Programme Stewardship and Planning

For the first time in decades, the response to the global HIV epidemic is poised to achieve lasting progress in HIV prevention for young women and adolescent girls. This is buoyed by three key trends:

1. a renewed HIV prevention platform — driven by breakthroughs in the development of novel prevention tools;
2. political will at the highest levels of global development for intersectoral programming — as articulated in the aspirations of the Sustainable Development Goals (SDGs);
3. an increase in investments for advancing gender equality acros all domains of health and well-being.

Across the most-affected regions, namely West and Central Africa and East and Southern Africa, national authorities are starting to see momentum in efforts to avert new HIV infections among young women and adolescent girls aged 15–24 years, the very demographic most central to the future sustainability of the entire HIV epidemic response. This progress is centred around the key epidemics of note, mainly in Southern Africa, which is encouraging. On a sobering note, although they were promising, recent documented declines in annual new HIV infections among young women and adolescent girls still fall far short of global commitments to reduce new HIV infections by over 75 per cent for the year 2020.

If recent history in the global HIV epidemic response is anything to go by, this opportunity will have a limited, if unknown, lifespan. Effective stewardship of both HIV-specific and broader health and development resources will be necessary to strengthen national systems and responses, with a clear eye towards a longer-term sustainable response once current funding levels recede. This will entail rational planning and decision-making, diligent resource management, savvy coordination of disparate actors and stakeholders across sectors, and disciplined use of data to drive programmatic decisions.

Strategic contracting to strengthen stewardship and coordination. Strategic contracting of civil society and academic partners has been utilized to address gaps in national authorities’ capacity, monitor and track prevention investments, align prevention partners and operate accountability structures for planning and management of resources. This approach has tremendous promise, particularly in contexts where the local epidemic is mixed, where broad expanses of territory or large networks of service providers must be coordinated, and where private sector service provision is a mainstay of the health and social system.

Co-financing across sectors. Joint investment across sectors allows for an intersectoral approach when taking a programme to scale and is more reflective of the realities within communities where various sectors, including education, health, development, poverty reduction and technology, naturally merge. Co- financing enables various HIV, health and development objectives to be achieved simultaneously, but demands effective cross-sectoral coordination mechanisms for planning, implementation and financing.10 Governments and funders or investors should consider co-financing across sectors within their budget allocations, as it represents a cost-effective measure. This option could also represent a new funding pathway for high-impact interventions to be implemented and even scaled up. South Africa and Tanzania have identified co- financing as an innovative modality for implementation of national strategic plans for HIV and social protection. South Africa has incorporated co-financing in its HIV and tuberculosis investment case and subsequently in its national strategic plan for HIV/tuberculosis and sexually transmitted infections (2017–2022).