Thanks for listening, PEPFAR, but could you come a little closer? Civil society members answer questions on HIV response planning

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Analysis finds gaps, opportunities, and appreciation as the President’s Emergency Plan for AIDS Relief opens door to local advocates, implementers, and affected populations

On paper, the U.S. President’s Emergency Plan for AIDS Relief guidance for country and regional planning in 2015 seemed to open a new era, as the document released last February instructed PEPFAR in-country leaders to follow at least four specific steps to include local activists and advocates when planning HIV responses. “Develop Civil Society [Country Operational Plan] Engagement Plan,” is Step 1, followed by “Convene Engagement Meetings” (at least two formal get-togethers), “Solicit Written Feedback From Civil Society,” and “Provide Written Feedback to civilsocietyengagementanalysisCivil Society.” The document also encouraged U.S. PEPFAR country teams to seek more input, provide more opportunities, including hosting or attending regular round-table discussions, recognizing the need some populations might have for a “safe space,” and seeking feedback on issues and insights that local participants have to offer outside of that year’s plan. Those participants should include, the guidance specified, groups “representing key affected populations, women, children, LGBT/gender and sexual minority, drug user networks and sex worker organizations; groups representing populations highly affected by the epidemic, such as persons with disabilities . . .”

Months into the process, the four formal steps created an opportunity that civil society members appreciated and were eager to participate in, but that was limited by gaps in efforts on the part of in-country PEPFAR staff to ensure full engagement with local groups, a recently released report shows.

The report, PEPFAR 2015 COP Civil Society Engagement Analysis, produced by the Health Policy Project, is the result of surveys administered to civil society representatives in 29 countries as well as follow up interviews. The answers, collected in July and August, indicate that participants welcomed the chance to strengthen local HIV program planning with their input, but frequently met frustrations in doing so. Those included not receiving information they needed to participate — including budgets, targets and disease burden data — in a timely fashion, or in some cases, at all. Many civil society members familiar with challenges in remote and rural areas did not have, and were not supplied with resources to attend meetings that were held mostly, if not exclusively in capital cities. In this first year of an inclusive planning process, many didn’t know enough about how PEPFAR operates, including with whom it works, to provide input for planning.

The results indicate a need for PEPFAR country teams to learn more about the diversity and circumstances of local organizations, said Ronald MacInnis of Health Policy Project. “We’re still at step 1,” he added.  So far, he said, country teams have not dedicated resources — staff or money — to seek and facilitate civil society engagement.  PEPFAR could benefit greatly from the contributions local civil society organizations could make to program design and monitoring, he added, “Why does community engagement have to be limited to [Country Operational Plans]?”

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