Changing the World through Local-to-Global Advocacy

1. Changing the World through Local-to-Global Advocacy Scaling and Assessing Impact from the Campaign to End Pediatric HIV/AIDS (CEPA) by Dr. Paul S. Zeitz, Executive Director & Professor Sanjeev Khagram, iScale Advocacy Breakfast SeriesAspen Institute Washington, D.C. 15 January 2011

2. “Waging Justice”– A Performance-based Advocacy Approach Agenda Setting Conception Policy Analysis Issue Identification Target Accountability Pressure Decision-Makers Mobilize Public Accountability Advocacy Advocacy Accountability Results & Outcomes Accountability Generate Media Build Partnerships NOTE: GPAN’s advocacy approach was developed utilizing the Annie E. Casey Foundation’s “Guide to Measuring Advocacy and Policy,” conversations with interviewees, and analysis by Dalberg Global Development Advisors.

3. Overview of the “Waging Justice” Advocacy Approach Develop clearly defined, campaign-specific Theory of Changeand Theories of Actionto achieve strategic political advocacy outcomes that align with GPAN’s overall Theory of Change. Utilize criteria for prioritizing among network models and targeted advocacy outcomes in order to successfully advance GPAN’s priority initiatives or campaigns. Develop a clear approach to achieving impactbased on experience, environmental mapping, and an understanding of key gaps in the advocacy landscape. Agenda Setting Conception Issue Identification Mobilize Public Policy Analysis Utilize a networked advocacy approach to pressure decision-makers, mobilize constituencies, and build partnerships. 5. Create or support campaign networks to design and implement advocacy action plans that prioritize specific outcomes and reflect the needs and priorities of affected communities. 6. Engage in strategic political communications that speak truth to power, help frame the advocacy debate, and ensure rapid response to emerging advocacy opportunities. Pressure Decision Makers Advocacy Generate Media Target Accountability Build Partnerships Support watchdog mechanisms and networks to hold political leaders and other stakeholders accountable for their commitments. Conduct performance-based advocacy through robust systems that facilitate monitoring, evaluation, and continuous learning, e.g., Impact Planning, Assessment, Reporting and Learning (IPARL) system. Results & Outcomes Accountability Advocacy Accountability Account- ability

4. Strategic Focus on Five Priority Advocacy Outcomes “Waging Justice” Performance based Approach ADVOCACY OUTCOMES Paradigm-busting POLICIES Secure evidence-based policies that achieve ground-breaking progress, rather than small-scale incremental change Increased and improved needs-based FUNDING Mobilize significant, sufficient, and sustained funding from diverse sources, e.g., public and private, and ensure efficient disbursement and implementation mechanisms Inter-Connected Strategic Objectives ACCOUNTABILITY for people-level impacts Strengthen and create watchdog and enforcement mechanisms to ensure improved implementation of global, regional, and national commitments CIVIL SOCIETY inclusion in decision-making and implementation Increase civil-society participation and engagement with global, regional, and national institutions, and ensure local ownership of program design and implementation New and transformed INSTITUTIONS Strengthen the performance and impact of existing institutions through policy, procedural, and governance reforms, and create new institutions as needed

5. Campaign to End Pediatric HIV/AIDS (CEPA) GOALS: Going to Scale with PPTCT+ and Pediatric Treatment 80% coverage for pediatric HIV/AIDS treatment and 80% coverage for PPTCT+ services by December 31, 2015 • Current CIFF Support: May 2009 –April 2012 • GPAN/GAA Committed to CEPA(+), 2011-2015

6. CEPA Local-to-Global Partners • Initiating Countries Kenya, Mozambique, Zambia, Nigeria, Tanzania, Uganda: indigenous civil-society networks • Sub-Saharan Africa Region • ANECCA, PATAM, HAI Stock Outs Campaign, Health GAP, OSISA, Graça Machel Trust • Global Partners GAA, Health GAP Evaluation & Learning Partner: iScale Funding Partners: Children’s Investment Fund Foundation (CIFF), UNICEF, others

7. CEPA IPARL COMPONENTS Link IE and M&E activities with Strategy • Clearly articulated CEPA-wide Theory of Change • Clearly articulated global and national, regional, and global level “Theories of Action” for CEPA partners • An integrated assessment framework aligned with global, regional and national level strategies – includes: baseline data, score card of indicators, evidence of change journals, and periodic assessments (review and evaluation)

8. CEPA IPARL COMPONENTS Link IE and M&E activities with Strategy • Learning and improvement activities • Constituency voice and feedback • Public and donor reporting

9. CEPA’s Advocacy Objectives Objective 1: Comprehensive Family Centered Care and Nutrition Objective 2: Early Infant Diagnosis and Treatment Objective 7: Overcoming Stigma and Discrimination Objective 3: Access to Appropriate Medicines and Commodities End 2015 Goal: 80% Coverage for Comprehensive PPTCT+ and Pediatric HIV/AIDS Treatment Objective 4: Full Funding Objective 6: Overcoming Human Resources Crisis Objective 5: Reprogramming to Achieve CEPA Impact

10. Theories of Action that Include Evidence/KPIs to Monitor Progress Towards Advocacy Outcomes and Advocacy Outputs Advocacy Outcome Bottleneck Advocacy Output National policy strengthened to prevent discrimination against HIV positive mothers and children. Stigma Report on national stigma index is published Bottleneck Evidence/KPIs: Stigma Report Evidence/KPIs: Punishments for discrimination in National policy are made more severe Lack of coordinated care Advocacy Output Advocacy Outcome National Training curricula is drafted by relevant actors An accredited set of National Training curricula for task shifting is established. Bottleneck Evidence/KPIs: National Training curricula document Evidence/KPIs: Draft of Training Curricula Limited number and capacity of trained health care professionals Advocacy Outcome Advocacy Output Comprehensive and harmonized pediatric care policies, guidelines, and standard operating procedures are adopted by National Government, donors, and providers. Pediatric care policy guidelines drafted by Ministry of Health Evidence/KPIs: Draft of Pediatric care policy guidelines Evidence/KPIs: Relevant legislation

11. “Robot” Traffic Light SystemColor Code for Monitoring Progress This describes the status of outcomes irrespective of CEPA contribution

12. MoH adopts Opt A of new WHO Guidelines by Aug 2010 Core Objective 1: Family centred care and nutrition Priority 1.1 Rapid adaptation and implementation of new WHO guidelines on ART, PPTCT+ and infant feeding by 2011 By end of 2010 MoH implements more effective PPTCT interventions, based on phased implementation of the new WHO PPTCT Guidelines 5 training wksps by CEPA partners on Ped HIV/AIDS and PPTCT for Com/tradit religious lead, healers, activists Com/tradit religious lead, healers, activists are trained about PPTCT and Ped HIV/AIDs treatment by end of 2010, by CEPA partners and endorsed by MoH Core Objective 2: Early infant diagnosis and treatment (EID+T) Priority 2.1 Development and implementation of EID+T guidelines to increase testing of children within two months of birth by 2011 CEPA identify/participate in 5 thematic wk groups open for CS participation by Jun 2010 CS engaged by MoH and Development partners in 12 meetings of thematic wk groups Core Objective 3: Access to appropriate medicines Priority 3.1 Effective policy and monitoring mechanisms in place to reduce point of care stock-outs of ART for adults and children, OI drugs, EDI and family planning commodities by 2012 Training plans and guidelines to authorize non-physician clinicians on PPTCT clinical manage include provis of HAART and to provide ART By Dec 2010 MoH implements task shifting to allow non-physician clinicians to prescribe Ped ART and PPTCT Core Objective 4: Full funding Priority 4.1 Increased national budget for PPTCT+ Ped treat, and services by 2012 Priority 4.3 Achieve the Abuja declaration commitment by 2012 MoH approv new strat plan for pharm logistics by Jun 2010 Within the next 12 months, supply chain management systems decentralized and better coordinated by MoH Gov+Multi-lat/Bi-lat donors commit to increase funding for Ped HIV /AIDs and PPTCT 15% of the 2011 annual national budget (internal resources) is allocated to health sector (Abuja Declaration) (and within this 15%, adequate resources to MCH including PPTCT, and paediatric ART Cross-Cutting Objective 5: Reprogramming to Achieve CEPA Impact Priority 5.1 Political commitments and nat plans/frameworks adopt CEPA goals and priorities by 2012 No Output identified in NAAP 80% targets for supplying PPTCT+ and paediatric treatment services to be achieved by Dec. 31, 2012 set by government Cross-Cutting Objective 6: Overcoming Human Resource Crisis Priority 6.1 Effective policies and guidelines to expand and improve HR capacity to support scale up of PPTCT+ and Ped treat services by 2012

13. Advantages of CEPA’s IPARL • “Agenda-setting” effect of extensive advocacy action planning • Aligned Campaign-wide theory of change, partner theories of action and KPIs • Shift in focus from activities to measurable advocacy outcomes and outputs • Real-time learning to inform strategy and course correction • Integration and triangulation of multiple types of evaluation data • Enhances capacity in all partners, improving non-CEPA related advocacy • Enhances a “global action network (GAN)” approach to transnational advocacy

14. Risks/Challenges of CEPA’s IPARL • Requires authentic ownership and trust amongst partners • Low capacity of advocacy organizations to implement reduces potential learning and course correction benefits • Overcoming KPI-fatigue • Attribution of contribution remains elusive • Donor-driven monitoring and evaluation can shift focus from strategic advocacy • Risk that funders will rigidly link performance-based advocacy to funding

15. Lessons: Performance-based Advocacy (PBA) • Should be an integral part of the early stage planning process, incorporating regular monitoring reviews and periodic impact evaluation • Requires a cultural shift among advocates • Requires intensive capacity building and robust peer mentoring systems • Must be fit-for-purpose, with sustained financial support by funding partners

16. "True peace is not merely the absence of tension: it is the presence of justice." --Reverend Martin Luther King Jr.