1. Supporting community action on AIDS in developing countries Liza Tong Programme Manager International HIV/AIDS Alliance “Whose Value Counts”: A community perspective on value for money

2. Supporting community action on AIDS in developing countries Presentation outline 1.The Alliance 2.Value for money – our approach so far 3.Community mobilisation and growing trends 4.Costing community mobilisation 5.What next? Questions and Discussion

3. Supporting community action on AIDS in developing countries A global partnership of 36 independent linking organisations Secretariat ‘added value’ (as defined by Alliance linking organisations): - knowledge & capacity building, policy influence, resource mobilisation, credibility & prestige and protection

4. Supporting community action on AIDS in developing countries The Alliance model: : International Secretariat 1 Knowledge & capacity building 2 Policy influence 3 Resource mobilisation 4 Credibility & prestige 5 Protection 37 linking organisations 7 TS Hubs Technical & financial assistance, & HIV prevention, care & support services 2,000 community based organisations HIV prevention, care & support services 2.9 million people reached (2010) Vision: a world in which people do not die of AIDS Mission: supporting community action to prevent HIV infection, meet the challenges of AIDS & build healthier communities

5. Supporting community action on AIDS in developing countries Nov 2010 mid 2010 VFM definitions Pilot SROI India/Zambia 2010-2012 Costing studies West Africa

6. Supporting community action on AIDS in developing countries Nov 2011 Jul 2011 External engagement SROI Cambodia 2012 Costing community mobilisation

7. Supporting community action on AIDS in developing countries local community responsibility Increasingly direct and non direct services provided by community, either as family members, volunteers, PEER/ community group leaders International and National level influence Donors, implementing governments, and NGOs slowly recognising importance of paying and extending social protection Increasing discussion about the potential benefits of large scale community healthcare worker programmes Community mobilisation achieves scale Evidence shows HIV related community services play a significant role helping to scale up antiretroviral (ARV) treatment and TB therapy, MNCH, SRH as well as linking patients to prevention care and testing Community mobilisation and growing trends

8. Supporting community action on AIDS in developing countries Important words of caution concerning community mobilisation and the drive for VFM Critical to avoid cost savings for donors being achieved at the expense of increased costs for communities. Community mobilisation should not equate to a reduction in state or donor responsibility, Governments, donors, and international institutions should include costs and strategies for the remuneration of community members in budgets, programme plans, and technical guidance related to their role It is vitally important that we understand VFM from a community perspective – in other words better understanding the meaning of whose value (and costs) count

9. Supporting community action on AIDS in developing countries Costing community mobilisation IHAA lead investigator UNAIDS funded study To generate more information about the methods to capture and understand cost data for CM within the HIV AIDS response – Little out there exists! Audience for study : IHAA network, national LOs and their CBO implementing partners, UNAIDS secretariat and COs

10. Supporting community action on AIDS in developing countries

11. What did we do? Used a common approach (UNAIDS costing toolkit on HIV/AIDS facility level services) adapted for community servicesUsed a common approach (UNAIDS costing toolkit on HIV/AIDS facility level services) adapted for community services Priced CM within PMTCT, prevention with key populations, Behaviour changePriced CM within PMTCT, prevention with key populations, Behaviour change Defined service chain for each area and unit cost /person reachedDefined service chain for each area and unit cost /person reached

12. Supporting community action on AIDS in developing countries Organisational cost Direct and indirect program cost of community mobilisation Cost at national NGO level Cost of CBO Cost of implementing network Community cost Cost to the community (community health worker, PEER educator, familiy member, village leader etc) in participating as volunteers, facilitators, beneficiaries Cost components measured

13. Supporting community action on AIDS in developing countries Community cost results Result costedProgramme description Cost per person reached Organisational Cost per person reached Community PMTCT in ZambiaCommunity awareness Drama Per educator training Safe motherhood groups IEC Breastfeeding campaign $21$3.29

14. Supporting community action on AIDS in developing countries Community cost results Result costedProgramme description Cost per person reached Organisational Cost per person reached Community Prevention HIV among sex workers in Cambodia Referrals and services Clients and sweethearts programs Drop-in centres Self-help and support groups BCC $170$7.34

15. Supporting community action on AIDS in developing countries Community cost data Result costedProgramme description Cost per person reached Organisational Cost per person reached Community Positive prevention Kenya Health worker training (youth friendly) Prevention messaging BCC HIV free generation Treatment literacy $64$4.3

16. Supporting community action on AIDS in developing countries Top line results of the study The development of a comparatively low cost methodology for costing community mobilisation that civil society organizations and planners are able to test and apply in other settings A structure for pricing community mobilisation as it relates to three specific types of HIV programme activities. These included prevention to mother to child transmission (PMTCT); focused prevention with key populations; and behavior change communication (BCC). Pricing (unit costs per person reached + sample activity costs) of community mobilisation for PMTCT in Zambia, focus prevention activities with key populations in Cambodia, and BCC in Kenya.

17. Supporting community action on AIDS in developing countries What’s next? Focus efforts on building capacity for this work in partner organisations Capturing examples of countries that will integrate costing/cost benefit work into their systems for year on year cost efficiency Working with countries to maximise the use of this work i.e. KHANA VFM policy brief, Thogomelo SA. SROI research and advocacy

18. Supporting community action on AIDS in developing countries THANK YOU!