Changing the World through
Local-to-Global Advocacy
Scaling and Assessing Impact from the
Campaign to End Pediatric HIV/AIDS (CEPA)
by Dr. Paul S. Zeitz, Executive Director
& Professor Sanjeev Khagram, iScale
Advocacy Breakfast Series
Aspen Institute
Washington, D.C.
15 January 2011
“Waging Justice”– A Performance-based Advocacy Approach
Agenda Setting
Conception
Target
Accountability
Accountability
Advocacy
NOTE: GPAN’s advocacy approach was developed utilizing the Annie E. Casey Foundation’s “Guide to Measuring Advocacy and Policy,”
conversations with interviewees, and analysis by Dalberg Global Development Advisors.
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Overview of the “Waging Justice” Advocacy Approach
Agenda Setting
1. Develop clearly defined, campaign-specific Theory of Change and Theories of Action to achieve
strategic political advocacy outcomes that align with GPAN’s overall Theory of Change.
Conception
2. Utilize criteria for prioritizing among network models and targeted advocacy outcomes in order
to successfully advance GPAN’s priority initiatives or campaigns.
3. Develop a clear approach to achieving impact based on experience, environmental mapping,
and an understanding of key gaps in the advocacy landscape.
Mobilize
Public
Advocacy
4. Utilize a networked advocacy approach to pressure decision-makers, mobilize constituencies,
and build partnerships.
5. Create or support campaign networks to design and implement advocacy action plans that
prioritize specific outcomes and reflect the needs and priorities of affected communities.
6. Engage in strategic political communications that speak truth to power, help frame the advocacy
debate, and ensure rapid response to emerging advocacy opportunities.
Target
Accountability
Accountability
7. Support watchdog mechanisms and networks to hold political leaders and other stakeholders
accountable for their commitments.
8. Conduct performance-based advocacy through robust systems that facilitate monitoring,
evaluation, and continuous learning, e.g., Impact Planning, Assessment, Reporting and Learning
(IPARL) system.
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Strategic Focus on Five Priority Advocacy
Outcomes
ADVOCACY OUTCOMES
Paradigm-busting POLICIES
Secure evidence-based policies that achieve ground-breaking progress,
rather than small-scale incremental change
Increased and improved needs-based FUNDING
“Waging
Justice”
Performance
based
Approach
Mobilize significant, sufficient, and sustained funding from diverse sources, e.g., public
and private, and ensure efficient disbursement and implementation mechanisms
ACCOUNTABILITY for people-level impacts
Strengthen and create watchdog and enforcement mechanisms to ensure improved
implementation of global, regional, and national commitments
InterConnected
Strategic
Objectives
CIVIL SOCIETY inclusion in decision-making and implementation
Increase civil-society participation and engagement with global, regional, and national
institutions, and ensure local ownership of program design and implementation
New and transformed INSTITUTIONS
Strengthen the performance and impact of existing institutions through policy,
procedural, and governance reforms, and create new institutions as needed
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Campaign to End Pediatric HIV/AIDS (CEPA) GOALS:
Going to Scale with PPTCT+ and Pediatric Treatment
80% coverage for
pediatric HIV/AIDS
treatment
and
80% coverage for PPTCT+
services
by December 31, 2015
• Current CIFF Support: May 2009 –April 2012
• GPAN/GAA Committed to CEPA(+), 2011-2015
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CEPA Local-to-Global Partners
Initiating Countries
Kenya, Mozambique, Zambia, Nigeria, Tanzania,
Uganda: indigenous civil-society networks
Sub-Saharan Africa Region
ANECCA, PATAM, HAI Stock Outs Campaign, Health
GAP, OSISA, Graça Machel Trust
Global Partners
GAA, Health GAP
Evaluation & Learning Partner: iScale
Funding Partners: Children’s Investment Fund
Foundation (CIFF), UNICEF, others
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CEPA IPARL COMPONENTS
Link IE and M&E activities with Strategy
•
Clearly articulated CEPA-wide Theory of Change
•
Clearly articulated global and national, regional, and
global level “Theories of Action” for CEPA partners
•
An integrated assessment framework aligned with
global, regional and national level strategies – includes:
baseline data, score card of indicators, evidence of
change journals, and periodic assessments (review and
evaluation)
6
CEPA IPARL COMPONENTS
Link IE and M&E activities with Strategy
• Learning and improvement activities
• Constituency voice and feedback
• Public and donor reporting
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CEPA’s Advocacy Objectives
Objective 1:
Comprehensive
Family Centered
Care and Nutrition
Objective 7:
Overcoming
Stigma and
Discrimination
Objective 2:
Early Infant
Diagnosis and
Treatment
End 2015 Goal: 80%
Coverage for
Comprehensive
PPTCT+ and
Pediatric HIV/AIDS
Treatment
Objective 6:
Overcoming
Human
Resources Crisis
Objective 3:
Access to
Appropriate
Medicines and
Commodities
Objective 4:
Full Funding
Objective 5:
Reprogramming
to Achieve CEPA
Impact
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Theories of Action that Include Evidence/KPIs
to Monitor Progress Towards
Advocacy Outcomes and Advocacy Outputs
Advocacy Output
Advocacy Outcome
Bottleneck
Report on national
stigma index is
published
National policy strengthened to prevent
discrimination against HIV positive mothers and
children.
Stigma
Evidence/KPIs: Stigma
Report
Evidence/KPIs: Punishments for discrimination in
National policy are made more severe
Advocacy Output
Advocacy Outcome
Bottleneck
National Training
curricula is drafted by
relevant actors
An accredited set of National Training curricula for
task shifting is established.
Lack of coordinated
care
Evidence/KPIs: Draft
of Training Curricula
Evidence/KPIs: National Training curricula
document
Advocacy Output
Advocacy Outcome
Bottleneck
Pediatric care policy
guidelines drafted by
Ministry of Health
Comprehensive and harmonized pediatric care
policies, guidelines, and standard operating
procedures are adopted by National Government,
donors, and providers.
Limited number and
capacity of trained
health care
professionals
Evidence/KPIs: Draft
of Pediatric care policy
guidelines
Evidence/KPIs:
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“Robot” Traffic Light System
Color Code for Monitoring Progress
Outcome/Output STATUS
Achievement of outcome/output
Progress towards outcome/output
Some progress towards outcome/output, but significant challenges exist
No progress to date (or) no achievement of outcome/output
Insufficient data for status assessment*
This describes the status of outcomes irrespective of CEPA contribution
CEPA CONTRIBUTION Towards Outcomes/Outputs
Significant CEPA contribution
Some CEPA contribution
No CEPA contribution
Insufficient data, un-validated data, or contested data which makes
contribution assessment difficult
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MoH adopts Opt A of new WHO
Guidelines by Aug 2010
5 training wksps by CEPA partners on
Ped HIV/AIDS and PPTCT for Com/tradit
religious lead, healers, activists
CEPA identify/participate in 5 thematic
wk groups open for CS participation by
Jun 2010
By end of 2010 MoH implements more effective PPTCT
interventions, based on phased implementation of the
new WHO PPTCT Guidelines
Com/tradit religious lead, healers, activists are trained
about PPTCT and Ped HIV/AIDs treatment by end of
2010, by CEPA partners and endorsed by MoH
CS engaged by MoH and Development partners in 12
meetings of thematic wk groups
Core Objective 1: Family centred care and nutrition
Priority 1.1 Rapid adaptation and implementation of new
WHO guidelines on ART, PPTCT+ and infant feeding by 2011
Core Objective 2: Early infant diagnosis and treatment
(EID+T)
Priority 2.1 Development and implementation of EID+T
guidelines to increase testing of children within two months
of birth by 2011
Core Objective 3: Access to appropriate medicines
Training plans and guidelines to
authorize non-physician clinicians on
PPTCT clinical manage include provis of
HAART and to provide ART
By Dec 2010 MoH implements task shifting to allow
non-physician clinicians to prescribe Ped ART and PPTCT
MoH approv new strat plan for pharm
logistics by Jun 2010
Within the next 12 months, supply chain management
systems decentralized and better coordinated by MoH
Priority 3.1 Effective policy and monitoring mechanisms in
place to reduce point of care stock-outs of ART for adults
and children, OI drugs, EDI and family planning commodities
by 2012
Core Objective 4: Full funding
Priority 4.1 Increased national budget for PPTCT+ Ped treat,
and services by 2012
Priority 4.3 Achieve the Abuja declaration commitment by
2012
Gov+Multi-lat/Bi-lat donors commit to
increase funding for Ped HIV /AIDs and
PPTCT
15% of the 2011 annual national budget (internal
resources) is allocated to health sector (Abuja
Declaration) (and within this 15%, adequate resources
to MCH including PPTCT, and paediatric ART
Cross-Cutting Objective 5: Reprogramming to Achieve CEPA
Impact
Priority 5.1 Political commitments and nat
plans/frameworks adopt CEPA goals and priorities by 2012
No Output identified in NAAP
80% targets for supplying PPTCT+ and paediatric
treatment services to be achieved by Dec. 31, 2012 set
by government
Cross-Cutting Objective 6: Overcoming Human Resource
Crisis
Priority 6.1 Effective policies and guidelines to expand and
improve HR capacity to support scale up of PPTCT+ 11
and Ped
treat services by 2012
Advantages of CEPA’s IPARL
•
•
•
•
•
•
•
“Agenda-setting” effect of extensive advocacy action
planning
Aligned Campaign-wide theory of change, partner theories of
action and KPIs
Shift in focus from activities to measurable advocacy
outcomes and outputs
Real-time learning to inform strategy and course correction
Integration and triangulation of multiple types of evaluation
data
Enhances capacity in all partners, improving non-CEPA
related advocacy
Enhances a “global action network (GAN)” approach to
transnational advocacy
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Risks/Challenges of CEPA’s IPARL
•
•
•
•
•
•
Requires authentic ownership and trust amongst
partners
Low capacity of advocacy organizations to
implement reduces potential learning and course
correction benefits
Overcoming KPI-fatigue
Attribution of contribution remains elusive
Donor-driven monitoring and evaluation can shift
focus from strategic advocacy
Risk that funders will rigidly link performancebased advocacy to funding
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Lessons: Performance-based Advocacy (PBA)
•
Should be an integral part of the early stage
planning process, incorporating regular
monitoring reviews and periodic impact
evaluation
•
Requires a cultural shift among advocates
•
Requires intensive capacity building and robust
peer mentoring systems
•
Must be fit-for-purpose, with sustained financial
support by funding partners
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"True peace is not merely
the absence of tension:
it is the presence of
justice."
--Reverend Martin Luther King Jr.
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