April 20, 2012 Health Policy Project Efficiency & Effectiveness (E 2 ) in the HIV/AIDS Response Involving Implementers in Kenya

 Current Financing of HIV/AIDS in Kenya  Understanding the role of implementer  Why should E 2 be a component in Kenya’s strategic planning process?  USAID|Health Policy Project and E 2 in Kenya  Current areas of investigation, two examples  Responses and areas of future collaboration Outline

 More 70% of targeted HIV funding comes from external resources  Resources constrained, with the exit of certain large funding sources from the sector  Government considering  Planning for predictable and sustainable HIV/AIDS financing - discussion on innovative financing  Improving efficiency and effectiveness in HIV programming Current Financing of HIV/AIDS in Kenya

Role of Implementers in Managing HIV/AIDS Funds

Implementers make decisions on both allocative and technical efficiency Good entry point for E 2 work Different approaches and definitions to E 2 HPP’s approach – Apply evidence on what works Solution-centered approach to make E 2 tangible: ↓ long-term costs without changing outputs or quality ↑ outcomes in prevention, treatment & care Role of Implementers 5

The objectives of an E 2 approach reflect the current demands on Kenya’s HIV/AIDS response.  Kenya’s programs are still working to expand coverage, access, and results…  However, decreasing donor funding is likely to shrink the resources available for this response.  Program managers are being asked to do more with less! Why is E 2 right for Kenya?

1.USAID OHA funds activities through the Health Policy Project (HPP) in NACC formally requested support on E 2 initiatives (June 2011) 3.The KNASP-3 Mid-Term Review offers platform 4.Country-led multisectoral TWG was set up to lead the E 2 process, identify focus areas 5.Government owns the solutions emerging from the TWG, working with HPP The Health Policy Project and E 2

 Blood Safety  Safe Injections  PEP & PrEP  Community-Based Programming for HIV  Key High-Risk Population Interventions  Voluntary Male Medical Circumcision  Procurement/Logistics  HTC  Goals Modeling  Training and Human Resources for HIV services  ART for Prevention… Areas Open to Investigation

 Through a multisectoral technical working group led by NACC/NASCOP, a number of initial focus areas were selected and analysis is continuing: 1.Goals Modeling of the Prevention Portfolio 2.HIV: Community-Based Programming 3.Investigating Best Training Modes for HRH needed for HIV 4.Blood Safety * 5.HIV Testing and Counseling (HTC) * * We look at the last one focus areas as an example later Selecting Focus Areas

 Goals Modeling of Prevention Portfolio  How would programmatic scale-up impact HIV outcomes in terms of infections averted, and total costs?  HIV Community-based Programs (HCBC)  Are HCBC programs in Kenya evidenced-based?  Can HCBC programs in Kenya be made more effective by altering the mix of interventions?  Training/HR for HIV service delivery  Which model(s) for provider training is the most efficient and feasible: off-site, mentoring, roving clinicians?  Do training models have different outcomes in terms of provider empowerment, motivation, capacity, etc.? Examples: Research Questions from Prioritized Areas

Example HIV Testing and Counseling

Context: The KNASP 3 target is 80% knowledge of status by the year The current coverage is 58% for women and 42% for men, implying a significant gap. HTC: Increasing coverage KNASP 3 Pillar: 1 Organization: NASCOP Key issues for analysis Can HTC resources be used more efficiently and effectively through different target-setting schemes? Given established goals, what is the best combination of testing strategies? Data needs Distribution of key population groups by province Distribution of incidence by province and key population Cost of testing strategies

 We find that structuring HTC targets based on prevalence may increase testing effectiveness.  Can regional targets be based on distribution of incidence?  How do we incorporate key population data and relevant testing methods into the targeting strategy?  When time and costs associated with testing methods are included, which testing strategies…  Minimize costs (maximize efficiency)?  Minimize time to universal knowledge (maximize effect)?  Maximize effect (as above) with a fixed budget (maximize E 2 )  What are efficient and effective re-testing targets? Areas of analysis…

Future Collaboration and Strategic Planning

 The HPP E 2 activity has been and will continue to be a country-led process.  Opportunities in E 2 : Long-term partnership with GOK  Multi-partner Consultation on E 2 in Nairobi  Building upon modeling and economic/impact analyses  Roadmap for improved program activities through the end of KNASP III  Support for strategic planning around E 2 for KNASP IV  Sustained focus through embedded E 2 staff at NASCOP and NACC, funded through HPP How can HPP and the E 2 team support further analysis?

Thank you!