1. Partnerships for Health Reform Public Sector Contracting of NGOs to Deliver HIV/AIDS Services: Case Studies from Brazil and Guatemala XIII International AIDS Conference Durban, South Africa July 2000 Catherine Connor &Courtney Barnett

2. Partnerships for Health Reform These case studies were prepared by the PHR Project at the request of the HIV/AIDS Division of the United States Agency for International Development

3. Why contract NGOs for HIV/AIDS? Reach certain target groups (sex workers, men who have sex with men, intravenous drug users) Reach certain target groups (sex workers, men who have sex with men, intravenous drug users) Tap their commitment and creativity Tap their commitment and creativity Deliver services that the public sector is not able or willing to deliver Deliver services that the public sector is not able or willing to deliver Deliver services more efficiently than the public sector Deliver services more efficiently than the public sector

4. Who can contract NGOs? Ministries of Health Ministries of Health Regional, State, Municipal Health Authorities Regional, State, Municipal Health Authorities International Donors International Donors International NGOs (mentor NGOs) International NGOs (mentor NGOs) Donor-funded projects Donor-funded projects

5. Funding Entity Donor, Government, MOH Managing Entity MOH, Donor, Mentor NGO, Commitee Implementing Entity NGOS Who Does What?

6. NGO Contracting Process Design/revise contracting objectives and procedures Selection and Award of Contracts Implementation of Contracts by NGOs Monitoring and Evaluation of NGO contracts and activities Solicit NGO proposals

7. Designing a NGO Contracting Program Sample of issues The role and objectives of NGO contracting within the larger national HIV/AIDS program? The role and objectives of NGO contracting within the larger national HIV/AIDS program? Coordinating donors, govt agencies, others - who should do what? Coordinating donors, govt agencies, others - who should do what? Institutional capacity: what are the gaps? What assistance to provide? By whom? Institutional capacity: what are the gaps? What assistance to provide? By whom? Selecting NGOs: criteria? competitive or sole source? Selecting NGOs: criteria? competitive or sole source? Payment terms: performance-based? Grant? Reimbursement? Payment terms: performance-based? Grant? Reimbursement? Monitoring: site visits? NGO reports? Who does it? How often? Monitoring: site visits? NGO reports? Who does it? How often?

8. Brazil and Guatemala Experiences Highlights Brazil and Guatemala Experiences Highlights Brazil Part of National AIDS strategy Part of National AIDS strategy Supported by 2 World Bank loans Supported by 2 World Bank loans $25 million for 794 contracts to 240 NGOs (1994- June 1999) $25 million for 794 contracts to 240 NGOs (1994- June 1999) NGO contracts for prevention, treatment, training, legal aid NGO contracts for prevention, treatment, training, legal aid Contracting managed by Unit in the MOH Contracting managed by Unit in the MOH Contracting an integral part of the National AIDS Strategy Contracting an integral part of the National AIDS Strategy Funding for contracting comes from multiple international agencies Funding for contracting comes from multiple international agencies Contracting strategies developed by a coordinating body of stakeholders (UN Expanded Theme Group) Contracting strategies developed by a coordinating body of stakeholders (UN Expanded Theme Group) Guatemala

9. Brazil and Guatemala Experiences Institutional Arrangements MOH World Bank Contracted NGOs Donors that are members of the Expanded Theme Group Overseen by National AIDS Program Contracted NGOs $ $ Brazil Guatemala $

10. Brazil and Guatemala Experiences Features of contracting process Brazil Performance-based contracting Performance-based contracting Selection process transparent,open and highly competitive Selection process transparent,open and highly competitive Contracts awarded based on NGO capacity, epidemiological needs and planned activity Contracts awarded based on NGO capacity, epidemiological needs and planned activity Strict procedures for NGOs to spend and account for funds Strict procedures for NGOs to spend and account for funds Performance-based contracting Performance-based contracting Selection process transparent and open Selection process transparent and open Contracts awarded based on NGO capacity, epidemiological needs, planned activity and previous work with HIV Contracts awarded based on NGO capacity, epidemiological needs, planned activity and previous work with HIV Strict procedures for NGO to spend and account for funds Strict procedures for NGO to spend and account for funds Guatemala

11. Brazil and Guatemala Experiences Monitoring Brazil NGOs workplan = performance criteria NGOs workplan = performance criteria NGOs submit technical/financial reports quarterly NGOs submit technical/financial reports quarterly site visits by MOH staff that were a mixture of oversight and TA site visits by MOH staff that were a mixture of oversight and TA NGOs wanted more frequent site visits NGOs wanted more frequent site visits Monitoring plans included in the NGO workplan Monitoring plans included in the NGO workplan Limited resources for monitoring Limited resources for monitoring Included site visits and financial reporting Included site visits and financial reporting Guatemala

12. Lessons Learned Make NGO contracting part of a larger national strategy Why? Why? Reduces duplication of services Reduces duplication of services Promotes a broader approach to service delivery Promotes a broader approach to service delivery Encourages stakeholders to move toward common objectives Encourages stakeholders to move toward common objectives How? How? Create coordinating structures (I.e. UN Expanded Theme Group) Create coordinating structures (I.e. UN Expanded Theme Group) Include NGO and services provided in the National Strategic Plan Include NGO and services provided in the National Strategic Plan

13. Lessons Learned Involve NGOs in the design and implementation of contracting Why? Why? to design a contracting process that is feasible/workable to design a contracting process that is feasible/workable to foster trust and transparency to foster trust and transparency How? How? NGO representatives participate in working groups and sit on advisory committee NGO representatives participate in working groups and sit on advisory committee planning workshops with NGO participation planning workshops with NGO participation recruit staff from the NGO sector to work on contract management recruit staff from the NGO sector to work on contract management

14. Lessons Learned Maximize transparency in the contracting process Why? Why? Foster trust and cooperation among all parties Foster trust and cooperation among all parties How? How? Wide dissemination of contracting rules and procedures Wide dissemination of contracting rules and procedures Use multiple means to communicate: website, mass mailings, meetings, site visits Use multiple means to communicate: website, mass mailings, meetings, site visits Disseminate results of selection process, status of projects, major changes in program plans, epidemiological data Disseminate results of selection process, status of projects, major changes in program plans, epidemiological data Sponsor meetings among NGOs to share experiences Sponsor meetings among NGOs to share experiences

15. Lessons Learned Provide TA to the NGOs and the entity managing the contracting process Why? Why? Address gaps in capacity among NGOs and the entity tasked with managing the contracting process Address gaps in capacity among NGOs and the entity tasked with managing the contracting process How? How? Managing entity: funding and fielding of contracting expert to assist with start-up and staff training, introduce/adapt procedures and tools, training Managing entity: funding and fielding of contracting expert to assist with start-up and staff training, introduce/adapt procedures and tools, training NGOs: may need capacity building in both technical and managerial areas; TA through site visits, conferences, training workshops, consultants NGOs: may need capacity building in both technical and managerial areas; TA through site visits, conferences, training workshops, consultants

16. Lessons Learned Dont skimp on monitoring Why? Why? Data on performance is critical to funding entities and future funding Data on performance is critical to funding entities and future funding NGOs are accountable for funds received NGOs are accountable for funds received Only way to improve the contracting process Only way to improve the contracting process How? How? Establish measurable performance criteria Establish measurable performance criteria Establish reporting system that balances NGO capacity with data needs of the funding and managing entities Establish reporting system that balances NGO capacity with data needs of the funding and managing entities Fund staff to make site visits Fund staff to make site visits Develop system to analyze and disseminate data collected Develop system to analyze and disseminate data collected Disseminate results to all parties in the spirit of learning Disseminate results to all parties in the spirit of learning

17. Institutional Arrangements Who does what? 3 Major Roles Funding Funding Managing the contracting process Managing the contracting process Implementing the contracts Implementing the contracts Alternatives donor, government, mentor NGO donor, MOH, mentor NGO, committee NGOs

18. For more information Or for copies of the reports on NGO Contracting for HIV/AIDS in Brazil and Guatemala Please contact: Catherine Connor catherine_connor@abtassoc.com or Courtney Barnett courtney_barnett@abtassoc.com At the Partnerships For Health Reform Project