STRATEGIC PLANNING

V.Slobozian

Coordinator, Harm Reduction Programs

SOROS Foundation Moldova

27.06.2011

2011-2015 National Program

Developed to enforce:

Law on State Surveillance on Public Health No 10- XVI of February 3rd, 2009 (Official Monitor, 2009, no 67, Art. 183)

Law on prevention of HIV/AIDS No 23-XVI of February 16th, 2007 (Official Monitor, 2007, No 54, Art. 250)

Global Commitments to Millennium Development Goals, Objective 6 “Halt HIV/AIDS and TB by 2015 and begin reversing the spread”

Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS of 2001

Commitment to provide Universal Access

2011-2015 National Program

Developed according to:

National Development Strategy for the 2008-2011 period approved by Law No 295 of December 21st, 2007

Plan of Actions to implement the National Development Strategy, approved by government Decision No 191 of February 25th, 2008

National Health Policy, approved through Government Decision No 866 of 15.08.07

National Strategy for the National Healthcare System Reform for the years 2008-2017, approved in 2007

2011-2015 National ProgramDeveloped according to:

Government Decision No 33 of January 11th, 2007 on the rules for development and unified requirements for policy documents

Methodological Guidelines on decision-making

Methodological Guidelines on ex-ante analysis of public policy impact

Terms of Reference of HIV/TB/STI National Coordination Council

Recommendations of the: Joint United Nations Programme on HIV/AIDS (UNAIDS),

World Health Organization (WHO),

United Nations Children's Fund (UNICEF),

United Nations Population Fund (UNFPA),

United Nations Office on Drugs and Crime (UNODC)

METHODOLOGICAL GUIDELINES on decision-making

The principle of prioritizing public policy - public policy planning is performed according to Government priorities and availability of (financial and human) resources managed by the government;

The principle of considering several policy options - in the public policy making process, several options are considered in order to adopt and implement the best one;

The principle of predicting the impact of public policies - the policy making process ensures analysis of all important dimensions of impact;

The principle of public policies continuity and coordination - in the process of elaborating new public policy, the evaluation and updating of existing public policies and their coordination with other public policy initiatives is ensured;

The principle of participation - requires the involvement of stakeholders in the planning, development and evaluation of public policies.

Stages of the process to plan public policies METHODOLOGICAL GUIDELINES on decision making, State Chancellery

Government program of activity

National intersectorial and sectorial public policy

documents

Annual plan of action

Public policy proposals

Legal and normative acts

National Response to HIV

Strategic planning

Developing, reviewing and approving public policies

Defining problem and objective

Identifying possible solutions

Analyzing the impact of public policy options and recommending

an option

Developing PPP

Approval of the PPP by the relevant line

institutions

Implementing

Monitoring and corrective actions

Evaluation and corrective actions

Internal and external consulting

Developing the normative act

Approval of normative act by Government

Stages of policy document development (GD 33, 2007)

a) Identification of problems;b) Information collection and analysis;c) Formulating policy proposal with the definition of the problem, policy objectives,

beneficiaries and scenarios of implementation;d) Carrying out impact analysis for policy scenarios (SWOT analysis);e) Consulting policy scenarios and the exhaustive nature of risk analysis using the

reporting verticals of the initiating institution, and laterally at the level of units in charge of policy analysis, monitoring and evaluation from the line Ministries;

f) Formulating the policy document;g) Extended consultations (including via posting on web) and reviewing of the document;h) Finalizing and presenting the final version for approval;i) Formulating requirements for the monitoring reports;j) Approving the policy document act;k) Monitoring and evaluating the implementation of the policy document.

The 2011-2015 National Program on HIV was additionally examined by all the TWG of the HIV/TB/STI NCC

2011-2015 National ProgramDeveloped based on the:

Midterm evaluation of the 2006-2010 NAP

Final evaluation of the 2006-2010 NAP / National Response Analysis

Ex-ante analysis of the 2011-2015 NAP draft

Estimates of sizes of MARPS and epidemiological estimations and projections (using the Estimations and Projections Package-EPP and Spectrum )

Behavioural and biological studies among vulnerable groups (IDU, FSW, MSM, migrants, prisoners)

Results of the modeling of probable Modes of Transmission and triangulation

Evaluation of prevention in the 2006 – 2010 NAP (2011)

Other relevant studies

Ex-ante analysis

SCENARIO AReduced

financing (state)

SCENARIO BTreatment based

financing

SCENARIO C Tratament+prevention

Prevalence in final year 2015 0.66% 1.15% 0.75%

Reduction of prevalence in final year 2015

-6% -155% -17%

Incidence in final year 2015 0.07% 0.52% 0.10%

Decrease of incidence in final year 2015

-21% -12.93% -69%

New registered cases of HIV 2015 8 140 46 159 10 559

Prevented HIV cases 2015 1 838 6 873 17 793

Life years 23 645 30 854 85 666

Cost per scenario, USD 2 247 985 47 131 300 127 572 860

Number of new infections by risk groups category, Scenario B, 2010-2015

Analysis of risks and opportunities Risks identified in the strategic planning phase of

developing the National Program - the National Program document includes strategies for mitigating risks

Risk analysis overarching for the national prevention and response efforts

Integration in existing national disaster preparedness and response mechanisms

2011-2015 National Program

Developed based on 6 principles:

a) National Response to HIV/AIDS is evidence-informed

b) Human rights based approach in prioritizing interventions for an equitable coverage of the most affected/marginalized groups

c) Ensuring that the gender equality principle is respected

d) Ensuring universal access to quality prevention, treatment and care e) Involving communities and people living with HIV / AIDS in

developing, implementing and evaluating the programf) Monitoring and evaluation

Logical framework of NP results

Determining the hierarchy of results based on the priorities identified through the situational analysis/national response analysis

SMART Objectives (Specific, Measurable, Achievable, Realistic and Time bound).

Impact, outcome and process indicators, disaggregated to measure equity of access to various services/thematic areas of the NAP

Baseline (2009) and targets (2015) stipulated for impact and outcome indicators

Targets established through a participatory process, based on modelling exercises/estimates/projections and expert opinion consensus, in line with Universal Access principles

Annual targets established by interpolation and validated participatively

NP purpose and impact indicators

Results Indicators Baseline indicator Target

Value Year Source Value Year Source

Programme Goal Impact indicators

The aim of the programme consists in the promotion of a healthy lifestyle, forming safe and risk-free behaviors, extending prevention activities among the population, including rural population, mobile populations, extending access to health services (voluntary counselling and testing, early diagnose, treatment and support) as well as maintaining the epidemical situation of HIV in the concentrated epidemic stage

HIV prevalence in the general population 0.37 2010

Estimates and projections

0.44 2015Estimates and projections

HIV prevalence in IDUs 16,4% 2009 IBBS 20% 2015 IBBS

HIV prevalence in FSWs 6.10% 2009 IBBS 11% 2015 IBBS

HIV prevalence in MSM 1.70% 2010 IBBS 5% 2015 IBBS

HIV prevalence in pregnant women

0.29% 2009

Administrative statistics

0.16% 2015

Administrative statistics

Objective 1: Objective 1 Outcome indicators

Incidence of HIV by 2015 will not exceed 20,0 per 100000 population in the 0-39 age group (on both banks)

HIV incidence to 100,000 population 17 2009

Administrative statistics

20 2015Administr

ative statistics

% of women and men aged 15 – 49 who have had sex in the last 12 months and have used a condom at the latest sexual encounter

68% 2009

Behavioural study

70% 2015

Behavioural study

% IDUs who have used sterile injecting equipment (did not share directly and indirectly) at last injection

99.30% 2009 IBBS 99% 2015 IBBS

% IDUs who have used a condom at last sex

35,6 2009IBBS

55% 2015IBBS

% FSW who have used a condom at last commercial sex

90.8% 2009IBBS

90% 2015IBBS

% MSM who have used a condom at the last anal sex

61,9% 2010IBBS

75% 2015IBBS

Objective 2:

Objective 2 Result indicators

Mortality of HIV/AIDS infected persons from the total number of estimated persons will decrease by 10% till 2015

AIDS deaths

808 2009Estimations and

projections 635 2015

Estimations and projections

% adults and children with HIV that are still on ARV treatment 12, 24, 36, 48, 60 months after initiation

12: 88.26%

2009Administrative

statistics

12: 88.26%

2015Administrative

statistics

24: 88% 24: 88%

36: 72% 36: 85%

48: 79% 48: 80%

60: 57% 60: 70%

Planning interventions

Based on specific NAP objectives Based on lessons learned by implementing previous

programme cycles Based on interventions that have proven their cost

efficiency Based on international good practices

recommendations/guidelines For the coverage of key groups with high risk of

infection For equity and increasing accessibility

Planning for the provision of sustainability

Planning to increase the share of funding from public sources over the years

Interventions to strengthen programme management Integrated interventions to consolidate systems - health

system, social protection system, education system, M&E system

Capacity building on levels of decision-makers, operational-technical levels and service provision levels

Technical assistance plan for strengthening systems and capacities of human resources

Thank you!

vslobozian@soros.mdSoros Foundation Moldova

32 Bulgara Street, tel. + 373 22 270031