1 MODALITIES FOR HIV/AIDS PLANNING, IMPLEMENTATION AND MANAGEMENT IN LOCAL GOVERNMENTS Stephen K. Kiirya Makerere Institute of Social Research August 6,

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MODALITIES FOR HIV/AIDS MODALITIES FOR HIV/AIDS PLANNING, IMPLEMENTATION PLANNING, IMPLEMENTATION AND MANAGEMENT IN LOCAL AND MANAGEMENT IN LOCAL

GOVERNMENTS GOVERNMENTS

Stephen K. KiiryaMakerere Institute of Social Research

August 6, 2007 Arua

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1. BACKGROUND1. BACKGROUNDNo structured response to HIV/AIDS before 1985No structured response to HIV/AIDS before 1985

1986 AIDS Control Program (ACP) established in MoH to 1986 AIDS Control Program (ACP) established in MoH to spearhead HIV/AIDS actions in public sectorspearhead HIV/AIDS actions in public sector

CSO/FBO initiated organized action in community CSO/FBO initiated organized action in community

1986 - 92, HIV/AIDS mainly coordinated & managed by 1986 - 92, HIV/AIDS mainly coordinated & managed by ACP through Task Forces linked to a few SectorsACP through Task Forces linked to a few Sectors

1988, realized that epidemic is multi-faceted & initiated 1988, realized that epidemic is multi-faceted & initiated discussion on a multi-sector strategydiscussion on a multi-sector strategy

1992, adopted policy on multi-sector Approach to the 1992, adopted policy on multi-sector Approach to the Control of AIDS (MACA) and created UACControl of AIDS (MACA) and created UAC

1994+ implementation of multi-sectoral national response 1994+ implementation of multi-sectoral national response with many players at national, district & lower levelswith many players at national, district & lower levels

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UAC

CCMWBMAP

Bilaterals

INGOs and

Foundations

National Level Action

District and Local Level Action

National Budgets

AcademicPartnerships

UN

PrivateSector

National AIDS Control Programmes

CSO Partnerships

Parliament

Numerous challenges to institutional and coordination Numerous challenges to institutional and coordination arrangementsarrangements

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2. MANAGEMENT ARRANGEMENT2. MANAGEMENT ARRANGEMENTCreated formal arrangements, structures and functions to Created formal arrangements, structures and functions to ensure that all stakeholders and aspects of the HIV/AIDS ensure that all stakeholders and aspects of the HIV/AIDS response work together in an organized and efficient way response work together in an organized and efficient way to achieve the national objectivesto achieve the national objectives

Political & technical coordination structures are responsiblePolitical & technical coordination structures are responsible– Political:Political: Parliamentarian HIV/AIDS Standing Committee, Parliamentarian HIV/AIDS Standing Committee,

DATF, SATF, parish/village councilsDATF, SATF, parish/village councils– Technical:Technical: UAC/SCEs, SAC, UAC/SCEs, SAC, DAC and SACDAC and SAC

UAC coordinates all HIV/AIDS activities at all levels. UAC coordinates all HIV/AIDS activities at all levels. SACs coordinate HIV/AIDS activities in line ministries.SACs coordinate HIV/AIDS activities in line ministries.DAC and SAC coordinate AIDS activities at district and DAC and SAC coordinate AIDS activities at district and lower levels with support from national structures lower levels with support from national structures

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AIDS PARTNERSHIP FORUM

(All Partners meet Annually:review progress, set priorities)

2.1 National Mechanism

UGANDA AIDS COMMISSION& SECRETARIAT

THE HIV/AIDS PARTNERSHIP COMMITTEE

(4 Permanent Representatives and Representatives from all Self-Coordinating Entities (SCEs)

Gov’tMinistries

UN & Bilaterals

NationalNGOs

INGOsPrivateSector

FBOsPHA

NetworksLG

Response

Research Academia Science

Youth Media

Post 2000 “Three Ones” Principle = One National HIV/AIDS Post 2000 “Three Ones” Principle = One National HIV/AIDS Framework, Coordinating Body and M& E FrameworkFramework, Coordinating Body and M& E Framework

Parliament

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2.1.1 National-Level Roles 2.1.1 National-Level Roles

Develop national programs, policies, guidelines Develop national programs, policies, guidelines and materials for facilitating HIV/AIDS planning, and materials for facilitating HIV/AIDS planning, implementation and management of interventionsimplementation and management of interventions

Mainstream AIDS in planning/budget frameworksMainstream AIDS in planning/budget frameworks

Advocate and lobby resources and other inputsAdvocate and lobby resources and other inputs

Building capacity of implementers by training, etcBuilding capacity of implementers by training, etc

Quality assurance by periodic supervision, M&EQuality assurance by periodic supervision, M&E

National surveys, assessments, etcNational surveys, assessments, etc

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District AIDS TaskforceChair: District Chairperson Secretary: CAO; Members: max 23; DEC, RDC, speaker, reps of CSO & PHA; Meet: Twice annually

District AIDS CommitteeChair: CAO; Secretary: Focal Point Officer; Members: max 23; heads of directorates, reps of CSO & PHA; Meet: At least ounce a Quarter

SC AIDS TaskforceChair: Sub-county chairpersonSecretary: Sub-county chief; Members: max 15; SC executive, speaker, reps of CSOs & PHA ; Meets: Twice annually

SubcountySC AIDS CommitteeChair: Sub-county chief; Members: max 15; heads of sub-county directorates, reps of CSOs & PHA; Meets: At least twice annually

Parish AIDS TaskforceCombines Political and Administrative Arms; Chair: Parish chairperson; Members: max 15; Parish executive, representatives of PDC, CSOs and PHA. Meets: Twice annually

2.2 Local Govt Mechanisms

Village AIDS TaskforceCombines Political and Administrative Arm; Chair: Village chairperson; Members: max 15; Village executive, representatives of VDC, CSOs and PHA; Meets: At least twice annually

District

Parish

Village

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2.2.1 Local Govt Level Roles 2.2.1 Local Govt Level Roles Develop, implement and manage local HIV/AIDS Develop, implement and manage local HIV/AIDS strategic and annual plans, bylaws and toolsstrategic and annual plans, bylaws and tools

Integrate AIDS activities in local development Integrate AIDS activities in local development plans, initiatives and budget frameworksplans, initiatives and budget frameworks

Mobilise communities & resources for AIDS Mobilise communities & resources for AIDS responsesresponses

Build capacity of implementers by training, etcBuild capacity of implementers by training, etc

Implement and assure quality of activities through Implement and assure quality of activities through periodic supervision/monitoringperiodic supervision/monitoring

Local situation/response analysis, surveys,etcLocal situation/response analysis, surveys,etc

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3. PLANNING MODALITIES3. PLANNING MODALITIES

3.1 Definition3.1 Definition

Is a process that involves assessing problems/needs Is a process that involves assessing problems/needs and identifying feasible actions and resources for and identifying feasible actions and resources for resolving them in the resolving them in the short and long-runshort and long-run

Long-run:Long-run: Strategic plan (more than 3 years Strategic plan (more than 3 years

Short-run:Short-run: Work-plan (quarterly, biannual, annual Work-plan (quarterly, biannual, annual

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What should beWhat should be What it isWhat it is

Participatory from below Participatory from below upward upward

Partial participation, process often Partial participation, process often starts & ends at district level staff & starts & ends at district level staff & politicianspoliticians

Inclusion of community groups Inclusion of community groups & need (go beyond LC structure) & need (go beyond LC structure)

Limited participation & integration of Limited participation & integration of community needs in development plan community needs in development plan processesprocesses

Decentralized management Decentralized management structures (DAC, CPCstructures (DAC, CPC

DAC & DDHS-led, central-led for DAC & DDHS-led, central-led for some CSOsome CSO

Multi-sectoral approachMulti-sectoral approach

Evidence-based multi-sectoral Evidence-based multi-sectoral strategic plansstrategic plans

Multi & single-sector (health) methodMulti & single-sector (health) method

Parallel planning/budgeting (driven by Parallel planning/budgeting (driven by respective AIDS funding mechanisms)respective AIDS funding mechanisms)

Mainstream AIDS in plans and Mainstream AIDS in plans and budgets for organizationsbudgets for organizations

Limited HIV/AIDS activities/budgets in Limited HIV/AIDS activities/budgets in department plans department plans

Sector HIV/AIDS provisions in Sector HIV/AIDS provisions in the District Development Planthe District Development Plan

HIV/AIDS activities seen in health HIV/AIDS activities seen in health section of district development plansection of district development plan

3.23.2 Planning PrinciplesPlanning Principles

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What should beWhat should be What it isWhat it is

DAC coordinates planning, DAC coordinates planning, budgeting, appraisal, budgeting, appraisal, implementation, M&E of the implementation, M&E of the district multisector HIV/AIDS plandistrict multisector HIV/AIDS plan

Non-participation of some Non-participation of some CSOs in joint planningCSOs in joint planning

Similar lower structures not Similar lower structures not workingworking

Stakeholders often come with Stakeholders often come with preconceived activitiespreconceived activities

Process not replicated & linked Process not replicated & linked to lower structures and leadersto lower structures and leaders

Deepen practice to SACs, etc.Deepen practice to SACs, etc.

Start in groups/not only leadersStart in groups/not only leaders

Synthesize issues in sub-Synthesize issues in sub-county and parish plancounty and parish plan

Assign general needs to LG Assign general needs to LG structures and special needs to structures and special needs to interest groupsinterest groups

Hold conference of all key LG Hold conference of all key LG stakeholders to plan collectivelystakeholders to plan collectively

Select small team of DAC and Select small team of DAC and stakeholders to synchronize stakeholders to synchronize activities, cost and draft plan in activities, cost and draft plan in line with national strategic planline with national strategic plan

DAC reviews completed plan DAC reviews completed plan and submit it to DC for Approvaland submit it to DC for Approval

3.3 Planning Process 3.3 Planning Process

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4. RESOURCE MOBILISATION 4. RESOURCE MOBILISATION AND MANAGEMENTAND MANAGEMENT

Funds mobilised locally from communities and LGs, or Funds mobilised locally from communities and LGs, or externally from government, donors and civil societyexternally from government, donors and civil society

Multiple funding arrangements: Multiple funding arrangements: - On-budget funding (local revenue/conditional grant) On-budget funding (local revenue/conditional grant) - Separate bank account for channelling project fundSeparate bank account for channelling project fund- Direct funding to implementersDirect funding to implementers

4.1 On budget4.1 On budget

Implementers request and funds are drawn from the Implementers request and funds are drawn from the respective budget linerespective budget lineAccounting done in line with public proceduresAccounting done in line with public procedures

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4.2 4.2 Off-BudgetOff-Budget

CAO & CFO responsible for all financial managementCAO & CFO responsible for all financial managementDFP & Sub-Accountant facilitate periodic financial DFP & Sub-Accountant facilitate periodic financial operations and report preparations operations and report preparations Implementers maintain project specific account Implementers maintain project specific account DAC prepare/submit quarterly activity schedule DAC prepare/submit quarterly activity schedule (extract from approved annual work plan/budget)(extract from approved annual work plan/budget)Funds are disbursed to LG project account with Funds are disbursed to LG project account with payment details payment details (activities, amount and implementers)(activities, amount and implementers) or directly to implementer with copies to LGor directly to implementer with copies to LGCheques written in the names of listed implementers. Cheques written in the names of listed implementers. Next release made after accounting 75% of advance Next release made after accounting 75% of advance and reflecting it in the monthly accountability returns.and reflecting it in the monthly accountability returns.Suspend payment if implementer fails to account well. Suspend payment if implementer fails to account well.

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4.3 4.3 Direct CBO FundingDirect CBO Funding

After approval of CBO proposals, CAO/DFP or the After approval of CBO proposals, CAO/DFP or the equivalent in LLG prepare/submit to financier a equivalent in LLG prepare/submit to financier a request with approved community plan and budgetrequest with approved community plan and budget

Request shows communities whose proposals are Request shows communities whose proposals are approved, location & amounts (local and requested)approved, location & amounts (local and requested)

Guide approved communities to open bank accountGuide approved communities to open bank account

Pay directly to respective CBO accounts by qheque. Pay directly to respective CBO accounts by qheque.

Train management committees in implementation, Train management committees in implementation, fiduciary management and reporting. fiduciary management and reporting.

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What should beWhat should be What it isWhat it is

Respective LG-based Respective LG-based departments, NGOs, FBOs and departments, NGOs, FBOs and CBOs implement activities CBOs implement activities stipulated in the plan. stipulated in the plan.

Some implementer (CSO, FBO) Some implementer (CSO, FBO) deliberately avoid LG priorities & deliberately avoid LG priorities & implement own activitiesimplement own activities

Substantial external funds Substantial external funds disbursed outside or without copy disbursed outside or without copy to LG mechanismsto LG mechanisms

Limited transparency and Limited transparency and accountability of activities and accountability of activities and budget size to LGs, communities budget size to LGs, communities

Articulate all implementation Articulate all implementation procedures in LG planprocedures in LG plan

Emphasize procedures to all Emphasize procedures to all financiers or implementers at financiers or implementers at negotiation, implementation and negotiation, implementation and follow-upfollow-up

Implementers develop workplan Implementers develop workplan based on approved strategic planbased on approved strategic plan

Workplan should go through all Workplan should go through all set approval process of LG, set approval process of LG, ministry, CSO or FBO ministry, CSO or FBO

Disburse funds to implementers Disburse funds to implementers through or with information to LG through or with information to LG authorityauthority

Account to or give reports to LG Account to or give reports to LG authority CAO/DAC for authority CAO/DAC for verification/audit, etcverification/audit, etc

5. IMPLEMENTATION5. IMPLEMENTATION

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5.2 Community Implementation5.2 Community Implementation

Based on community action plan and budget. Based on community action plan and budget.

Community is informed about exact disbursementCommunity is informed about exact disbursement

Community meets and prepares a simple activity Community meets and prepares a simple activity timetable, and request based on funds disbursed. timetable, and request based on funds disbursed.

Community submits request and timetable to LG Community submits request and timetable to LG authority, and cheque is paid and depositedauthority, and cheque is paid and deposited

After cheque has matured, persons assigned activity After cheque has matured, persons assigned activity request funds and implements.request funds and implements.

Implementation & accountability reports are prepared Implementation & accountability reports are prepared and submitted to treasurer who compiles reports. and submitted to treasurer who compiles reports.

All reports, accountabilities and requests are All reports, accountabilities and requests are endorsed by CPC and forwarded to LG.endorsed by CPC and forwarded to LG.

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Monitoring (check progress:Monitoring (check progress: Evaluation(assess outcome:Evaluation(assess outcome:

Implementation of activitiesImplementation of activities

How they are being done,How they are being done,

If beneficiaries are reachedIf beneficiaries are reached

Identify obstaclesIdentify obstacles++solutionssolutions

Extent objectives are Extent objectives are achievedachieved

Effects of activities on Effects of activities on beneficiary well-beingbeneficiary well-being

Weekly, monthly, quarterly, .Weekly, monthly, quarterly, . Mid, end, after(post-audit)Mid, end, after(post-audit)

ChecklistChecklist Evaluation/survey toolEvaluation/survey tool

Internal:Internal: DAC, SAC, ATFs, DAC, SAC, ATFs, EWs, PDC, VC, CPC, etcEWs, PDC, VC, CPC, etc

External: IndependentExternal: Independent

Why?Why? Improve performance Improve performance Why?Why? See change caused See change caused

6. MONITORING & EVALUATION6. MONITORING & EVALUATION

6.1 Definition6.1 Definition

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6.2 LG Modalities6.2 LG ModalitiesSet measurable indicators linked to LG situation and Set measurable indicators linked to LG situation and specific NSF objectivesspecific NSF objectives

Set/use standard monitoring tool (linked to key AIDS Set/use standard monitoring tool (linked to key AIDS indicators in LG & National M&E modules) indicators in LG & National M&E modules)

Periodic monitoring of implementers by HIV/AIDS Periodic monitoring of implementers by HIV/AIDS committees, EWs, political and community leaderscommittees, EWs, political and community leaders

Respective agencies must monitor/report on activitiesRespective agencies must monitor/report on activities

Establish Management Information System (MIS)Establish Management Information System (MIS)

Periodic analysis of existing data on HIV/AIDSPeriodic analysis of existing data on HIV/AIDS

Periodic reporting on key AIDS indicators in the LG & Periodic reporting on key AIDS indicators in the LG & national M&E modulenational M&E module

Determine activity impact through periodic Local Quality Determine activity impact through periodic Local Quality Assurance and Supervision (LQAS) surveys in districtAssurance and Supervision (LQAS) surveys in district

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7. CONCLUSION7. CONCLUSIONLG HIV/AIDS planning, implementation and LG HIV/AIDS planning, implementation and management modalities have been disseminated management modalities have been disseminated widely but are not functioning in all LG widely but are not functioning in all LG Joint planning is limited to districts which receive Joint planning is limited to districts which receive external support, and this process often starts and external support, and this process often starts and ends with department staff & politiciansends with department staff & politiciansParticipation & integration of community needs in Participation & integration of community needs in development plan processes is still limited development plan processes is still limited Implementation is still disjointed and weakened by Implementation is still disjointed and weakened by incongruent procedures set by various AIDS funding incongruent procedures set by various AIDS funding mechanismsmechanismsThe deliberate bypassing of LG systems by several The deliberate bypassing of LG systems by several existing funding mechanisms & implementers has existing funding mechanisms & implementers has undermined the functioning of the set HIV/AIDS undermined the functioning of the set HIV/AIDS coordination and management arrangementscoordination and management arrangements

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8. RECOMMENDATIONS8. RECOMMENDATIONSDeepen joint planning practices into LLG structures Deepen joint planning practices into LLG structures (SACs, etc) and ensure that it starts in the (SACs, etc) and ensure that it starts in the community groupscommunity groupsSynthesize community issues and integrate them in Synthesize community issues and integrate them in parish/sub-county plans while assigning general parish/sub-county plans while assigning general needs to LG structure and the special needs to needs to LG structure and the special needs to respective interest groupsrespective interest groupsInclude budget provision for HIV/AIDS in all LG Include budget provision for HIV/AIDS in all LG sectors (not only health)sectors (not only health)Articulate all planning, funding, implementation and Articulate all planning, funding, implementation and management procedures in LG HIV/AIDS planmanagement procedures in LG HIV/AIDS plan

Repeatedly emphasize procedures to all financiers Repeatedly emphasize procedures to all financiers and implementers during negotiation, and implementers during negotiation, implementation and follow-upimplementation and follow-up

Replicate the partnership arrangements in all LGsReplicate the partnership arrangements in all LGs

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THANK YOUTHANK YOU