TABLE OF CONTENTS. Born Free Africa s Mission. The Goal To Eliminate Mother to Child Transmission of HIV. Born Free Africa s Contributions

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1 IMPACT REPORT

2 In an age of seemingly infinite disagreement, we can all agree that no child, anywhere, should be born with HIV. We have the tools and knowledge to block this transmission. We cannot back down from this fight now, not when we are so close to achieving elimination of one of HIV s most devastating byproducts. I am confident that with continued investment, eliminating mother to child transmission of HIV will be one of the greatest accomplishments of our generation. John Megrue, Cofounder and Chairman, Born Free Africa Testimony at United States Senate Foreign Appropriations Committee Hearing in Washington D.C., 2015

3 TABLE OF CONTENTS Born Free Africa s Mission The Goal To Eliminate Mother to Child Transmission of HIV Born Free Africa s Contributions Impact of Policy Approach To Talent + Implementation Impact In Nigeria + Kenya Feedback From The Field Innovative Use Of Data In Kenya Impact Of Advocacy Reflecting On Our Work i

4 BORN FREE AFRICA S MISSION BORN FREE AFRICA IS A PRIVATE PHILANTHROPIC INITIATIVE, FORMED BY A GROUP OF BUSINESS LEADERS WITH THE SUPPORT OF THE GLOBAL PUBLIC HEALTH COMMUNITY WITH THE SOLE OBJECTIVE OF ELIMINATING MOTHER TO CHILD TRANSMISSION OF HIV. From , Born Free Africa partnered across sectors to invest resources and business acumen to accelerate the elimination of mother to child transmission of HIV in the African countries most affected by this issue. Born Free Africa contributed catalytic resources, including ideas, networks, small amounts of funding, and management expertise and energy for the cause. These assets contributed to significant progress toward the elimination of mother to child transmission of HIV, as well as improvements to clinical policy and health services delivery; and increased global awareness and funding. Born Free Africa s efforts were experimental, and intended to be catalytic and collaborative. We sought to contribute to elimination by maximizing the ongoing work of many partners, thus having the greatest possible effect on outcomes. Documenting best practices and lessons learned along the way, we have made insights from this work available to the global community to inform continued efforts to eliminate mother to child transmission and strengthen health systems by enhancing management and leadership capacity.

5 PARTNERSHIPS BETWEEN 2012 AND 2017, BORN FREE AFRICA MADE UPSTREAM CONTRIBUTIONS TO EFFORTS TO ELIMINATE MOTHER-TO-CHILD TRANSMISSION OF HIV. 13 Partners 23 Change makers embedded across Nigeria and Kenya 20M+ Federal Ministry of Health Nigeria Ministry of Health of Kenya 60% DECLINE IN NEW INFECTIONS Awareness views generated by Born Free Africa activations $50B+ IMPACT REPORT 1

6 UNPARALLELED PROGRESS TOWARD A GLOBAL HEALTH GOAL Number of new HIV infections among children in 21 Global Plan priority countries, DECLINE IN NEW INFECTIONS IN CHILDREN In 2001, 500,000+ children were infected with HIV. Most cases were transmitted from mother to child. 75% BORN FREE PROJECTION SOURCE: UNAIDS NOTE: Data point for 2018 is a Born Free Africa Projection 2 IMPACT REPORT

7 THE GOAL TO ELIMINATE MOTHER TO CHILD TRANSMISSION OF HIV In 2001, 500,000+ children were infected with HIV. Most cases were transmitted from mother to child. COUNTDOWN TO ZERO Born Free Africa rallied support from the global business community to support The Global Plan alongside UNAIDS and the US President s Emergency Plan for AIDS Relief. Women living with HIV are advised to begin lifelong treatment to preserve their health and the health of their families. 1/2 Of children die if they don t receive treatment before the age of 5 98% Mother to child transmission of HIV is 98% preventable with effective treatment during pregnancy, delivery and breastfeeding. 60% As of 2015, 60% decline in new infections has been achieved in the African countries most affected IMPACT REPORT 3

8 PILLARS OF BORN FREE AFRICA S WORK HEALTH POLICY improving drug regimens and management approaches ADVOCACY maintaining global funding and awareness TALENT + IMPLEMENTATION IN AFRICA supporting Ministries of Health in Africa to improve implementation 2012 Developed evidence based recommendation to update the PMTCT treatment regimen, in partnership with the Clinton Health Access Initiative and UNICEF 2016 Presented at International AIDS Conference in Durban to highlight the impact of talent in Nigeria 2012 Led 8 US Senators to Delegation to Ethiopia, Rwanda and Liberia to learn about PMTCT efforts 2014 Partnership with Vogue, Amazon and the fashion industry created special edition clothing collection, global press and documentaries Partnership with the Government of Nigeria to embed a team within the Ministry of Health Partnership with the Government of Kenya to embed a team within the Ministry of Health 2017 Evaluated the impact of the embedded talent model on PMTCT health outcomes, in partnership with University of California, San Francisco 2015 Testimony at US Senate Foreign Appropriations Hearing helped preserve $50B in funding 2017 Published article in the Journal of Acquired Immune Deficiency Syndromes about role of private sector in PMTCT efforts 2016 Hosted UNAIDS Goodwill Ambassador Victoria Beckham in Kenya 4 IMPACT REPORT

9 PILLAR: HEALTH POLICY COLLABORATIVE ANALYSIS OF CLINICAL SOLUTIONS CONTRIBUTED TO A MAJOR POLICY SHIFT AND THE PROVISION OF LIFELONG TREATMENT FOR MOTHERS LIVING WITH HIV. Born Free Policy Initiative CHALLENGE: Different countries around the world were using many different regimens, many of which were nonefficacious. ACTION: In collaboration with UNICEF, the Clinton Health Access Initiative (CHAI) and McKinsey, Born Free Africa led an economic data analysis to examine options for clinical treatment. IMPACT: The report recommended a shift in clinical policy to the use of Option B+, a simpler and more effective treatment protocol, and the mobilization of the resources needed to support governments who wished to change to this treatment regimen No consistent treatment for PMTCT All of the African countries adopted new PMTCT treatment protocol 91% Of the 1.1 MILLION WOMEN 2 UNAIDS Prevention Gap Report, 2016 in need of treatment received treatment as part of PMTCT services IMPACT REPORT 5

10 BORN FREE AFRICA IN NIGERIA From 2012 to 2013, Nigeria achieved a 60% INCREASE IN COVERAGE OF PREGNANT HIV+ WOMEN ON TREATMENT NIGERIA S partnership with Born Free Africa began in a single state, Nasarawa, where we worked together to use a data-driven approach to goal setting, planning, and scale up. In one year, with support and leadership from the government, the President s Emergency Plan for AIDS Relief (PEPFAR), The Global Fund, and the NGO implementing partners, Nasarawa state achieved a 1.5x increase in the number of pregnant women tested and counseled for HIV and a 3.5x increase in the number of pregnant women living with HIV initiated onto the antiretroviral drugs they need to be healthy and prevent infection in their babies. Work set in motion by this partnership continues in Nigeria, and progress has continued even after partnership ended. 6 IMPACT REPORT

11 BORN FREE AFRICA IN KENYA From 2014 to 2016, Kenya achieved a 64% DECREASE IN TRANSMISSION OF HIV TO CHILDREN IN KENYA, devolution informed both the need for and the structure of the strategy to embed talent. Devolution was enacted through Kenya s 2010 Constitution to transfer power, resources and representation to the local level. It was among the most rapid and ambitious decentralization processes in the world. In 2013, 47 new county governors and assemblies were elected and assigned new responsibilities, including the provision of health care. New teams ramped up quickly, in some cases with little experience in the challenges that lay ahead. Government partners prioritized 20 counties based on number of new infections in children in prior year, geographic proximity and county leadership. The embedded staff played a key role in supporting the devolution of health care management to the county level. IMPACT REPORT 7

12 RESULTS IN NIGERIA AND KENYA 70% Increase in coverage of HIV+ women on treatment ( ) Source: UNAIDS Global Plan Progress Report % Increase in women on lifesaving treatment ( ) Source: Born Free Africa % Increase in coverage of HIV+ women on treatment ( ) Source: Kenya DHIS, % Decrease in transmission rate ( ) Source: Source: Kenya DHIS, % 53% Decrease in the number of new infections in children ( ) Source: UNAIDS Global Plan Progress Report 2014 and Kenya DHIS, 2016 Decrease in transmission rate ( ) Source: UNAIDS Global Plan Progress Report 2015 NIGERIA KENYA 52% Decrease in number of new infections in children ( ) Source: UNAIDS Global Plan Reports 2011 and IMPACT REPORT 16% 98% Decrease in non-efficacious treatment for HIV+ pregnant women ( ) Source: Born Free Africa Impact Assessment, Rapid Response Priority Counties Increase in data reporting in priority counties ( ) Source: Kenya DHIS, 2017

13 FEEDBACK SHOWS IMPACT ACROSS THE HEALTH SYSTEM Before people thought that [the] issue of HIV is for one office alone - [mine.] But now...it is everyone s problem. Community strategy, focal person, the laboratory guy, the HIV guy, [the] reproductive health person. Now it s a holistic way of thinking. COUNTY HEALTH DIRECTOR The TA became a uniting factor between the [County Management Team] and our sub-county management team and our facilities... The TA came as a supporter, as a trainer, [and as a] sort of a supervisor SUB COUNTY AIDS COORDINATOR [After the Technical Advisor leaves,] I m not going to be stuck because I was taught how to handle and look at issues. It was a transitioning mentorship. Somebody is teaching you so that you re not dependent. I can continue and I can also teach others. PMTCT FOCAL PERSON They had about 60 implementing partners who were not coordinated. You would find three partners doing the same things and no one was responsible for results. I started a partner mapping within the counties Now, they are aligned to the county s work plan. BORN FREE AFRICA SUPPORTED ADVISOR Initially PMTCT was a preserve of a very few people. Now from the directors to the county ministers, they ask you all the indicators that touch on PMTCT. If a child turns to be HIV+ the first thing the directors will ask you, What happened? Follow through and tell us what could have been the reasons. BORN FREE AFRICA SUPPORTED ADVISOR IMPACT REPORT 9

14 INNOVATIVE USE OF DATA COLLECTING AND UNDERSTANDING DATA IS A KEY CHALLENGE FACED IN THE MANAGEMENT OF HEALTH PROGRAMS. When working with individuals and community organizations who focus on delivering clinical services to patients, it is critical to present data in a way that can easily be understood, analyzed and acted upon. Data are often collected in paper log books before entering the digital system. In the digital system, data is most often presented in large tables of numbers, which can be difficult to interpret, even for the most analytic individuals. COMMUNITY DATABASE SERVERS HEALTH INFORMATION SYSTEMS KENYA NATIONAL CENSUS Born Free Africa s embedded team member improved the availability, analysis and use of data for effective management and implementation. He launched the use of a geographic information system (GIS) data into the national PMTCT program. Ken Danielson Strategic Information Advisor 10 IMPACT REPORT

15 For example, upon viewing a heat map representing data about the number of women giving birth at a health facility, one community revealed that results in a certain village could be attributed to the proximity of the facility to the public road and the likelihood that women might lack privacy if they chose to deliver their babies at the facility. In contrast to a spreadsheet, geographic information system (GIS) mapping is a visual representation of data layered on a map or satellite imagery. This allows users see where issues occur, the intensity of those issues, and where action is most needed. The use of GIS mapping transformed the way PMTCT data was used in Kenya. By reviewing data visually, with heat maps, health workers and community members were able to see the data about different villages in a format that allowed immediate comparison. This stimulated more questions about patterns in the data and deeper discussions about how to address emerging issues. IMPROVE UNDERSTANDING OF THE PMTCT DATA STIMULATE DISCUSSIONS AMONG COMMUNITY LEADERS ULTIMATELY IMPROVE SERVICE DELIVERY FOR PREVENTION IMPACT REPORT 11

16 IMPACT OF ADVOCACY BORN FREE AFRICA FASHION CAMPAIGN Vogue, Amazon and top fashion designers joined forces with Born Free Africa to design a special edition clothing collection to raise funds and awareness. KNOWLEDGE SHARING WITH THE AIDS COMMUNITY Born Free Africa co-authored an article in the Journal of AIDS (JAIDS), alongside UNAIDS, to share lessons learned from the private sector support for The Global Plan to Eliminate Mother to Child Transmission of HIV. $50B In funding preserved US FUNDING PRESERVED AFTER 2015 SENATE HEARING In 2015, at a US Senate Hearing to review foreign appropriations funding for HIV programs abroad, Born Free Africa testified alongside Bill Gates Ben Affleck to encourage sustained US funding for global health. WITH JOHNSON & JOHNSON DONATE A PHOTO CAMPAIGN For each photograph uploaded to Johnson & Johnson s Donate a Photo app in support of Born Free Africa, Johnson & Johnson donated $1 to mother to child transmission of HIV. 12 IMPACT REPORT

17 KNOWLEDGE SHARING WITH THE AIDS COMMUNITY $10M+ New funds raised The Born Free Africa-supported team in Nigeria were featured at the International AIDS Conference in 2016, sharing lessons learned from the initiative to embed talent into government to drive health systems change. GLOBAL CITIZEN FESTIVAL Born Free Africa was Johnson & Johnson s featured partner at the Global Citizen Festival in 2016 and at the International AIDS Conference in Millions of people learned about the issue by visiting the photobooth online and at these events. HARDBALL WITH CHRIS MATTHEWS ON MSNBC Born Free Africa was featured in a four-part series on Hardball with Chris Matthews, one of the top watched MSNBC news programs in the United States. Among the guests was Dr. Eric Goosby, former Head of the President s Emergency Plan for AIDS Relief and strategic partner to Born Free Africa. IMPACT REPORT 13

18 FASHION S LEADERS COME TOGETHER TO ELIMINATE MOTHER TO CHILD TRANSMISSION The concept for the launch of Born Free was to involve designers who are mothers and they are all going to be working together with us to be visible faces in the initiative. - Anna Wintour 14 IMPACT REPORT

19 I couldn t be prouder to have the women of the world coming together to say this is unacceptable. - Donna Karan IMPACT REPORT 15

20 IMPACT: 13M+ people exposed to the issue by articles in Vogue, InStyle, Women s Wear Daily and more THE MOTHERS OF FASHION united in partnership with Born Free Africa to prevent mother to child transmission of HIV. Twenty-one leading female fashion designers who are also mothers created a limited edition clothing collection, and participated in documentaries, campaigns and special events to raise awareness and funding. The fashion industry as a whole brought fresh voices and increased global awareness to the issue that influenced the global public and global decision makers to accelerate progress toward elimination. 16 IMPACT REPORT

21 UNAIDS AMBASSADOR VICTORIA BECKHAM VISITS KENYA WITH BORN FREE AFRICA Education + Advocacy: Victoria met top leadership in the Ministry of Health and Kiambu and Kisumu Counties, where mother to child transmission is a particular challenge. De-stigmatization + Support: Victoria attended a graduation ceremony where HIV exposed infants and their mothers were recognized for their completion of the prevention program. Brooklyn played in a football match as part of Kenya s national campaign to #kickouthivstigma. Global Awareness: Victoria and Brooklyn shared their experiences on social media, reaching and educating 20 million+ people across the world. IMPACT REPORT 17

22 PILLAR: TALENT + IMPLEMENTATION IN AFRICA BORN FREE AFRICA S INVESTMENTS IN MANAGEMENT TALENT SIGNIFICANTLY ACCELERATED PROGRESS TOWARD ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION IN NIGERIA AND KENYA. Born Free observed that neither clinical solutions nor funding were the rate limiting factors in the elimination of mother to child transmission. Many countries had these ingredients but had not achieved a generation born HIV-free. Countries that were making significant progress also had strong management, with talented people working at all levels of the system to apply a results-oriented, collaborative, no-excuses approach. The missing link talent that achieved effective management and implementation. TALENT WAS THE LINCHPIN FOR ACCELERATION PROGRESS TOWARDS EMTCT EMBEDDING TALENT INTO THE EXISTING SYSTEM STRENGTHENED THE GOVERNMENT RESPONSE KEY CHARACTERISTICS ENABLED THE TEAM TO BE SUCCESSFUL SET CLEAR TARGETS BUILT ACTIONABLE PLANS Financial resources Clinical solutions Talent and management for execution NAVIGATED LOCAL POLITICS WORKED WITH A COLLABORATIVE MINDSET PERSISTED WITH GRIT AND RESILIENCE 18 IMPACT REPORT

23 The essence of my work is inside the government, working with all stakeholders to make sure everyone is aligned. I succeed if they succeed. Born Free-supported Advisor in Nigeria IMPACT REPORT 19

24 From its inception, Born Free Africa has been committed to the principles of experimentation, partnership and knowledge sharing with the goal of serving to further future philanthropic and public health efforts around the world. Taylor Buonocore, President, Born Free Africa 20 IMPACT REPORT

25 THREE KEY DELIVERABLES Impact Assessment Although there is broad agreement that building management capacity positively impacts health system performance and health outcomes, there is little empirical evidence to support this hypothesis. Born Free Africa supported an external assessment of the intervention in Kenya evaluate the impact of embedded management talent in Kenya. The results showed a positive association and were supported by qualitative data collected by 50 interviews with key stakeholders in the Kenyan health system. Human Capital Playbook Envisioning and building a team is an intensive effort, and one of the biggest investments an organization can make. The Playbook shares best practice methodologies and resources for building high-quality teams and managing human capital to achieve results, drawing from Born Free s experiences building teams in Nigeria and Kenya. The content is available to governments, NGO organizations, global philanthropists and more. Article in the Journal of AIDS As the world grapples with meeting the ambitious target to As the world works to end the AIDS epidemic by 2030, it is valuable to reflect on the lessons learned from the Global Plan in harnessing the energy and resources of nonstate partners, including the corporate community and philanthropic sector. This article explores the contributions of these actors toward the remarkable achievement of a 60% decline in new HIV infections in children. IMPACT REPORT 21

26 REFLECTING ON OUR WORK BORN FREE AFRICA BEGAN WITH A SET OF GUIDING PRINCIPLES THAT WERE REFINED INTO LESSONS THAT CAN BE APPLIED TO EFFORTS TO CATALYZE CHANGE. CHAMPION EFFECTIVE MANAGEMENT Set specific, time-bound goals and aggressively pursue them CATALYZE IMPACT Contribute new perspectives and secure fresh resources towards an existing effort PLAY NICELY IN THE SANDBOX Respect existing partners and work behind the scenes to positively position others MAKE DECISIONS BASED ON EVIDENCE Secure the best data available and rigorously analyze and question it to ensure reliable evidence ITERATE AND ADAPT Iterate along the way, analyzing both the impact and the process used to get there 22 IMPACT REPORT

27 In many ways, the incredible progress toward eliminating mother to child transmission was driven by a clear and uniting goal and a significant push for progress attached to a specific deadline: virtual elimination by 12/31/15. Although the global community did not achieve this goal, we believe that progress was significantly accelerated as a result. Born Free Africa s partnerships were notable for their fresh contributions and laser focus on impact. The goal was always to co-create with a new potential partner, and enable partners to identify the variety of resources (not just financial) that could create impact. For example, the fashion industry contributed a fresh voice, expertise and global reach to the effort to eliminate mother to child transmission of HIV. Born Free Africa-supported teams worked behind the scenes within their own governments, supporting leaders at all levels of the system to do their work more effectively. Egos were set aside and the teams focused on broad, collective goals. Time and time again, this approach fostered trust and led to breakthroughs in the way work was done Early on it became clear that Kenya s PMTCT data tracking had some issues. Through Kenya s 2015 Bring Back the Women and Children Initiative, the Born Free Africa-supported team collected, corrected, and analyzed data to improve the accuracy of data tracking women in need of PMTCT who had not received it. The effort ensured data correctness and allowed health care workers to focus on those who could be brought back into the system to receive treatment. At various points, Born Free Africa encountered stumbling blocks to progress, from big changes like political or organizational leadership shifts to day to day challenges like personality clashes among team members. It remained important to address challenges head on, and act and communicate proactively. IMPACT REPORT 23

28 LEARNING FROM OUR EXPERIENCES AS AN EXPERIMENTAL AND LEARNING ORGANIZATION, BORN FREE AFRICA LEAVES BEHIND LESSONS FOR THE FUTURE, GLEANED FROM A MYRIAD OF CROSS-SECTOR PARTNERSHIPS AND A COMMITMENT TO LOCAL LEADERSHIP. When we started Born Free, we knew that we were embarking on a journey of collective impact. There is an ever-increasing and necessary need to collaborate with extraordinary leaders from across many sectors - public, private, NGO, civil society and philanthropy, among others - to solve some of the world s most important challenges, including ending mother-to-child transmission of HIV. It s been an honor to work with such a widearray of global partners, without whom our goals could have never been achieved. - Jennifer McCrea, Co-founder of Born Free Africa We were empowered to achieve impact by using a state-driven approach to interface closely with key state actors and provide insights that identified often small yet significant alterations for success. - Dr. Charity Chenge, Born Free supported Team Lead in Nigeria Born Free Africa s efforts in Nigeria and Kenya have shown that management impacts health outcomes. It is critical that programs and governments increasingly engage management, in addition to clinical skills, in order to save lives. - Dr. Eric Goosby, Professor of Medicine and Director Global Health Delivery and Diplomacy, UCSF and Former U.S. Ambassador-at-Large, PEPFAR 24 IMPACT REPORT

29 Born Free represented a unique approach to constructive partnership and philanthropy for achieving great results. Having experienced both sides, first in Government in Nigeria and then on the side of Big Win philanthropy, I appreciated the value of private sector and management skills to ensure performance of government programs. Born Free is clearly a pace setter in its area of work. - Dr. Muhammad Pate, Executive Director of Big Win Philanthropy and former Minister of Health in Nigeria While most people believe that strong leadership and management drives improved outcomes, few programs in global health have sought to develop evidence of this impact. Born Free Africa invested in generating data and sharing lessons to help other programs. Amy Lockwood, MS, MBA, PhD(c), Chief of Staff, Global Health Delivery and Diplomacy and AIDS Research Institute, UCSF At the heart of every program we fund are exceptional people visionary leaders that are making a difference in the lives of those most in need. SNF s support to Born Free Africa, bolstered the efforts of a small group of committed individuals, who in turn invested their time and expertise in catalytic talent and collaborative partnerships in Kenya. Their methodologies for building effective, impact-driving teams, relevant to any issue in population health, have enabled progress toward the elimination of mother to child transmission of HIV and its catastrophic consequences. Roula Siklas, Senior Program Officer at the Stavros Niarchos Foundation Cross sector collaboration is more important than ever as we work to eliminate HIV by Born Free Africa s partnerships with governments, NGOs, and the private sector demonstrate the multiplier effect that occurs when we join forces to accomplish a goal. Michel Sidibe, Executive Director of UNAIDS IMPACT REPORT 25

30 COORDINATED AND COLLABORATIVE EFFORTS TO ACHIEVE GLOBAL GOALS BORN FREE AFRICA IS JUST ONE STAKEHOLDER AMONG A WIDE ARRAY OF ORGANIZATIONS AND INDIVIDUALS TIRELESSLY WORKING TOGETHER TO ELIMINATE MOTHER TO CHILD TRANSMISSION OF HIV IN NIGERIA AND KENYA. Nigerian States Akwa Ibom Bayelsa Cross River FCT Kano Nasarawa Plateau Rivers Kenyan Counties Bungoma Busia Homabay Kakamega Kericho Kilifi Kisii Kisumu Kwale Migori Mombasa Nakuru Narok Nyamira Siaya Taita Taveta Trans Nzoia Turkana Uasin Gishu Vihiga 26 IMPACT REPORT

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