Transitioning National HIV and AIDS Programs from Donors to Countries

  • By: Sara Wilhelmsen, Kathleen Alvarez, and Veronica Triana
  • Published Date: May 2017
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The Government of Vietnam has led a swift response to its concentrated HIV and AIDS epidemic, significantly reducing new HIV cases. However, as a result of Vietnam’s strengthened capacity to address the epidemic and its lower middle-income country status, donors have been gradually reducing their funding and transitioning their support for HIV and AIDS programs to national governments for a sustained country-led response.

This transition process required thoughtful planning, communication, and engagement to ensure a smooth transfer to government management, and planners have required tools and approaches that provide fast and comprehensive data for planning and decision-making.

In response, the USAID-funded Leadership, Management, and Governance-Transition Support Project (LMG-TSP) applied a systems thinking approach to systematically explore the complexities of the context and to learn how interventions should be designed by unpacking the health system and its needs.

The HIV and AIDS Provincial Planning Simulator (HAPPS) tool, developed by LMG-TSP, is an interactive modelling tool that planners can use to visualize the dynamic interaction between HIV and AIDS programs and the numbers of people with the disease.

The HAPPS tool uses system dynamics – a methodology and mathematical modeling technique to frame, understand, and discuss complex issues and problems – to simulate how different configurations of services might play out in terms of HIV and AIDS prevalence and future funding requirements for services.

Because users can simulate multiple scenarios and compare the different interactions of key variables, the HAPPS tool helps to promote increased stakeholder ownership and engagement.

The tool was developed in time for Hai Phong stakeholders to begin using it for their 2015 planning cycle in late 2014; however, LMG-TSP ended in December 2014, limiting the possibilities for further coaching and follow-up on the use of the tool.

Another challenge hindering scale up is the cost to adapt the tool to other country contexts. The estimated total cost of adaptation per country would be approximately $35,800. This cost includes adaptation of the tool to the new country context; modification of the software; a modeler to adapt, orient, identify data for, and coach users on the tool; and subscriptions for five active simulations and 100 authenticated users.

The limited extent to which the HAPPS tool was used beyond its pilot phase in Vietnam further complicates efforts to scale up, but even the limited pilot indicated the tool’s value in helping to produce better plans and better services for HIV-affected populations in Vietnam during the transition from donors to countries.

Adopting a systems thinking approach to develop the HAPPS tool in Vietnam demonstrated that it can play a meaningful role in the transition to sustained, country-led HIV and AIDS programs, and participatory model building leads to a more complete and responsive tool.

Similarly, using the tool fostered a dialogue about the variables in and effects of policy on HIV and AIDS outcomes. It illuminated challenges shared by different stakeholders involved in HIV and AIDS programs who were directly and indirectly affected by the shifts in funding. This work produced a practical and scalable tool for teams involved in planning for the transition of HIV and AIDS prevention, care, and treatment programs from donor funding to national funding.