Efficiency & Effectiveness
(E 2 ) in the HIV/AIDS
Response
Involving Implementers in Kenya
April 20, 2012
Health Policy Project
Outline
 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
Current Financing of HIV/AIDS in Kenya
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
Role of Implementers in Managing
HIV/AIDS
Funds
Figure 4.2: Financing Agents for HIV/AIDS Funds
Role of Implementers
• 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
5
Why is E 2 right for Kenya?
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!
The Health Policy Project and E 2
1. USAID OHA funds activities through the Health
Policy Project (HPP) in 2011
2. 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
Areas Open to Investigation
 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…
Selecting Focus Areas
 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
Examples: Research Questions from
Prioritized 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.?
HIV Testing and
Counseling
Example
HTC: Increasing coverage
K N ASP 3 P illar: 1
Organ i z at i on: N A SCOP
Context: The KNASP 3 target is 80% knowledge of status by the year 2013.
The current coverage is 58% for women and 42% for men, implying a
significant gap.
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
Areas of analysis…
 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?
Future Collaboration
and Strategic Planning
How can HPP and the E 2 team
support further analysis?
 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
Thank you!