The Multisectoral Approach, Investment Thinking and National AIDS Response Coordination

1. The MultisectoralApproach, Investment Thinking and National AIDS Response Coordination Mesfin Getahun & Benjamin Ofosu-Koranteng November 2013 Addis ababa United Nations Development Programme

2. Background • Rationale for the multisectoral approach • Need for innovative ‘solutions’ beyond the confines of the health sector • Impact of the epidemic on national development • Main aspects of the multisectoral approach • Unprecedented mobilisation of public, private and CS sectors • Inclusion of the HIV and AIDS response in development planning and implementation processes including national development plans

3. Impact of the multi sectoral approach • The multi sectoralapproach promoted: • Political will and leadership at all levels • Gender sensitive and human rights based approaches • Establishment of partnerships across sectors • Participatory approach and community mobilisation • Institutional capacity development • Resource mobilization • The establishment of M&E and accountability systems • Decentralised structures and ensured decentralisation of services

4. Challenges of the multisectoral approach • Major limitations of the multi sectoral approach: • Lack of focus – engaging all sectors at all levels • Limited capacity building interventions for HIV and AIDS mainstreaming • Varied levels of commitment across sectors • Dependence on external funding • Limited cross sectoral accountability • Within the public sector • Between the public sector and CS and private sectors

5. From multisectoral approach to investment thinking • What is the investment thinking and what is different about it: • Focus on basic programme activities proven to result in averting maximum number of infections averted and lives saved • Identify critical enablers and synergies that improve quality, efficiency and effectiveness of basic programme activities • Promotes country ownership and shared responsibility • Simplifies the country strategy to get better focus – population groups, geographic areas, etc • Systematically prioritizes interventions based on country epidemiology and context • Reduces parallel interventions that spread resources thinly across sectors

6. Conventional multi sectroal approach

7. Investment thinking

8. The Investment Framework CRITICAL ENABLERS BASIC PROGRAMME ACTIVITIES Keypopulations Children & mothers OBJECTIVES • Social enablers • Political commitment & advocacy • Laws, policies & practices • Community mobilization • Stigma reduction • Mass media • Local responses, to change risk environment Stopping new infections Behaviour change Condoms • Programme enablers • Community-centered design & delivery • Programme communication • Management & incentives • Production & distribution • Research & innovation Care & treatment Male circumcision Keeping people alive SYNERGIES WITH DEVELOPMENT SECTORS Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employer practices.

9. Enablers and synergies as key aspects of the investment thinking

10. Why invest on enablers and synergies • Continued investment on enablers and synergies ensures: • Efficacy, equity efficiency, reach and scale up of basic programme activities • Financial and programmatic sustainability of the response through integration into broader health and non-health sectors • Non health sectors continue to implement programs that directly reduce risk to HIV • Protection and promotion of human rights and human rights principles: participation, accountability, inclusion, non-discrimination and informed consent; • AIDS response contributes to other development and health outcomes across the MDGs

11. Implications of the investment thinking for national coordination • Successful application of the investment thinking requires strong multisectoral coordination in order to ensure: • Strong ownership and leadership for enablers by different institutions/sectors (e.g. parliaments, justice and interior ministries, local governments) • Continued investment on enablers and synergies in the context of increased domestic financing • Strong technical guidance on national strategies and global principles • Prioritization of relevant sectors based on specific contexts (e.g. concentrated vs generalised epidemic)