Joint Assessments of Moldova National Strategic Plan for HIV

1. Joint Assessments of Moldova National Strategic Plan for HIV Overview: Peter Godwin, Team Leader Chisinau, 27 June

2. Joint Assessment – what is it? Joint assessment A process whereby country stakeholders and international partners come together… … to carry out an independent assessment of a national strategy and its accompanying documentation… … that is seen as valuable and is accepted by multiple stakeholders (including within the country) Purpose of joint assessment To provide country with constructive feedback on the national strategy that could be used to further strengthen it To inform decisions on funding or technical support by the government and international agencies

3. Joint Assessment – why? Developmental feedback Government: budget allocations to disease program National disease strategy documentation* from countries ‘Jointly assessed’ national disease strategy documentation International agencies: financial and/or technical support * National disease strategy documentation = national disease strategy + complementary documents (e.g., operational plan, M&E framework)

4. Joint Assessment – benefits? • Focus on development, financing and implementation of robust national strategies aimed at improving health outcomes and • supports Paris aid effectiveness principles and Accra Agenda for Action • Specific anticipated benefits: • Improved quality and credibility of national strategic frameworks • Renewed focus on national strategies as a basis for alignment and harmonization • Improved harmonization among funders that have agreed to use the same approach to assess the soundness of national strategies • Opportunity to improve strategy development/implementation process, including breadth of stakeholder involvement

5. Joint Assessment – Process Takes place in country, over an 8-12 calendar day period Conducted by an independent, multi-disciplinary joint assessment team of national and international experts(selected by country stakeholders and international partners), with the support of national facilitators Based on the set of attributes for sound national strategies contained in the Joint Assessment of National Strategies (JANS) Tool

6. Organized by a multi-stakeholder, country-based Joint Assessment Organizing Body • Involves the joint assessment team conducting documentation review, discussions with key stakeholders,andsome site visits • Output of the assessment: • Debriefing to present and discuss findings with country stakeholders • A report highlighting the identified strengths and weaknesses of the country’s national disease strategy documentation

7. What a joint assessment is (and isn’t)

8. Joint Assessment team – who? legend external • National facilitators • local (or from locally-based international agencies) • can be non-independent • can participate in assessment to observe or provide information, but not contribute to deliberations or report • Joint assessment team • members must all be independent • members can be either external or local • team leader however must be external • assessment team members conduct assessment and contribute to and sign off on final assessment report local Team leader Other experts (to cover all attributes) S t a k e h o l d e r s i n t e r v i e w e d b y j o i n t a s s e s s m e n t t e a m National disease authority e.g., from government, civil society, private sector, technical partner and donor agencies

9. Roles and responsibilities Joint Assessment Organizing Body* • Works with team leader to prepare and organize joint assessment; • Coordinates and facilitates the involvement of relevant country stakeholders throughout the process, including their involvement in discussing / commenting on joint assessment findings Provide feedback on joint assessment process as part of effort to capture “lessons learned” Assessment team • Conducts assessment of national strategy using the JANS Tool, via document review, stakeholder interviews and some site visits; • Debriefs stakeholders; • Develops assessment report National facilitators • Participate in joint assessment alongside assessment team to provide context, clarifications, and other relevant information; • However, do not contribute to writing the joint assessment report; • Their participation in some interviews may not be appropriate Other in-country stakeholders • Provide information as potential interviewees and/or comment on draft joint assessment report (with a focus on factual accuracy); • Use joint assessment report to inform internal decision making on financial and technical support as appropriate Joint Assessment Support Group** • Supports the preparations of joint assessments, offers guidance, facilitates country-level support, and examines lessons learned to inform future design of joint assessments; • Representative(s) to accompany joint assessments to provide support as needed and gather lessons

10. JANS Tool The Joint Assessment of National Strategies (JANS) Tool and the “Information Note on the Use of the JANS Tool to Assess National Disease Strategies” are used as the basis of the assessment.

11. Joint assessment team

12. Assessment team expertise • The joint assessment team possesses expert knowledge of international best practice and standards in: • disease control; • national strategy formulation and implementation; • relevant health system considerations; • budgeting and financial management systems; • procurement; • monitoring and evaluation; and • multi‐stakeholder involvement.

13. Assessment team for Moldova Peter Godwin: Team Leader, Strategic Planning, MSI Alexander Turdzeladze: Finance and audit Boris Sergeyev: HIV disease expert Roger Drew: M&E, MSI Ulrich Laukamm-Josten: Programme management Mihai Ciocanu: Procurement and supply management GF observer: Cindy Carlson UNAIDS observer: Anja Nitzsche-Bell

14. Independence and conflict of interest The joint assessment team leader lives outside the country and has no ongoing or previous engagements with the country that could create the perception that he/she cannot fulfill his/her role as team leader in an independent and impartial manner.

15. Independence and conflict of interest All joint assessment team members must be independent and impartial: each team member must have had no material involvement in the development of the national strategy; and each team member and his/her employer must not be a potential financial beneficiary of a funding decision that is based on the jointly assessed strategy.

16. A few experts proposed and paid for by some of the donors participating inthe joint assessment may be included in the joint assessment team.

17. National facilitators

18. National facilitators: responsibilities • National facilitators selected by the JAOB, with inputs from the team leader, to participate alongside the joint assessment team in interviews, fact-finding activities and assessment team discussions (as requested). They will provide context, clarifications, and other relevant information • Can take part in team discussions about findings and provide further context as needed • Will not contribute to writing the joint assessment report, but will be able to comment on draft versions of the report along with other country stakeholders.

19. JANS Tool

20. JANS Tool: Background Developed by multi-partner working group, under International Health Partnership (IHP+), 2008-2009 Defined a set of principles to underpin joint assessment Developed for different types of national strategy (health sector or sub-sector/disease) Piloted by IHP+ for various health sector joint assessments; – 5 countries in 2010/11 Piloted in Global Fund NSA First Learning Wave (for disease strategies

21. JANS Tool: Structure Based on the attributes of a sound strategy; 5 categories of attributes The situation analysis, and coherence of strategies and plans with this analysis ('programming’) The process through which national plans and strategies have been developed Financing and auditing arrangements Implementation and management arrangements Results, monitoring, review mechanisms Attributes: describe ideal elements contained in a sound national strategy Characteristics: describe further the ideal elements in the attributes

22. JANS Tool: Guidelines on use Tool provides overall framework for joint assessment Not a ‘yes/no’ approach Attributes may be most useful level of reference; can serve as guide to joint assessment agenda setting and team composition Joint assessment report sets out strengths and weaknesses according to each attribute « National strategy/plan » in Tool refers to a portfolio of documents (national strategy document plus operational plan, M&E plan, budget, etc.) Guidance document entitled “Information Note on the Use of the JANS Tool to Assess National Disease Strategies” references technical documents for HIV/AIDS, tuberculosis, and malaria, that are recommended for use alongside the JANS Tool for certain attributes More detailed information and interpretation of the JANS Tool is provided in the “Joint assessment guidelines” document on the IHP+ website

23. JANS Tool: Five categories of attributes

24. 1. SITUATIONAL ANALYSIS & PROGRAMMING - ATTRIBUTES National strategy is based on a sound situational and response analysis of the context (including political, social, cultural, gender, epidemiological, legal, and institutional determinants). Clearly‐defined priority areas, goals, objectives, interventions, and expected outcomes/products that contribute to improving health outcomes and meeting national and global commitments (such as the Millennium Development Goals and WHA resolution on PHC) Planned interventions are feasible, locally appropriate, equitable and based on evidence andgood practice, including consideration of cost effectiveness and sustainability (both financial and programmatic) Bothassessment of risks (analyzing feasibility of and potential obstacles to implementation) and proposed mitigation strategies (including specifying technical assistance needs) are present and credible.

25. 2. PROCESS - ATTRIBUTES Multi-stakeholder (including government) involvement in development of national strategy and operational plans (led by government, with a transparent participative process) and multi‐stakeholder final endorsement of national strategy. High level of political commitment (at the highest level) to national strategy National strategy consistent with relevant higher- and/or lower-level strategies,financing frameworksandunderlying operational plans

26. 3. FINANCE & AUDITING - ATTRIBUTES Expenditure framework with comprehensive budget/costing of the program areas covered by the national strategy. Expenditure framework includes financial gap analysis – including a specification of known financial pledges against the budget from key domestic and international funding sources (specification of sources of domestic funds desirable). Description of financial management system (including financial reporting against budgeted costs, and accounting policies and processes) and evidence that it is adequate, accountable, and transparent Description of audit procedures and evidence of appropriate scope of audit work, as well as independence and capacity of auditors In the context of national development policies (where applicable): Explanation of how external resources will be channeled, managed and reported on.

27. 4. IMPLEMENTATION & MANAGEMENT - ATTRIBUTES • Operational plans are regularly developed through a participatory process and detail how strategic plan objectives will be achieved. • Description of how resources will be deployedto achieve clearly defined outcomes (with attention to staffing, procurement, logistics and distribution. Plan describes transfer of resources [human, commodities] to sub‐national level and non‐state actors). • Procurement policy that complies with international guidelines and evidence of adequate, accountable, and transparent procurement and supply management systems with capacity to reach target populations. • Specification of governance, management and coordination mechanisms/framework for implementation (describing roles, responsibilities and decision-making of all stakeholders)

28. 5. RESULTS, MONITORING & REVIEW - ATTRIBUTES • Plan for monitoring and evaluation that includes clearly-described output and outcome/impact indicators, with related multi-year targets that can be used to measure progress and make performance based decisions. • Plan for monitoring and evaluation includes sources of information for indicators and description of information flows. • Plan for monitoring and evaluation that includes descriptions of data collection/data management methods, tools and analytical processes (including quality assurance). • There is a plan for joint periodic performance reviews (reporting of results against specified objectives and respective targets explaining any deviations) andprocesses for the development of related corrective measures. • Monitoring and evaluation plan describes processes by which monitoring results can influence decision making (including financial disbursement).

29. Agenda: 27 June – 8 July Agenda for the joint assessment developed by JAOB in consultation with the team leader. The joint assessment agenda includes the opportunity for the joint assessment team to interview relevant stakeholders, including civil society and private sector organizations, and visit facilities to obtain and verify further information as needed.