The analysis and advocacy (A2) project: Role in translating Thailand’s national AIDS strategy into provincial implementation plans S. Pantuwatana1, S. Osiri1, W. Phoolcharoen2, W. Sittitrai3 1 Burapha University, Chonburi, Thailand 2 Thailand A2 Team, Policy Researchy and Development Institute Foundation, Bangkok, Thailand 3 Thai Red Cross Society, Bangkok, Thailand

Scope of Presentation From Challenging Goal to Feasible AIDS Strategy Constraints of Pragmatic Implementation Evolution of Governance Transitional social context of vulnerability The need of effective intervention to keep pace with the socio-political change Chonburi - an eastern seaboard province voluntarily join the A2 in creating of the “AIDS Strategic Information Center” (ASI) to advocate all sectors in the province for effective HIV/AIDS prevention Plan for Scaling Up to meet the demand of all targeted population in the province

Key behavioural determinants To reduce Thailand’s HIV Incidence by half, goals of behavioral changes were set ! Key behavioural determinants 2005 2008 Female Sex workers - Condom use 82% 95% MSM Condom use 70% 85% Injection Drug User Condom use 76% Casual sex Condom use 36% 60% Discordant couple - Condom use 2% 30% IDU Needle sharing 18%

Realizing the Governance evolution 1990’s 2010’s 1997 and 2007 Constitution National AIDS Committee National AIDS Committee National Policy Sectors Policy Province Policy Local Authority Policy

Analyzing Thailand’s change in mode of transmission of HIV as reflection of transformation in social context related to targeted populations’ sexual behavior and addiction

Strategy to cope with the change Build effective management and technical capacity among responsible authorities Develop appropriate coordination skills in province to facilitate and support the integrated care-prevention intervention Strengthen the advocacy and resource mobilization skills of civil society in support the effective activities Operational research aimed at keeping pace with changing demand of each targeted population

Strategic management in Chonburi Province Chonburi is a province of Thailand’s eastern seaboard with drastic economic growth from its sea-port, tourism and industrial estate In 2007, the President of Burapha University established the AIDS Strategic Information Center (ASI) by the endorsement of the University’s council Thailand’s A2 committed to support and empower the analysis and advocacy capacity at the province level The Board of ASI composes of Vice Governors, the Local Authorities, civil society and the Province AIDS committee’s secretariat

Strategic Information Development ASI collated and collected HIV/AIDS related data available and analyzed to be preliminary situation analysis Mapping targeted groups according to their accessible sites Mapping responsible organizations of each targeted groups including province’s officers, local authorities, private sectors and NGOs Academics with their research in each targeted group solicited to join ASI

Pragmatic Operation Plan Formulation Prioritizing the targeted populations by the Provincial AIDS Committee Assessment of existing interventions in each targeted populations by ASI’s alliances Assessment of human resources available and capable in implementation the plan Joint planning by the responsible agencies under government, NGOs and private sectors Estimation of budget required for 4 - years plan

Classification of Intervention based on effectiveness management criterion Evidence of Effective Management Objective of Implementation Aims of strategy Control and monitoring Key Evaluative Indicators for Achievement Known Effective Intervention Scaling up to cover all target population in the country Resources mobilization to ensure the quality of the implementation Coverage of preventive implementation on the target population and its impact to reduction of new HIV infected cases Insufficient Evidence of Effectiveness Assessment of the effectiveness and unit-cost for implementation Capacity building and health service systems to ensure efficiency of intervention program Efficiency of activities in modification the target groups’ behavior to a protective conduct from HIV and STD Innovative Intervention Pilot project to assess the process practicality and activities’ efficacy Appropriate design of operational research to ensure successful and productive innovation Efficacy of the designed intervention to change the HIV risk behaviors or lifestyles to safer conducts

4 Examples of 4 - years plan for scaling up Targeted Population Setting to access Effectiveness Management level Model Development and Evaluation Scaling up Discordant Couples ANC and HIV/AIDS services Innovative Intervention Burapha U. with hospitals Provincial Public Health MSM Outreach and Drop In Centers Known effective intervention NGOs and health care network Local Government FSW Illegal migrated labors Workplace owners (Fisherman Boat) Insufficient evidence of effectiveness NGOs and Fishery Association Province’s Fishery and Labor Authority

Conclusion Burapha University and Chonburi’s experiences demonstrate the feasibility of local cooperation among technical taskforces, implementing groups and policy makers in consortia to develop effective HIV prevention programs With decentralization placing prevention responsibility upon provincial and local government, expanded adoption of this mechanism for collaborative strategic management can empower localities to respond effectively and long-term behavioral change