Review Rationale & Context for MER: Programmatic Shifts

1. Review Rationale & Context for MER: Programmatic Shifts Amy Gottlieb, PhD, MPH OVC M&E Meeting February 19 – 20, 2014

2. PEPFAR after 10 years, two phases • Emergency to sustainability • Increased collaboration with multilateral partners • Emphasizing contribution to national programs, alignment with national strategies, evidence based for national epidemics • Continued emphasis on results and efficiencies • Phase I (FY04-FY08) driven by 2-7-10 • PEPFAR processes routinized and country teams formed • Reported on: Direct, Indirect, and Total • With many revisions in first five years • (e.g. Reduced burden of reporting) • Phase II (FY09-FY13) driven by 3/6-12-12 • Reported on: Direct and National • Limited attention to policy, quality, capacity (lab), HSS (HRH) • Implementation in context of Partnership Frameworks with multilaterals, in support of national program • Phase III (FY14-FY18) seeks to evolve how we describe PEPFAR support • Reporting on: Direct Service Delivery & Technical Assistance • Improved M&E of capacity, quality, country ownership, impact • Implementing in context of Country Health Partnerships to advance results and country ownership, in close collaboration with multilaterals PEPFAR Support – A View of the First 10 Years PEPFAR MER Introduction 2013_11_21 2

3. Background of Phase III • As part of the MER, an interagency task team was established to review the definition of ‘direct’ and provide guidance for FY14-18. • The task team proposed that PEPFAR should adhere to the historical intent of ‘direct’ while refining and clarifying its definition. • Field and TWGs provided input on revised definition. Definition was further clarified in response to their feedback.

4. Why Revise the Definition of “Direct” To date, PEPFAR has counted individuals as ‘directly supported by PEPFAR’ using broad criteria, largely left to program areas and country teams to define. As PEPFAR support evolves, we need a more rigorous and standardized definition of ‘direct support’. As country capacity increases, PEPFAR support evolves in response, and PEPFAR results will change. This revised definition acknowledges that not all PEPFAR efforts will count as ‘directly supported’. This change is appropriate because it more accurately characterizes the nature of our support.

5. Defining “Direct Support” – Before and After 4

6. Revised Definition of PEPFAR Support More accurately describes PEPFAR’s evolving contributions in alignment with national HIV strategies and programs: • Refined definition of direct service delivery (DSD) support to individuals • Introduce definition of technical assistance (TA) support to sites and above sites • What is a ‘site’?‘Site’ is a proxy for ‘points of service delivery’ and refers to health facilities, labs, communities, CBOs, school wards, and other such entities. • Above ‘site’ level includes support to districts, regions, and national government offices that is above the level of service delivery.

7. Revised Definition of PEPFAR Support Individual Level Individualsreceiving HIV related services will be counted as receiving direct support for service delivery (DSD) from PEPFAR when the support: 1) is critical* to the delivery of the service to the counted individuals; AND 2) involves established presence at and/or routinized, frequent (at least quarterly) support to those services to those individuals at the point of service delivery. Both conditions must be met in order to count individuals as directly supported by PEPFAR. * “Critical support” is defined on an indicator by indicator basis

8. Examples of Critical Support & Established Presence (TA Support) by Indicator 7

9. Revised Definition of PEPFAR Support “Site” Level Distinguished as DSD or TA-only • Sites, facilities, labs, organizations, communities, schools, etc. can be counted as receiving PEPFAR direct service delivery (DSD) support when: • individuals served at that ‘site’ are receiving support as defined on the previous slide. • Sites, facilities, labs, organizations, communities, schools, etc. can be counted as receiving PEPFAR technical assistance (TA)- only support when PEPFAR is: • providing recurrent (at least quarterly) technical support to improve the functioning or capacity of that entity 8

10. Revised Definition of PEPFAR Support • Above “Site” Level • Districts, regional, and national governments or organizations above the service delivery levelcan be counted as receiving PEPFAR technical assistance (TA) support when PEPFAR is: • providing recurrent (at least quarterly) technical support to improve the functioning or capacity of that entity. 9

11. Applying Revised Definitions Through Portfolio Review Review Partner Agreements Re-Classify Partner Support By Program Area, By Facility DSD TA Neither Re-Allocate FY14 Targets and Results to DSD, TA, Neither 10

12. Type of Partner Support Influences Reporting Requirements Individuals Site Partners providing DSD support to sites will report individual level counts for all applicable indicators Partners providing TA only support to sites will report individual level counts only for selected indicators (determined by our legislative reporting requirements) Partners providing DSD or TA only support will both report on site level quality indicators (when applicable) • Mostly likely scenario: partner provides same type of support within a given program area. However, we need to create room for exceptions. • For example, within the same program some partners may provide DSD to some sites, TA only to other sites. Again, this is about classifying the type of support provided to the site.

13. What does this mean for our numbers? They will change

14. Here’s the “How to”:Applying MER definitions in COP14(Practical examples are in the next slides…)

15. Example: Applying MER Definitions to a Prevention (Key Pop) Support Partner In FY14, will the partner report on P8.3.D Number of key populations reached with individual and/or small group level HIV preventive interventions that are based on evidence and/or meet the minimum standards requiredusing NGI definition of Direct? yes no In FY14, does the partner provide support ‘critical’ (i.e. procurement of condoms, salary of personnel providing any of these services (i.e. outreach workers, program manager), or program design i.e. the development of training curricula, prevention guidance development, or standard operating procedures (SOPs), & follow-up to ensure fidelity to the program design) to the delivery of Key Pop interventions to individuals where services are delivered ? yes no In FY14, does the partner provide recurrent (at least quarterly) technical support to the service delivery org/ site to improve functioning/capacity in key pop interventions(such as mentoring/supportive supervision; training; organizational strengthening; QA/QI; regular assistance with M&E functions and DQAs; or condom forecasting and supply management)? In FY14, does the partner provide recurrent (at least quarterly) technical support to the service delivery org/ site to improve functioning/capacity in key pop interventions(such as mentoring/supportive supervision; training; organizational strengthening; QA/QI; regular assistance with M&E functions and DQAs; or condom forecasting and supply management)? yes no no yes DSD Neither* Neither TA DETERMINE REPORTING REQUIREMENTS *If not previously NGI – not critical, no recurrent tech support, continue not to report

16. Revised PEPFAR REPORTING TIMELINE • Oct/Nov/Dec • Jan/Feb/March • April/May/June • July/Aug/Sept • Q2 • Q1 FY15 • Q4 • Q3

17. Thank you! Questions, Comments?