Table of Contents. NASTAD s Technical Assistance to the HIV & AIDS District Coordination

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3 Table of Contents Acronyms... 2 Acknowledgement... 3 Background... 4 Facilitators of the District HIV and AIDS Response... 6 District Multi-Sectoral AIDS Committee... 6 District AIDS Coordinators and Assistant District AIDS Coordinators... 7 NASTAD s Approach to Strengthening the District Coordination... 8 Functioning Structures and Processes... 8 Robust District Workforce... 9 Impactful Public Health Programs Monitoring and Evaluating the District Coordination Appendices Appendix A: DMSAC Terms of Reference Appendix B: Framework and Operational Guidelines for CCE-CC Appendix C: ALDP Facilitator s Guide Appendix D: DMSAC Evidence Based Planning Toolkit Appendix E: CCE-CC Training Manual Appendix F: CCE-CC Facilitator s Guide Appendix G: CCE Methodological Framework Poster Appendix H: NASTAD s Technical Assistance to the District Coordination Poster

4 Acronyms AIDS: ALDP: APHPMT: CCEP-CC: CDC: CSO: DAC: DGHA DMSAC: EBP: HIV: MLG&RD: NACA: NASTAD: NFS: PEPFAR SMDP: TOR: UNAIDS: VMSAC/WMSAC: Acquired Immune Deficiency Syndrome Applied Leadership Development Program Applied Public Health Program Management Training Community Capacity Enhancement Program for Community Conversations Centers for Disease Control and Prevention Civil Society Organization District AIDS Coordinators Division of Global HIV/AIDS District Multi-Sectoral AIDS Committee Evidence Based Planning Human Immunodeficiency Virus Ministry of Local Government & Rural Development National AIDS Coordinating Agency National Alliance of State and Territorial AIDS Directors National Strategic Framework for HIV and AIDS President s Emergency Plan for AIDS Relief Sustainable Management Development Program Terms of Reference Joint United Nations Programme on HIV/AIDS Village and Ward Multi-Sectoral AIDS Committee 2

5 Acknowledgement In 2000, NASTAD established the Global Program to expand its domestic work to peers in countries around the world. NASTAD Global enables U.S.-based state AIDS directors and their staff to share their public health experience with counterparts globally, as a part of the President s Emergency Plan for AIDS Relief (PEPFAR). Working together, NASTAD has helped build the capacity of public health agencies and systems around the world to better manage and implement jurisdictional HIV programs. NASTAD Botswana is proud now, to present this legacy portfolio representing the last ten years of NASTAD s collaborations with public health partners in Botswana. This portfolio includes guidelines, models, tools, and curricula designed collaboratively with the National AIDS Coordinating Agency (NACA), and the Ministry of Local Government and Rural Development (MLG-RD) through its Primary Health Care Services Department, to strengthen Botswana s district HIV response. These are also intended as a resource for these partners, as they independently continue this work in the future. NASTAD acknowledges and thanks our partners, the National AIDS Coordinating Agency (NACA), the Ministry of Health and the Ministry of Local Government and Rural Development (MLG-RD), especially the Primary Health Care Services Department. Our gratitude also goes to the District Multi-Sectoral AIDS Committees, the District Health Management Teams, as well as the District AIDS from around the country for their collaborative and welcoming spirit, commitment, patience, and good cheer. We also thank our members, our NASTAD Botswana staff, and our donors being the Centers for Disease Control and Prevention (CDC) for their support for our global work, and we are honored to have been able to assist the Government of Botswana in developing local, sustainable solutions to the public health challenges they face. Lucy Slater Director, Global Program Development of this publication was funded by the President s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) Division of Global HIV/AIDS (DGHA) Cooperative Agreement 1U2GPS Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. 3

6 Background Botswana is a middle income country in the Southern part of Africa with an estimated population of 2.04 million. According to the 2013 UNAIDS Report of the Global AIDS Epidemic, Botswana has a very high adult HIV prevalence rate, estimated at 21.9% with an estimated 320,000 HIV infected people in the country. The government of Botswana has taken an active role in its response to HIV and AIDS, entrusting the National AIDS Coordinating Agency (NACA) with coordinating and facilitating the nation s response to the HIV and AIDS epidemic. The National Strategic Framework for HIV and AIDS II (NSF II ), which is the current blueprint to fighting HIV and AIDS in Botswana, outlines a decentralized strategy to address the epidemic. At the district level, this decentralized response is led by the District Multi-Sectoral AIDS Committees (DMSACs), consisting of district government and community stakeholders, facilitated by District AIDS Coordinators (DACs) who develop and coordinate implementation of interventions, captured in annual work plans, to address the epidemic in their districts. However, the NSF II acknowledges that while the response at the district level has made some progress in terms of establishing coordination mechanisms, managing funds, and supporting activities, the response remains somewhat fragmented and lacks sound coordination. The NSF II mandates Ministry of Local Government & Rural Development (MLG&RD) with the overall responsibility to coordinates the districts HIV and AIDS responses the national HIV. MLG&RD also has the responsibility to ensure effective implementation of HIV and AIDS programs that are in line with national strategic guidelines and policies. Among other things, the MLG&RD is also responsible for building the capacity and strengthening the role of the DMSAC and the office of District AIDS Coordinators (DAC). NASTAD has had a presence in Botswana since 2003, establishing strong relationships with NACA and the Ministry of Local Government and Rural Development (MLG&RD). For over 10 years, in line with the National Strategic Framework, NASTAD has provided technical assistance to the MLG&RD and NACA, in building capacity of district government to plan for and implement needsbased HIV prevention programs and strengthening public health systems to support sustainable and effective program delivery and outcomes. During the course of this relationship, NASTAD has worked with MLG&RD to build a structural framework for the district response, developing revised national terms of reference for District DMSACs, and standardized national guidelines for evidence based planning. NASTAD also worked to build capacity of the district workforce to coordinate and manage the district response, supporting MLG&RD with the development of a tailored Applied Public Health Program Management Training (APHPMT), also known as the Applied Leadership Development Program (ALDP), for the DACs to address the identified gaps relating to management and leadership and their expected job duties and overall, providing ongoing, one-on-one, on-site technical assistance and training to all districts and sub-district level staff. Finally, 4

7 NASTAD has supported the design and delivery of impactful public health programs, promoting institutionalization evidence based planning (EBP) across districts, and promoting the Community Capacity Enhancement Program (CCEP- CC), which is designed to build the capacity of Botswana Government Institutions to use community capacity enhancement strategies to enhance HIV prevention planning and intervention. This Toolkit presents the different materials (Guidelines, Operational Frameworks, Training Curriculum and Manuals, etc.) produced and disseminated during the last ten years as part of NASTAD s technical assistance and support to strengthen the district level HIV and AIDS response coordination in collaboration with MLG&RD, NACA, the Centers for Disease Control and Prevention (CDC), Sustainable Management Development Program (SMDP) and other local and international partners. District strengthening workshop in Letlhakeng 5

8 Facilitators of the District HIV and AIDS Response The national HIV and AIDS response is a multi-sectorial approach that is coordinated by different sectors at the national, district and local level (see Figure 1). The district HIV and AIDS response is facilitated by the DMSAC, DACs and Assistant District AIDS Coordinators (ADACs), key individuals tasked with developing and coordinating interventions and the annual district HIV and AIDS plan. An overview of the roles of DMSAC and the DACs and ADAC in the district response is outlined below. Figure 1. Coordination of Botswana s National HIV and AIDS Response District Multi-Sectoral AIDS Committee The DMSAC s main role is to coordinate HIV and AIDS activities at the district and sub-district level. It is not directly involved in the implementation of activities, but it is tasked with ensure that priority areas are included in all planned activities, and that they are in line with the national policies and strategies for the response. The DMSAC is also tasked with mobilizing resources for the district and sub-districts, where present. It is also the DMSAC s responsibility to design strategies to overcome barriers to an effective response, while ensuring that no one is left-behind by advocating against the stigma and discrimination of people living with HIV and AIDS, and by mainstreaming HIV and AIDS into social and economic development programming. 6

9 District AIDS Coordinators and Assistant District AIDS Coordinators District AIDS Coordinators and ADACs are critical to the management and coordination of the district response. As secretariats to the DMSAC, they manage inputs, facilitate the development of multi-sectorial annual HIV & AIDS Action Plan, support local level capacity building for implementation, mobilize resources, coordinate strategic implementation partnerships across sectors, and monitor and document district responses. District strengthening workshop in Palapye 7

10 NASTAD s Approach to Strengthening the District Coordination NASTAD s technical assistance to NACA and MLG&RD involved building the capacity of the district workforce to coordinate a response that is in line with the national framework, and to fulfill their respective duties. Using its capacity building approach, NASTAD focused on enhancing structures at the district level, improving the performance of the district workforce, and promoting the design of impactful evidence based public health programs. FUNCTIONING STRUCTURES AND PROCESSES A defined structural framework is necessary in order to coordinate the district HIV and AIDS response. Written charters and guidelines are important to ensure that all involved in the district response are accountable for the execution of their duties. NASTAD has provided technical assistance to NACA and MLG&RD to develop three documents that are to be used for this exact purpose, the DMSAC Terms of Reference, and the Framework and Operational Guidelines for Community Capacity Enhancement through Community Conversations. DMSAC Terms of Reference (TOR) NASTAD assisted MLG&RD in developing the DMSAC Terms of Reference (TOR), a document that provides the necessary direction and guidance in the operations of the DMSAC and VMSAC/WMSAC. The DMSAC TOR outlines what is expected of the DMSAC and of its members, and identifies the decision-making authorities within the DMSAC. The DMSAC TOR outlines in great detail the responsibilities of the DMSAC, provides guidelines on DMSAC membership, governance and reporting structures. This document is meant to increase accountability among DMSAC members and to provide a set framework and structure within which the DMSAC is to fulfill its duties. See Appendix A for a more detailed description of the DMSAC Terms of Reference. Framework and Operational Guidelines for Community Capacity Enhancement through Community Conversations (CCE-CC) This is a good program. Because of CCE, people now have a platform where they can seriously debate on HIV issues. People like this program even the chiefs because it bring us together as a community. The Framework and Operational Guidelines for CCE-CC provides a foundation for the achievement of meaningful community mobilization and engagement, which will inhibit the spread of HIV. This document contains an outline of the framework for CCE-CC in Botswana and guidelines for the implementation of the framework. It provides contextual background and history of community mobilization in Botswana, as well - Community member in Chobe (translated from Setswana) 8

11 as a comprehensive methodology for implementation, training and resource mobilization, and detailed outline of stakeholder roles and responsibilities. Strategies to monitor and evaluate the success of the CCE-CC program area are also discussed in the document. This is a reference document to be used by organizations, sectors who wish to design and implement Community Conversations. A more detailed description of the Framework and Operational Guideline for CCE-CC can be found in Appendix B. ROBUST DISTRICT WORKFORCE The human resources charged with the coordination and implementation of the district s HIV and AIDS related activities are crucial to its success. Therefore, the district workforce needs to possess the right set of competencies and capabilities to drive the district response. The MLG&RD has identified the District AIDS Coordinators (DACs) and the District of Multi-sectoral AIDS Committee as two important contributors in the district response, and has requested the assistance of NASTAD in developing curricula and trainings aimed at developing their capacity. NASTAD provided technical assistance to MLG&RD in developing the Applied Leadership Development Program for District HIV & AIDS Coordination. Applied Leadership Development Program for District HIV/AIDS Coordination The Applied Leadership Development Program (ALDP) for District HIV/AIDS Coordination was developed to building the capacity of DACs and ADACS. The topics covered throughout The training was interactive and relevant experiences and examples were shared. - Week 1 ALDP participant the training are based on an assessment that enabled MLG&RD to identify specific public health management gaps among the DAC and ADAC workforce. An ALDP Facilitator s Guide is available for Master Trainers from MLG&RD to train DACs and ADACs as needed. The trainings cover a range of topic from a general overview of the national HIV and AIDS response, to building management skills such as budget development, planning and executing successful meetings. Consult Appendix C for more information about the ALDP Facilitator s Guide. Applied Leadership Development Program Training in Gaborone 9

12 IMPACTFUL PUBLIC HEALTH PROGRAMS Impactful public health programs are to be supported by strong data that reveal the state of the district concerning HIV and AIDS, and indicate where the efforts and resources of the district should be invested. Not only do programs need to be evidence based, but they also need to be implemented according to a set framework to preserve the integrity of the program. NASTAD has provided technical assistance to MLG&RD in establishing a distinct guideline to assist DMSAC and community partners in developing succinct program implementation plans that are data-driven. The documents that were developed for this purpose were the DMSAC Evidence Based Planning Toolkit, the CCE-CC Training Manual, and the CCE-CC Facilitator s Guide. DMSAC Evidence Based Planning (EBP) Toolkit The DMSAC EBP Toolkit is to be used by districts for HIV and AIDS planning. Data is used to inform programmatic decision making in the district regarding HIV and AIDS. Evidence based planning optimizes the planning process and improves HIV and AIDS program results because needs are determined by reviewing the HIV and AIDS situation of the district. Evidence based planning brought structure, focus and guidance on how to effectively identify and plan for HIV and AIDS issues and activities in the districts. Planning is no longer done haphazard but it is guided by evidence. - TAC Member, Francistown Evidence based planning also helps ensure collaboration to set priorities for the coming years, that proposed activities are responsive to the identified priorities, and that the plan is comprehensive and provides guidance for various sectors and funding sources. The toolkit outlines the importance of monitoring and reporting, and evaluating the district response, while providing a set of useful tools and forms. More information on the EBP Toolkit can be found in Appendix D. CCE-CC Training Manual The CCE-CC Training Manual supplements the Framework and Operational Guideline for CCE-CC. The Training Manual serves as a reference for all trainings related to CCE-CC in Botswana, training of Trainers, and Community Conversation Facilitators. It uses interactive processes consistent with the principles of community capacity enhancement to assist the trainers in facilitating CCE-CC training sessions. During the training sessions, the facilitator will use self-direction method for adults where participants will engage in a process of inquiry, analysis, and decisionmaking rather than simply engaging in a transmission of knowledge process. See Appendix E for more information on the CCE-CC Training Manual. 10

13 CCE-CC Facilitator s Guide The CCE-CC Facilitator s Guide is aimed at providing Community Conversation Facilitators a step-by-step guide to facilitate community conversations in their community. It guides the Community Conversations Facilitators through each step of the CCE-CC Methodological Framework. The guide provides detailed instructions on relationship building, concern identification, concern exploration, decision making, implementation, and reflection and review). For additional Capacity enhancement helps us immensely. You see, now we even have a port-a-cabin, and are accessing ARVs with relative ease as they are dispersed from here. It s because of the power of the people. - Community member in Chobe (translated from Setswana) information on the CCE-CC Facilitator s Guide, refer to Appendix F. The CCE Methodological Framework poster is a supplement to the Facilitator s Guide (see Appendix G) Community conversation in Chobe 11

14 Monitoring and Evaluating the District Coordination Building strong District Coordination for an effective HIV and AIDS response is an ongoing process that needs to be continuously monitored, reviewed, and revised based on the achievements and setbacks of all the sectors involved in the district response. Monitoring and evaluating District Coordination is essential to understanding if the goals set for the district response are being met, and if the activities and interventions undertaken are in line with the NSF. Essentially, a monitoring and evaluation (M&E) process is a means to summarize progress, achievements and lessons learned with partners and stakeholders to refine strategies to contribute to an even more effective district HIV and AIDS response. The district should monitor and evaluate its performance towards reaching proposed district HIV and AIDS response goals in an ongoing manner utilizing both process and outcome evaluation methods. Data should be gathered on how and when activities were implemented, the number of individuals reached by those activities, and the content/products delivered to determine whether program implementation is occurring as planned and resulting in the proposed outputs. It is the responsibility of all parties involved in the district response the DMSAC, the implementers, the CSOs, local organizations, and the private sector to monitor their activities and report according to their reporting requirements and the district reporting structure. All parties have different reporting requirements, and those are all outlined in the documents previously introduced. All the documents include a monitoring and evaluating section that can be further consulted to get more information. 12

15 Appendices Appendix A: DMSAC Terms of Reference Appendix B: Framework and Operational Guidelines for CCE-CC Appendix C: ALDP Facilitator s Guide Appendix D: DMSAC Evidence Based Planning Toolkit Appendix E: CCE-CC Training Manual Appendix F: CCE-CC Facilitator s Guide Appendix G: CCE Methodological Framework Poster Appendix H: NASTAD s Technical Assistance to the District Coordination Poster.. 22 Community Conversation in Chobe 13

16 Appendix A: DMSAC Terms of Reference 14

17 Appendix B: Framework and Operational Guidelines for CCE-CC 15

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19 Appendix C: ALDP Facilitator s Guide 17

20 Appendix D: DMSAC Evidence Based Planning Toolkit 18

21 Appendix E: CCE-CC Training Manual 19

22 Appendix F: CCE-CC Facilitator s Guide 20

23 Appendix G: CCE Methodological Framework Poster 21

24 Appendix H: NASTAD s Technical Assistance to the District Coordination Poster 22

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