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Evaluating HIV Policy Advocacy: The Local Capacity Initiative


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Presented by Mary Freyder, Tory M. Taylor, Apollo Nkwake, Thomas Miles, and Katherine Andrinopoulos at the 2016 AEA conference.

Published in: Health & Medicine
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Evaluating HIV Policy Advocacy: The Local Capacity Initiative

  1. 1. MEASURE Evaluation EvaluatingHIVPolicyAdvocacy: TheLocalCapacityInitiative Mary Freyder, Tory M. Taylor, Apollo Nkwake, Thomas Miles, Katherine Andrinopoulos Tulane University School of Public Health and Tropical Medicine MEASURE Evaluation American Evaluation Association October 27, 2016
  2. 2. LCI is innovative because it focuses on building the advocacy capacity of civil society organizations (CSOs). The premise is that fostering an enabling environment for CSOs, supporting their role as health advocates in their communities, and catalyzing their active engagement in local and national health systems will lead to improved delivery and uptake of quality HIV/AIDS services. About LCI
  3. 3. About LCI • Fourteen country/regional projects • Local CSO consortia with iNGO TA • Three-year projects staggered across 5 years (2015 to 2019) • PEPFAR 3.0 Human Rights Agenda • 7 CDC offices • 7 USAID missions
  4. 4. Where is LCI working?
  5. 5. What is LCI trying to do? Legal and policy structural barriers to a quality HIV response Stigma and discrimination directed at key populations Enabling policy, financing, and revenue environments for CSOs Transparency and accountability in national commitments/planned results
  6. 6. Project activities • CSO and citizen coalition building • Policy tracking and analysis • Community planning/advisory group meetings • Communicating with officials about policy priorities • Releasing research and reports • Mass media outreach
  7. 7. What makes LCI complex? • The projects generate feedback that affects their performance • Pathways to policy change are long, non-linear, and sensitive to context • Many factors have to be present in the right, hard-to-predict combination • LCI project characteristics and outcomes may both be emergent
  8. 8. LCI logic model (original)
  9. 9. LCI logic model (revised) CSOs contribute to the policy advocacy environment when: • Public officials use information and other policy advocacy resources provided by CSOs • The general public receives information about policy relevant issues from CSOs • The organization of constituencies, be it groups of CSOs or individuals about systems-level issues takes place with the help of CSOs. CSOs actively: • Build coalitions and partnerships • Communicate with officials • Track and analyze policy process • Support community planning/advisory group meetings • Release research and reports • Encourage community members to contact policy makers • Support mass media campaigns/advertising • Testifying during policy hearings • Write editorials or letters to the editor • Provide HIV services to priority populations • Protest and boycott HIV policy advocacy environment is changed by: • Increased accountability and transparency of government’s national commitments and planned results • Reduced legal and policy structural barriers to quality HIV response • Reduced stigma and discrimination for key populations • Enabling policy, financing, and revenue environment for civil society organizations Increased uptake of quality services by key populations and vulnerable groups Capacity Building for CSOs to: • Track, monitor, address barriers and advocate for policy development and implementation • Engage in each stage of HIV program development and implementation • Engage civil society networks/ coalitions • Engage citizens in recognizing, and advocating for quality services • Run a sustainable organization beyond life of USG funding Sphere of control Sphere of influence Sphere of interest Improved health for key populations and vulnerable groups Capacity building implemented Policy advocacy activities implemented Policy barriers reduced Impact
  10. 10. Evaluating LCI The evaluation’s purpose is to describe the mechanisms by which policy advocacy engagement supports uptake of quality HIV services by key populations and vulnerable groups, in order to foster learning across HIV policy advocacy capacity-building projects.
  11. 11. Design considerations • Multiple projects, many components • No standard classification of policy advocacy activities • Limited understanding of how built capacity leads to other changes • Intermediate outcomes poorly defined • Long causal chain, short evaluation period, limited resources
  12. 12. Evaluation approach • Complexity-aware • Enable triangulation • Tailor to context • Accommodate emergence • Participatory ethos • Foster learning across LCI projects • Balance depth with breadth • Address intermediate outcomes
  13. 13. Research elements • Systematically identify and define the intervention components • In-depth case series in one or more countries/regions (Uganda, others?) • Intensive qualitative inquiry, including Most Significant Change method • Surveys to yield descriptive statistics about projects and outcomes over time • Cross-sectional and longitudinal
  14. 14. Study design: Uganda Instrument development Translation Piloting Public official survey CSO network survey CSO worker survey In-depth interviews Focus groups Observations Public official survey CSO network survey CSO worker survey |-----------------2016--------------|----------------2017--------------|-------------2018------------| Final participatory analysis workshop In-depth interviews Focus groups Observations
  15. 15. Quantitative methods • Cross-sectional surveys of workers at LCI-affiliated CSOs • Network analysis completed by each CSO • Panel survey of public officials • Surveys examine work activities, task self-efficacy, policy priorities, perceived sociopolitical control…
  16. 16. Qualitative methods • In-depth interviews with project stakeholders • Focus groups with CSO staff and healthcare providers • Guided observations of Community Score Card processes at model HIV service facilities
  17. 17. MEASURE Evaluation MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) under terms of Cooperative Agreement AID-OAA-L-14-00004 and implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International, John Snow, Inc., Management Sciences for Health, Palladium, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.