Discrimination Gallup Poll USAID/PASCA through the technical support of the Interdisciplinary Consultancy for Development conducted a survey by gallup poll on opinions and knowledge on HIV and AIDS among the adult population in all the Central American Countries. The Belize report includes the results from a sample taken in January A total of 433 adults, one per household, across the country which is representative of the total adult population in Belize were interviewed.

14 Methodology Part A administered to Government officials Strategic plan Political support and leadership Human Rights Prevention Treatment, care and support Monitoring and evaluation

15 Methodology Part B administered to representatives from civil society organizations and international partners Civil Society involvement Political support and leadership Human rights Prevention Treatment, care and support

16 Key Informants Selected from the NAC and other key partners: Government Officials - 9 Civil Society and International partners - 20 Total: 29 respondents representing 27 agencies

17 Overall Findings Sustained efforts to achieve the Three Ones principle and maintained commitment to accelerate an effective response to HIV in Belize. Accomplished some progress in reaching goals while there continue to be challenges in specific areas. The NCPI shows that the country has one National Strategic Plan (NSP) which has recently been revised for the years ,

18 Overall Findings One National AIDS Coordinating Authority which has increased its efforts to coordinate government and civil society initiatives in one multisectoral response. One National Monitoring and Evaluation Plan which needs to be aligned with the new strategic plan and operationalized. Urgent need to implement policies and legislation to promote human rights and decrease stigma and discrimination.

19 Composite: NCPI A Government officials Strategy Planning Poli cal Support Policy efforts in HIV Preven on

20 Composite: NCPI A Government officials Preven on Programmes Treatment, Care and support OVCs M & E

21 Composite: NCPI B Civil Society Par cipa on Policies and Legisla on to protect human rights Implementa on of Human Rights Policies

22 Composite: NCPI B Preven on Programmes Treatment, Care and support OVCs

23 Comparative: NCPI A and B Government Civil Society and Int'l Partners 1 0 Preven on Treatment, C and S OVCs Policies and Legisla on

24 Efforts in the Strategy Planning

25 Findings - Achievements The process of developing the new HIV Strategic Plan for Belize has been described by the majority of key informants as the most inclusive and participatory in the history of the response in Belize. Government, Civil Society and International partners indicated a greater sense of ownership and responsibility with the new NSP as they were more involved in the process of developing and validating it.

26 Findings - Achievements The process was based on evidence as data from recent assessments as well as the Belize Health Information Systems was used to guide and inform the process. Greater involvement of key vulnerable populations such as persons living with HIV, men who have sex with men and sex workers. Civil Society played a major role as consultations were held at the community and the national levels and they were invited to provide input.

27 Efforts in the Strategy Planning Strategy Planning

28 Efforts in the implementation of prevention programmes

29 Findings - Achievements During the past two years there has been sustained implementation of prevention programs by both civil society and government. Organizations at the national and district level have continued to implement IEC, BCC, peer education and stigma and discrimination initiatives with key populations There is more support for provision of prevention services in the area of training, education, human rights and sexual transmitted infections through the involvement of entities such as the US Embassy.

30 Findings - Achievements Sustained efforts in HIV Counseling and Testing with an increase of services available at the district level in addition to increased promotion of provider initiated testing at private facilities. Continued implementation of the prevention and mother to child transmission across the country. New protocols for post exposure prophylaxis for occupational and non-occupational exposure.

31 Efforts in the implementation of prevention programmes Government Officials Civil Society Organiza ons and Int'l Partners

32 Efforts in the implementation of treatment, care and support

33 Findings - Achievements Sustained provision of free antiretroviral medications to all persons who fit the criteria. Increase in combination ARVs and increased access to CD4 tests. Another achievement has been the revision of the treatment guidelines and the updating of the national TB guidelines to reflect HV as a component.

34 Findings - Achievements Employers guide on HIV and AIDs has been developed which provides guidance to employers and employees on treatment, care and support for persons affected by HIV in the workplace setting. The establishment of a national Network of Persons Living with HIV is recognized as an achievement as it will provide a mechanism for advocating and monitoring the provision of quality treatment, care and support to PLHIVs and others affected.

35 Efforts in the implementation of treatment, care and support Government Officials Civil Society Organiza ons and Int'l Partners

36 Efforts in the implementation of treatment, care and support for OVC

37 Findings - Achievements Continued efforts of Hand in Hand Ministries in provision of services to OVCs and their families During the past two years HHM has continued to provide support to an estimated 90% (87 cases) of documented OVCs in the country. They have scaled-up their services which include: ARV delivery at their centre for persons who are unable or unwilling to access their medications at the public Pro- Care and Treatment Centre.

38 Findings - Achievements Collaboration with local agencies such as Claret Care and the Productive Organization for Women in Action (POWA). Another achievement is the strengthened collaboration between the Ministry of Health and Hand in Hand Ministries. Collaboration between MHDSTPA and the Global Fund Round 9 project for the Boost Program which provides support to families affected by HIV and AIDS. Completion of an Impact Assessment of OVCs in Belize that was conducted in 2011.

39 Efforts in the implementation of treatment, care and support for OVC Government Officials Civil Society Organiza ons and Int'l Partners

40 Political Support

41 Findings - Achievements Minister of Health led the Belize delegation to the UN High Level Meeting of 2011 where he signed on to the Political Declaration. Representation at the Caricom meeting Ministers of Health to endorse PANCAP Regional Policy to Reduce HIV Related Stigma and Discrimination. Ministries such as Health and Labour report that support has been for budgets and implementation of programs

42 Findings - Achievements At the district level, one of the committees highlighted the fact that the Minister of Health who is from this municipality, the Mayor of the town and the councillors are very much involved in the district committee. More visibility of the Minister of Health at forums and HIV related functions.

43 Political Support Poli cal Support

44 Efforts in implementation of HIV policies and Legislations

45 Findings - Achievements The National Human Rights Dialogue on Human Rights, the Law and HIV which provided civil society an opportunity to raise concerns on the issue of human rights, the law and HIV. The PANCAP Regional Stigma and Discrimination Unit has also been implementing a project in Belize which has focused on the empowerment of vulnerable groups through training on human rights and advocacy to address stigma and discrimination.

46 Findings - Achievements In collaboration with the National AIDS Commission and as a part of the Global Fund Round 9 the RSDU embarked on the development of a communitydriven human rights campaign. The development of a Youth Policy conducted by the Youth for the Future which also included an HIV component. Revision of the Labour Act 2011 which specifically prohibits dismissal or the imposition of disciplinary action against workers based on their HIV status

47 Efforts in implementation of HIV policies and Legislations Government Officials Civil Society Organiza ons and Int'l Partners

48 Monitoring and Evaluation

49 Findings - Achievements Monitoring and Evaluation Systems Strengthening exercise in 2011 which provided the opportunity to identify challenges and make concrete recommendations. There is an NSP now that will provide an opportunity to update the M&E and facilitate implementation of the plan

50 Findings - Achievements The USAID/Central American Capacity Project in Belize has also been engaged with the Ministry of Health in assessing standards of service delivery and providing performance monitoring. This project has been helpful during the past two years in providing a form of monitoring and evaluation in the area of HIV service delivery within the public system. Even though there has not been a functional M&E unit at the NAC for most of the past two years, Belize has been able to submit international reports and access data to respond to specific indicators.

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52 Challenges and Opportunities

53 Challenges and Opportunities Dissemination of revised HIV Strategic Plan and Operational Plan to ensure that all partners are aligned and committed to its implementation Mobilization of resources to provide support to non-government organizations and community-based groups. Increased political support for HIV programs through budgetary allocations and support for HIV policies and legislation. Urgent need to introduce HIV legislation to provide the necessary legal framework for the implementation of the revised NSP

54 Challenges and Opportunities Prevention strategy needs to prioritize sexual and reproductive, risk reduction and behaviour change needs of vulnerable populations Psychosocial support for PLHIV and their families needs to be prioritized in the continuum of care Comprehensive strategy for addressing the needs of OVCs based on recent assessment Update, alignment, costing and operationalization of the Monitoring and Evaluation Plan

55 COMMENTS QUESTIONS SUGGESTIONS