Operational Planning for HIV/AIDS: A Guidance Note Produced by the AIDS Strategy and Action Planning Service (ASAP)

Operational Planning for HIV/AIDS: A Guidance Note Produced by the AIDS Strategy and Action Planning Service (ASAP) DRAFT COMMENTS WELCOME May 2009

i Contents Acronyms... ii Purpose... 1 Process of Developing this Guidance Note... 1 How to use this Guidance Note... 2 Context... 2 Lessons Learned about the Substance of Operational Planning... 4 Link to the Strategic Plan... 4 Time Frame... 4 Level of Detail and Standardization... 4 Implementation Challenges... 5 Prioritizing Activities in Operational Plans... 5 Lessons Learned about the Operational Planning Process... 6 Assessment... 6 Planning... 6 Costing the OP... 7 Performance Monitoring... 8 Management and Coordination of the OP Process... 8

ii Acronyms ABC Tool - Activity-Based Costing Tool AIDS - Acquired Immunodeficiency Syndrome ASAP - AIDS Service and Action Plan Service CSOs - Civil Society Organizations ECA - Eastern Europe and Central Asia GFATM - Global Fund to Fight AIDS, Tuberculosis and Malaria HIV - Human Immunodeficiency Virus JAPRs - Joint Annual Program Reviews M&E - Monitoring and evaluation MENA - Middle East and North Africa MSM - Men who have sex with men NGOs - Non-governmental organizations NSA - National Strategy Applications OP - Operational Plan OPSAT - Operational Plan Self-Assessment Tool PEPFAR - Presidential Emergency Plan for AIDS Relief SP - Strategic Plan SWs - Sex workers UN - United Nations UNAIDS - The Joint United Nations Programme on HIV/AIDS

1 Purpose In order to achieve the most efficient use of resources and promote rapid-action and results-based management, a set of principles for the coordination of national AIDS responses, known as the three ones, were endorsed in April 2004. These principles include: (i) one agreed HIV/AIDS action framework, (ii) one national AIDS coordinating authority, and (iii) one agreed national monitoring and evaluation (M&E) system. The national HIV and AIDS strategic plans constitute the one action framework that provides the basis for coordinating the work of all partners. Under this principle, organizations at both the global (within the UN, World Bank, and other agencies) and national levels have put a tremendous amount of effort into developing evidence-based, multisectoral HIV and AIDS strategic plans. Standardized tools for epidemiologic and HIVresponse analysis, as well as costing approaches and the establishment of baselines and targets to measure progress, have been formulated to guide countries in developing these strategic plans. However, there has been limited attention placed on the operationalization of these strategic plans, resulting in operational plans that vary in content, scope, and format. The purpose of this Guidance Note 1 is to present lessons learned about the substance and the process of operational planning from HIV and AIDS programs as well as from experience with operational planning generally. It also outlines a framework for developing operational plans. Process of Developing this Guidance Note This Guidance Note was developed based on an extensive literature review and consultations with multiple countries. The initial draft Guidance Note was then reviewed by national HIV and AIDS program managers who have participated in AIDS Strategy and Action Plan (ASAP) Service strategic and operational planning workshops in the Caribbean, Africa, Eastern Europe and Central Asia (ECA), and Middle East and North Africa (MENA) regions. Key aspects of the development process are as follows: Reviewing operational plans from public and private sectors and civil society organizations (CSOs) to identify good examples. Consulting with UNAIDS Country Coordinators from various countries to provide sample operational plans for assessment. National strategic and operational plans submitted to ASAP for peer review were assessed to identify good practices in operational planning. Country experiences and lessons learned in the process of planning and conducting the ASAP regional workshops in Mexico (Caribbean countries), South Africa (Anglophone and Francophone African countries), Hungary (ECA countries), and Tunisia (MENA countries) between 2007 and 2009, were used to inform the process. Experienced practitioners implementing HIV programs and consultants providing technical assistance services to countries on effective HIV and AIDS programming provided expert advice on the development of operational plans through personal communication. 1 This Guidance Note should be used in conjunction with ASAP s Operational Plan Self-Assessment Tool (OPSAT).

2 How to use this Guidance Note This note is intended to serve as a resource to support national policymakers; program planners; donor representatives; non-governmental, faith-based, and community organizations; technical working groups; and others who are involved in developing and implementing operational plans for HIV and AIDS. It provides lessons and advice on key elements that should be included in an operational plan. However, it is not a blueprint. Contents of each section should be adapted to suit country specific circumstances and planning process. 2 Context Since 1995 the amount of money available for HIV and AIDS programs has increased from approximately US$250 million to more than US$10 billion in 2008. The main challenge today is how to spend this money efficiently and in compliance with good governance practices in order to achieve demonstrated results that will sustain and expand the current level of funding to achieve universal access. Key instruments in obtaining financial support and guiding implementation of prevention, care and treatment, and mitigation programs are strategic and operational plans. Strategic plans are usually developed every four to five years as national guides to: (i) document the evidence of the drivers of the epidemic, (ii) assess and learn from a country s past response, (iii) identify key stakeholders and ensure their participation in program planning and implementation, (iv) set clear program priorities for the future, (v) estimate the financial and human resources needed to respond to the epidemic, (vi) enhance coordination especially among donors and providers of technical support, and (vii) establish a results framework to measure performance. A strategic plan mainly identifies and defines outcomes that should be achieved at the conclusion of a four- or five-year period. The emphasis of a strategic plan is how the key drivers of HIV and AIDS can be addressed effectively to reduce the burden of the disease. It also outlines the strategies necessary to achieve the identified outcomes. The strategic plan is, therefore, a document that guides a country, and not a blueprint for implementation. It should be concise and understandable to decision makers and implementers. It should present the evidence, define the key results, and identify at a general level the key interventions most likely to have an impact on the epidemic and guidance on roles and responsibilities of various stakeholders. The strategy should not go into details on activities, which belong in operational plans. Operational plans are becoming even more important as the major development partners move from a project to program funding approach. For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is piloting its Board s decision to support National Strategy Applications (NSAs), and the Presidential Emergency Plan for AIDS Relief (PEPFAR) encourage countries to produce country compacts. Operational plans are developed every year or every two years and are more focused on outputs that can be achieved in the short term in order to build towards achieving the outcomes defined in the strategic plan (SP). The strength of an operational plan (OP), to some extent, is in clear 2 A number of countries have adopted the Joint Annual Program Review, during which they take stock of achievements, identify changes in the situation and identify priorities for the coming year is used as the basis for the elaboration of the annual operational plan, which results in an annual planning process.

definition on what the country seeks to achieve in one to two years in order to cause the outcomes to be realized. Thus, the link between the SP and an OP should seek to ensure that the results defined in the OP have a logical relationship with the outcomes defined in the SP. Operational plans are the blueprints that translate strategic objectives and results of the national strategic plans into activities, indicating: 1. the intermediary results to be achieved (derived from the national strategic plan results), 2. the implementation period, 3. the specific interventions/actions that will be undertaken to achieve the result, 4. the specific implementing partners, 5. the human and financial resource requirements, and 6. how implementation will be monitored (including the indicators to track performance). While operational planning is not new to HIV and AIDS, it has gone through an evolutionary process. Initially OPs consisted largely of a list of activities. More recently, operational plans have become matrices usually listing program activities, potential or actual implementing agencies, notional funding levels, and general performance indicators. Operational plans could be enhanced by the following five components: (i) starting with the results indicated in the strategic plan, or its revision if new information on the epidemic is available; (ii) paying greater attention to prioritization and sequencing of activities and ensuring that proposed activities and outputs contribute toward achieving the prioritized higher level results; (iii) determining the cost of interventions and addressing gaps in external support; (iv) dealing with actual implementation challenges (especially those faced by key sector ministries, civil society, and communities and those arising from the need to scale-up activities substantially); (iv) identifying specific mechanisms to deal with coordination; and (v) improving performance through better use of strategic information. 3

4 Lessons Learned about the Substance of Operational Planning Link to the Strategic Plan 1. A good OP must be based on the SP and, most importantly, should clearly indicate the results to be achieved and the priorities identified by the SP. The link between a strategic and an operational plan is at the outcome-output level. The SP defines the outcome (the change that should be achieved at community level) and the OP defines output level results that should be achieved in order to contribute to the achievement of the desired change to take place over time. The means to achieve these results (what, when, where, by whom, and how much) is at the heart of the OP. This is often ensured by having the OP summarize the key elements of the strategy, especially the evidence base, the situational analysis, implementation lessons learned, priority programs areas, and the results framework. 2. In order for an OP to be effective, it needs to be based upon a strategy that is evidence-based, prioritized, and costed with a results framework. Some countries ensure the link between strategic and operational planning by incorporating a one- or two-year OP as a component of the strategic document. Time Frame 3. Given the inevitable delays in budgeting and release of funding, and the need for implementing agencies to know what resources they will have, a two-year OP is suggested as a good OP timeframe. However, a number of countries do use a one-year timeframe based on their planning cycles. Level of Detail and Standardization 4. Operational plans at the district/local level will be more detailed than those done at the sector level, which will be more detailed than a national OP. The large number of implementing partners in a country with a generalized epidemic present much more of a challenge for generating OPs than the smaller number in a country with a concentrated and/or low prevalence epidemic. 5. Should an OP be an aggregation of regional/district level OPs or should it be developed at the national level and disseminated to lower level partners? There is no one way of developing an OP; it depends on the country situation. Aggregating regional and district level OPs to develop a national one negates the need to link an OP with a SP. 6. A national OP may not capture all the issues that regional and districts want to prioritize. However, if the SP is a starting point, the national OP should aim to set out national level one- or two-year outputs. That is an OP should identify the outputs a country wants to achieve in prevention, treatment and care, etc. in one- to two-years that would in turn lead to achievement of the outcomes defined in SP. The issue should not be so much about bottomup or top-down approaches but rather making the SP the starting point for developing an OP. 7. Therefore, being clear about the purpose of an OP at each level is essential. At the district/local level, the OP is a detailed blueprint. At the sector level, it identifies the comparative advantage of key sectors, prioritizes programs at district, regional, and national levels and provides the cost of such programs. This information is useful for sector budget

preparation. At the national level, it is mainly for coordination, resource allocation, M&E, and to identify systemic issues, particularly with regard to financial management and reporting and procurement processes. Once the national OP has been developed, it should serve as a guide to planning at other levels. Partners can use different aspects of the OP to determine their own interventions. 8. The process for operational planning varies across countries, and is complicated by the multiplicity of programs, partners, sectors, and levels of government. There are two approaches commonly used by countries: top-down and bottom-up. In the top-down approach, countries prepare OPs by specifying activities that should be accomplished immediately after developing the SP or, where a SP is not new, following a review of the existing SP by a technical panel or through formal mechanisms such as Joint Annual Program Reviews (JAPRs). In a bottom-up approach, countries develop a national OP by consolidating OPs already developed by different regions, sectors, and various implementing partners. The top-down approach offers a more structured process for implementing a strategic framework while the bottom-up approach is better suited to countries with decentralized planning, because it is more accommodating of different funding streams and more vertical stakeholder (development partners, national institutions, NGOs, CSOs) programming priorities. The challenge is on how to consolidate these OPs at the regional/provincial level and then nationally without conducting separate OP exercises at each level. In larger countries OPs are developed at the provincial/state level. Whichever approach is adopted by a country, the overriding principle is that the OP should be linked with the SP and should seek to operationalize the SP. Implementation Challenges 9. While the SP should include a section dealing with implementation challenges, this is rarely sufficient or comprehensive, especially with regard to the roles and responsibilities of different organizations in scale up of programs. The OP should include information about the implementing partners; how the partners coordinate amongst themselves and with the government; challenges of implementing prevention, care and treatment, and mitigation programs; and how these challenges will be addressed. Prioritizing Activities in Operational Plans 10. At the start of most operational planning exercises, there are likely to be a number of potential activities competing for resources. The challenge is to decide on a process to further prioritize activities in order to achieve the results identified in the SP. A number of methods have been applied, for example: Informed judgment. The team developing the OP uses its judgment on an urgent and priority agenda after consulting with a wide range of stakeholders. Evidence on the elements of the epidemic that should be addressed (already identified in the SP) should also guide prioritization (i.e., those aspects of the epidemic that are causing the highest impact on the population would be prioritized and the OP should ensure interventions for addressing such issues are planned for). 5

6 Explicit criteria, with rating and weighting. Rating criteria could include the following: (i) capacity to implement; (ii) cost efficiency, with different weights assigned to reflect relative importance; and (iii) availability of resources to implement the intervention. Explicit criteria (impact and feasibility), with yes or no decisions. Priority activities must satisfy two criteria: (i) quick impact on the epidemic, and (ii) capacity to implement existing SPs. Lessons Learned about the Operational Planning Process There are five interrelated components of the operational planning process: Assessment, Planning, Costing, Performance Monitoring, and Management and Coordination. An appropriate starting point for the preparation of an OP is a review of the epidemiological profile to inform the prioritization of interventions and specific activities to be implemented in the OP period. Assessment This component reviews the previous OP, where one exists, to document implementation challenges, lessons learned, and inform the preparation of the next OP, especially if systemic or broad changes need to be made. This assessment is particularly important to ensure: (i) that CSOs and community organizations are being appropriately supported, (ii) that hard to reach high-risk groups are being reached, and (iii) information about program effectiveness and efficiency are being incorporated by implementation partners. Planning The OP should answer at least eight critical questions: 1. Where do we want to be at the end of the OP period? (I.e., what results are to be achieved?) 2. Where are we now? (baseline data for each result to be achieved) 3. What are the necessary and sufficient programmatic activities to achieve output results? 4. Who can implement these activities?

5. What resources are needed to implement the plan, especially in terms of money, people, capacity enhancement, and improvements to systems? 6. Where are the resources coming from? And, what would be added with additional funding (or dropped if funding is reduced)? 7. What intermediate results (milestones) will be used to assess progress toward the strategic results? And, how will these be measured? 8. What arrangements are in place to enhance OP management at the national and district levels to ensure coordination, especially among sources of funding and technical support? In order to answer the above questions, programmatic data from the previous and current year needs to be analyzed to assess progress against targets and to inform the operational planning process. The financial data is also analyzed to guide resource allocation and any financial changes made during the budget development process. There should be a clear understanding of the risks that exist and how they will be mitigated in the plan period. While some of these elements can be presented in matrix form within the OP, others require a narrative. The sample template shown below illustrates outputs from this planning step. Output Activities Time Frame Responsible Base line 2009 data Q1 Q2 Q3 Q4 Targets for end 2009 These should be output level targets and not activity level targets 7 Strategic Plan targets (for 2012) Costing the OP Unlike estimating costs for a national strategy through modeling and scenario building costing an OP is primarily budgeting. Costing OPs calls for a micro perspective of defining how to systematically implement national SPs on a yearly basis. This results in attaching costing data to specific cost drivers and deriving detailed cost estimates. The challenges are agreeing on a standard format for costing, agreeing on key costing assumptions, and ensuring that implementing agencies in turn present their OPs according to the standard format with appropriate explanations for differences in unit costs (which is inevitable when dealing with the public sector, civil society, the private sector, and programs that range from the community level to the national level). One useful approach is provided by the Activity-Based Costing (ABC) Tool, an Excel-based budgeting tool that can assist in deriving detailed cost estimates for specific programs. The ABC Tool can also assist in consolidating large numbers of OPs (to analyze different programs and activities); categorize expenditure according to a standard chart of accounts; map expenditure between programs and functions; and compare, eventually, estimated versus actual expenditures. A sample OP costing template for inclusion in the OP is provided below. Output Activities Quantity /Units Frequency Unit Cost Total Costs Funding Source Approx. Time/Qtr Implementing Agency

8 Performance Monitoring Performance monitoring is the process of planning and managing the collection of performance data. It articulates how strategic and programmatic information will be collected, processed, analyzed and used at different levels. Given the large amounts of money supporting HIV and AIDS programs at a time of world-wide financial crisis, and the use of performance indicators required for disbursing of funds by GFATM, justifying the utilization of funds through evidence of efficiency and impact will be critical. However, the ability of implementing partners to provide performance data, and of coordinating agencies to analyze and use these data sets is generally weak. Consequently OPs need to focus on making performance monitoring a reality by indicating: (i) definitions of performance indicators; (ii) baselines and targets; (iii) source, method, frequency, and schedule of data collection; and (iv) clear responsibilities for and resourcing of the performance monitoring system at the national level, including data quality. A sample OP performance monitoring template is provided below. Output Verifiable Indicator Data source Data collection method Reporting Responsibility A lesson learned in performance monitoring is that developing a monitoring plan for the OP can be easily achieved. The challenge is to implement this plan and ensure partners are reporting. Adherence to the one M&E framework is a challenge for many countries. The national AIDS coordinating agency can take a lead in developing the SP and the OP but when it comes to monitoring, partners tend to report to donors funding them; reporting rates to the national coordinating agency is very low. This impacts negatively on the review of the OP and development of the next OP. Performance monitoring can be said to be the missing link between reviewing the current OP and developing the next OP. Countries have tended to address this weakness by carrying out JAPRs but the data collected from this process is not always reliable. Management and Coordination of the OP Process Successful operational planning depends on the technical and financial resources to coordinate the planning and implementation of the OP process. A management and advisory structure needs to be established, terms of reference defined, and specialized expertise contracted (especially in areas such as costing and information technology). Good governance practices are also essential in the management process, including a focus on successful coordination, information flow, transparency, and accountability. The national coordinating agencies in countries are mandates to lead in the development of both the strategic and operational plan. The main stakeholders in the country should be involved in the development of these plans. The agency also ensures that the plans are based on the most up-todate data available. For a successful planning process, the coordinating agency sets up technical working groups for various priority areas of the plans and supports communication among the stakeholders. The purpose of such extensive consultations is to enhance ownership of these plans. Ownership is critical for enhancing alignment of implementing partners programs with the respective national plans.