District AIDS Coordinator Capacity Assessment Report April ... · PDF fileDistrict AIDS...

Republic of Botswana Ministry of Local Government

Department of Primary Health Care Services

District AIDS Coordinator Capacity Assessment Report

April 2012

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TABLE OF CONTENTS

ACRONYMS ...................................................................................................................................................... 3

EXECUTIVE SUMMARY ........................................................................................................................................ 4

BACKGROUND ................................................................................................................................................... 9

METHOD .......................................................................................................................................................... 9

FINDINGS ....................................................................................................................................................... 13

CONCLUSIONS AND RECOMMENDATIONS ............................................................................................................ 34

APPENDICES ................................................................................................................................................... 50

Appendix A: Self Assessment Questionnaire ...................................................................................... 51

Appendix B: Self-Assessment Questionnaire Findings ....................................................................... 60

Appendix C: Structured Conversation Questionnaire ........................................................................ 67

Appendix D: Summary of Structured Conversation Findings ............................................................. 68

Appendix E: Stakeholder Meeting Agenda and Minutes…………………………………………………………………73

Appendix F: APHPMT Competency Model - Botswana ...................................................................... 78

Appendix G:Organizational/Structural Needs Identified in Structured Conversations ...................... 91

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ACRONYMS

APHPMT Applied Public Health Program Management Training

BHRIMS Botswana HIV Reporting Information Management System

CB Capacity Building

CBO Community Based Organization

CSO Civil Society Organization

DAC District AIDS Coordinator

DHIS District Health Information System

DHMT District Health Management Team

DMSAC District Multi-Sectoral AIDS Committee

EBP Evidence Based Planning

EDU Epidemiology for Data Users

HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

HOP Headquarters Operational Plan

IPs Implementing Partners

I-TECH International Training and Education Center for Health

M&E Monitoring and Evaluation

MLG Ministry of Local Government

MoH Ministry of Health

NACA National AIDS Coordination Agency

NASTAD National Alliance of State and Territorial AIDS Directors

NGO Non-governmental Organization

NSF National Strategic Framework

PDP Performance Development Plan

PEPFAR President’s Emergency Plan for AIDS Relief

SMDP Sustainable Management Development Program

SOP Standard Operating Procedure

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STI Sexually Transmitted Infection

TA Technical Assistance

TAC Technical Advisory Committee

TB Tuberculosis

TMT Technical Management Team

ToR Terms of Reference

VMSAC Village Multi-Sectoral AIDS Committee

WMSAC Ward Multi-Sectoral AIDS Committee

Republic of Botswana Ministry of Local Government

Department of Primary Health Care Services


EXECUTIVE SUMMARY

Rationale In Botswana, District AIDS Coordinators (DACs) are critical to the management and coordination of the district response to HIV. As secretariats to the District Multi-Sectoral AIDS Committees (DMSACs), they manage inputs, facilitate the development of a multi-sectoral annual HIV/AIDS Action Plan, support local level capacity building for implementation, mobilize resources, coordinate strategic implementation partnerships across sectors, and monitor and document the district response. Since 2000, as the national HIV/AIDS response evolves, the role of the DAC has changed significantly as the DAC’s office adjusts to expectations on the part of different national and local stakeholders. Thus, the Ministry of Local Government (MLG) is seeking ways to better equip and support DACs in responding to the dynamic national HIV epidemic. The National Alliance of State and Territorial AIDS Directors (NASTAD), in collaboration with CDC’s Sustainable Management

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Development Program (SMDP), was asked by MLG to support them in the development and implementation of a skills-based needs assessment. The purpose of the assessment to provide information on gaps in DAC office capacity to deliver the core public health functions expected of them, as well as gaps in managerial and leadership skills needed by DACs to fulfill their assigned roles and responsibilities.

Process Information was gathered to design the self-assessment questionnaire from an extensive literature review of management competencies and indicators, existing Botswana national guidelines and documents, DAC Terms of Reference, and current and past job descriptions in order to assess: 1) the DAC’s perception of the priority of their job duties and functions; and 2) the DAC’s perception of their skill levels in their job duties and functions. NASTAD Botswana staff and a NASTAD consultant held structured conversations with individuals overseeing DAC activities at the national and district levels, and with district colleagues in government and civil society organizations. The structured conversations captured information about the important skills needed by the DACs and the existing gaps between actual and desired skills needed to perform the job effectively. In addition, a preliminary review of past and current internal MLG orientation and training courses and external public health program management training programs were conducted to complete the assessment process. The information gathered from the review was designed to help minimize training duplication and maximize the use of available resources. Finally, a draft report and summary of findings was shared with stakeholders at a working meeting in Gaborone on March 8, 2012. Their suggestions and recommendations were incorporated into this final report.

Results The results from both the self-assessment questionnaire and the structured conversations identified the following as priority job duties and functions of the DACs:

• Planning (strategic planning, program planning, financial planning, and planning and priority setting)

• Decision making

• Communication (oral and written communication)

• Collaborating and Partnering

• Monitoring and Evaluation

• Supervision Table 3 in this report, “Key Competencies and Associated Skill Gaps,” notes the priority duties and functions listed above, as well as the specific tasks under each of these prioritized duties and functions for which 40% or more of the DACs rated their skill levels as low or medium. For example, the priority item “Monitoring and Evaluation” has one key task for which 67% of the DACs said they have a low or medium skill in “Set clear, well-defined outcomes for work activities.” Table 3 thus shows where the key skill gaps are for the priority competencies, which provide critical information for designing a management capacity building approach to address

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these gaps. Additional information from the structured conversations provides valuable suggestions on DAC workforce development and insights into organizational/structural issues which may impede DACs from functioning more effectively. Some of the latter include, “Providing a consistent and comprehensive orientation to the job, role, key partners, expectations, etc.” and “Modifying the DMSAC planning cycle to a multi-year cycle.”

Recommendations To fully address the identified gaps, capacity building activities in both workforce development and organizational/structural development are recommended, as detailed below. A. Workforce Development: the process of equipping individuals with the understanding, skills and access to information, knowledge and training that enables them to perform effectively. Suggested activities include: 1. A comprehensive orientation conducted soon after a DAC enters his/her new position,

covering the DAC’s key partners, resources, expectations, roles, etc.; and 2. A comprehensive training program to provide refresher training for existing personnel, basic

skills for new DACs, and ongoing training to increase DACs’ skills to address a changing environment. An applied training methodology is recommended, that capitalizes on NACA and MLG tools, guidelines and processes used by DACs in their daily work. Training should address the following areas:

Planning

o Translating national policies/strategies into district/sub-district HIV/AIDS response activities

o Making detailed program, unit, and/or district/sub-district plans that include task assignments, scheduling, funding, and resource allocation

o Defining activities and tasks in order to prioritize program activities and workload for staff

o Manage contracting of equipment, facilities, supplies, and services

Decision making o Using evidence-based data to develop culturally sensitive interventions Communication o Translating evidence-based information for public health decision makers and partners o Providing interviews or written articles to the media (TV, radio, and/or newspaper)

Collaboration and Partnering o Establishing strategies for identifying and/or involving community organization

participants regarding identified needs and interest

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o Developing partnerships with key stakeholders (colleagues, public-and private-sector representatives, and/or government officials) to achieve objectives in a synergistic fashion

o Engaging community leaders to help advocate for the availability, accessibility and utilization of HIV testing and other national programs in the community

Monitoring and Evaluation o Setting clear, well-defined outcomes for work activities o Coordinating with Monitoring and Evaluation Officers to design data collection tools,

surveillance systems, and materials o Managing response activities by tracking progress in a database o Analyzing epidemiologic service and program data to measure effectiveness of

district/sub-district programs/activities to determine the impact on HIV/AIDS o Making recommendations based on evidence and data o Presenting results and lessons learned to stakeholders

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Employee management o Assessing current and future staffing needs based on the program’s goals and budget

realities o Ensuring reporting lines are clearly outlined o Coordinating with staff to establish objectives and work plans, based on program goals o Monitoring and appraising performance of staff o Working with team members to establish and implement useful guidelines for team o Facilitating effective resolution of conflicts within the unit, community, and/or regulated

parties o Conducting training needs assessments to identify the skills gaps of DMSAC, NGOs,

CBOs, and capacity building members o Analyzing available resources to determine the needed resources o Applying adult learning theory to develop curricula, course materials, and lesson plans o Implementing a training program based on gaps identified in the needs assessment to

build the capacity of the DMSAC and VMSAC/WMSAC members and other stakeholders in the community

In addition, participants in the stakeholder meeting recommended the following:

o Implement the comprehensive refresher training as an induction short course with individual applied projects based on individual needs and tied to MLG priorities

o The refresher training be developed as a modular training with an accompanying toolkit, to allow for selection of high priority modules to provide additional continuing education addressing individual needs of existing staff

o Consideration should be made for the role of mentors in the training curriculum including, for example, assigning experienced DACs to entering DACs and convening Annual Meetings of DACs to provide for peer-to-peer experience sharing, peer support and perhaps delivery of highlighted training modules

*Please see Appendix on E: Applied Public Health Program Management Training (APHPMT) Competency Model – Botswana for a list of potential applied training approaches that specifically address identified DAC needs.* B. Organizational/Structural Development: the elaboration of management structures, processes and procedures, not only within the organization but also the management of relationships between the different organizations and sectors (public, private, and community). Suggested activities: 1. Familiarize stakeholders (including independent funders and national level office staff) with

the roles and responsibilities of the DAC office and its staff. 2. Incorporate a two or three year DMSAC planning cycle to allow better evaluation of

intervention activities and consistent direction over multiple years. 3. Harmonize the data collection tools and required reports from MLG and MoH to reduce the

number of different tools in use.

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BACKGROUND

District Multi-Sectoral AIDS Committees (DMSACs) were formed during the implementation of the HIV/AIDS Medium Term Plan II (1997-2002) to initiate, direct and coordinate the implementation of HIV response at the district level. DACs were then employed to drive the district HIV/AIDS response by coordinating the work of the implementing organizations and sectors within the district and also by serving as the DMSAC secretariat. The DAC and his/her office are expected to facilitate the strength, effectiveness and assertiveness of the DMSACs, according to the 2006 DMSAC Terms of Reference. The DACs’ role requires a number of skills, including: 1) core public health skills plus strong networking, communication, organizational, leadership, management/supervisory, collaboration and coordination skills to implement the NSF II inter-sectoral and multi-sectoral approach; 2) the ability to assess grant proposals and manage grants in response to the increase in funding opportunities for Civil Society Organizations; and 3) strong data management, analysis, communication, coordination, policy interpretation and advocacy skills to coordinate effectively with national and local partners in order to implement and monitor the National Operational Plan at the district level. A number of factors have indicated the need for a needs assessment of DACs, including: 1) The NSF II has identified the system for coordination of the multi-sectoral national response as an area of concern; 2) the Country Ownership Exercise has also prioritized Coordination at District and National level as an area of great need; 3) the DACs have found it difficult to keep abreast and updated with the many developments influencing them; and 4) the large numbers and categories of people participating in the response and their high turnover require continuous training to provide them with the knowledge they need to function effectively on the job. The findings of the assessments done for this project provide information on capacity gaps related to core public health delivery functions expected of the DACs’ office. Taken with other relevant information, this assessment will inform development of an appropriate intervention strategy aimed at building and strengthening the necessary capacities in the DAC’s office.

METHOD

In 2011, the Botswana Ministry of Local Government (MLG) requested that NASTAD assist them in conducting a skills assessment of the District AIDS Coordinators (DACs). CDC’s Sustainable Management Development Program (SMDP) provided technical assistance on survey development, analysis and reporting. CDC Botswana provided technical support and the

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PEPFAR Headquarters Operating Plan (HOP) provided funding. The assessment consisted of three activities, in which: 1. 27 DACs completed a self-assessment questionnaire in September 2011. The self-

assessment questionnaire was administered to the DACs at their bi-annual review meeting in Gaborone on September 28th by national-level MLG personnel. The facilitator collected the completed questionnaires and mailed them directly to CDC’s SMDP in Atlanta, Georgia (United States of America) for data analysis and reporting.

2. In October and November 2011, NASTAD Botswana staff and a NASTAD consultant completed 34 structured conversations with 51 individuals overseeing DAC activities at the national and district levels and district colleagues in government and civil society organizations with whom DACs interact in the course of their regular activities.

3. SMDP and NASTAD staff members conducted a preliminary review of training courses. Five past and current internal MLG orientation and training courses and five past and current external public health training courses and programs were examined. Information about each course and program was collected in March 2012 from in-person meetings held with program directors and/or managers.

A. DAC Self-Assessment The self-assessment questionnaire was developed from an extensive literature review of management competencies and indicators, existing Botswana national guidelines and documents, DAC Terms of Reference, and current and past job descriptions. Based on the review of these materials, an 11-page paper questionnaire was developed and reviewed by the various stakeholders before finalization. The goal was to assess: 1) the DACs’ perception of the priority of their job duties and functions; and 2) the DACs’ perception of their skill levels in their job duties and functions. Job duties included:

• Serve as secretary to the DMSAC

• Coordinate the HIV/AIDS response at district level

• Identify and articulate priority areas for HIV and AIDS activities

• Translate national policies/strategies into HIV and AIDS response activities district/sub-district specific responses

• Build capacity of identified skills gaps of DMSAC members

• Form strategic partnerships to strengthen the functions of the DMSAC

• Build capacity for implementation by community based organizations and other sectors

• Produce annual evidence-based district HIV/AIDS comprehensive plan

• Mobilise resources for the district response

• Provides technical/administrative guidance to the DMSAC Technical Advisory Committee and other sub-committees and to consolidate their reports for reporting at the DMSAC meetings

• To mobilize communities for the formation of Village Multi-Sectoral AIDS Committees

• To facilitate formation of VMSACS/WMSAC at community level for the enhancement of HIV and AIDS response activities

• Serve in District Administration Management

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In Section 1 of the questionnaire, “Key Management Job Duties/Functions,” respondents placed a check mark by all of the key management job duties/functions that apply to their position as DACs. A tally was taken for the number of times each job duty/function was selected. In Section 2, “Top 5 Job Duties/Functions,” respondents were asked to write and rank their top 5 job duties/functions in priority order. Each answer was weighted according to the following scale to produce the final weighted score:

• Choice 1 having a value of 5




• Choice 5 having a value of 1 Section 3, “Skill Level Self-Ratings,” respondents rated their current skill as low, medium or high for each task description provided. An average was calculated to represent the overall skill level (low, medium, or high) for the 27 DACs for each task. *Please see Appendix A for a copy of the Self-Assessment Questionnaire.* B. Structured Conversations Questions included in the Structured Conversations questionnaire were drawn from training needs assessment tools drafted in mid-2011 by a joint NASTAD-SMDP Working Group. This working group included participants from Botswana, Ethiopia, and Zambia -- areas potentially interested in using such tools -- as well as from the U.S. The tools were subsequently condensed by NASTAD Botswana staff and the NASTAD consultant into one, ten-item Structured Conversation questionnaire to serve as a Ministry of Local Government DAC skills assessment. The instrument focused on identifying skills important to DAC performance and existing gaps in skills, and was brief in order to accommodate a relatively large number of potential respondents. Questions included:

• “What do you view as the most important purposes and end products/outputs of DAC Offices?”

• “What is your vision of an optimally functioning DAC Office?”

• “What skills are most important for a DAC to be effective?”

• “What is working well in the current situation?”, and

• “What in the current situation do you think could be strengthened?” Several additional questions provided context for respondents’ remarks, and a final question offered respondents an opportunity for additional comments. *Please see Appendix C for a copy of the Structured Conversation Questionnaire.*

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Between October 25 and November 7, 2011, MLG arranged for a NASTAD Botswana staff member and a NASTAD consultant to conduct 34 structured conversations with 51 national and district level personnel in Gaborone, Molopolole, Ramotswa, Mabutsane, and Kasane. Conversations were conducted face-to-face, generally in respondents’ offices, and responses were recorded by hand by the interviewers. The categories of respondents selected included individuals overseeing HIV/AIDS activities at the national level, individuals directly supervising DACs, and individuals in districts with whom DACs routinely interact with to carry out their responsibilities (Table 1). Two DACs were included among those interviewed (in one case, the DAC was the sole staff member in the DAC Office). The geographic areas were selected by MLG and ranged from urban to remote rural areas. Conversations with individuals at the district level were scheduled by the DAC or Acting DAC in each district, and conversations with individuals at the national level were scheduled by NASTAD Botswana staff. Structured conversations averaged 30-40 minutes in length, with variation depending on the degree to which respondents expanded on these and other details. In addition to their perceptions of DACs’ responsibilities, the skills important to DAC performance, and areas where strengthening was needed, some respondents also provided information on system and structural issues they believed influenced DAC performance. The categories of individuals asked to participate in structured conversations are shown in Table 1, below, along with the number of interviews conducted and the number of participants interviewed in each category.

Table 1: Structured Conversation Participation

Category of Individuals Participating in Structured Conversations

Number of Conversations

Conducted

Number of Participants

District Level Personnel

District Commissioners or senior administrative officers supervising DACs

4 4

District Health Management Team heads and staff 4 12

Social & Community Development Office heads and staff 4 5

Civil Society Organization staff members 4 5

DAC Office staff 6 12

National Level Personnel

Ministry of Local Government, Primary Care Services Director, Deputy Director, and other officials

7 7

Ministry of Health, Department of HIV/AIDS Prevention & Care Director

1 1

National AIDS Coordinating Agency officials 3 3

Botswana-US Centers for Disease Control & Prevention officials

1 2

Total 34 51


Terms used varied widely across respondents, and responses varied considerably in detail and in associated themes addressed. The content from each structured conversation was analyzed for the skills and/or behavioral indicators of skills identified in response to any of the questions. The identified skills, behavioral indicators, and gaps in skills were aggregated into broader groupings and stratified by the category of respondent. C. Preliminary Review of Training Courses/Programs As a part of the assessment process, a preliminary review of past and current training courses and programs were conducted in Botswana by NASTAD and SMDP staff members. The purpose of these training reviews was to gather data about the various trainings available (past and present) in order to minimize training duplication and maximize all current resources. An overview of each course/program is highlighted in Table 2a: Past and Current Internal MLG Training Courses and Programs and Table 2b: Past and Current External Public Health Training Courses and Programs. 1. Internal MLG Training Courses and Programs for District AIDS Coordinator Offices:

An initial comprehensive orientation was provided to newly recruited DACs in 2000. This orientation provided overviews of the following: existing HIV/ADS programs, administrative issues, program management, and monitoring and evaluation. However, this orientation was not provided to any subsequent cadre of DACs because the orientation ended after 2000. In-person meetings were held with the directors/managers/participants of the following courses offered by MLG and/or NACA to District AIDS Coordinators.

• Evidence Based Planning (EBP), conducted by Ministry of Local Government (MLG) and NASTAD

• Research Training, conducted by National AIDS Coordination Agency (NACA), and MLG.

• Monitoring and Evaluation (M&E), conducted by MLG and I-TECH

• Community Capacity Enhancement (CCE), conducted by MLG and NASTAD

• Multiple Concurrent Partners (MCP), conducted by NACA

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Table 2.a. Past and Current Internal MLG Training Courses and Programs

EBP - NASTAD

Research - NACA/MLG

M&E -MLG/I-TECH

CCE-MLG/NASTAD

MCP

-NACA

Safe Male Circumcision

Audience DACS DACS + M&E Officers

M&E Officers Assistant DACS (ADACS)

ADACS/DACS and Others

DACS

Timeframe 2-3 day trainings as needed

7 days 3-5days depending on issues

2 weeks 2 days 3 days

Location MLG/on-site

University of Botswana

District Based

MLG/on-site District Based

District Based

Applied Approach

Yes No Yes Yes No No

Mentorship (during or after)

During and after

No Yes During and after

PSI engaged NACA

No

Evaluation Yes - 2010 No 2011. Draft Report

In process 2011 Draft Report

No

Follow-Up Yes No Yes Yes Yes By District Health Educators

2. External Public Health Training Courses and Programs:

In-person meetings were held with the directors/managers of the following:

• SMDP Leadership Training Programme at the Institute of Development Management (IDM)

• Leadership Development Programme (LDP) at the Ministry of Health

• District Health Management Improvement (DMI) Course at the Ministry of Local Government

• DPHCS Monitoring and Evaluation (M&E) Course at the Ministry of Health

• Project Management Programme (PMP) at the Botswana Public Service College (BPSC)


Table 2b: Past and Current External Public Health Training Courses and Programs

SMDP - IDM

LDP - MoH

DMI (not currently offered) - MLG

M&E - MoH

PMP -BPSC

Audience Mid-Level Managers

Facility Managers

District Health Managers

M&E Officers Public Health Directors

Timeframe 6- months 6-months 2-3 weeks 2-weeks 3 days

Location IDM Hospitals and Clinics

Hotels IDM BPSC

Applied Approach

Yes Yes No No Yes

Mentorship (during or after)

During During No During Yes

Evaluation Yes - 2005 ? No Yes Yes

Follow-Up Yes No No Yes No

D. Stakeholder Meeting

A stakeholder meeting was convened on March 8, 2012 to review initial findings, seek input on report recommendations and discuss next steps. Twenty people participated in the meeting: Six were from the Ministry of Local Government, two were District AIDS Coordinators, two from CDC-Botswana, three from the Ministry of Health, one from NACA, and six from NASTAD/ SMDP. Findings from the self assessment and structured conversations were presented during the stakeholder meeting. As a result, the following responses/suggestions were provided:

a. Use existing training institution offerings

While using existing offerings avoids duplication of training efforts, enhances existing training capacity in the country, and utilizes skills of existing trainers, assessment of existing trainings showed that none of the external offerings specifically target DACs as a cadre, most are not applied to specific gaps in DAC skills and competencies, and releasing staff from their job duties to attend institutional course offerings would be challenging. For those offerings that are currently provided internally, a District AIDS Coordinator must attend multiple offerings in order to gain skills in ALL competency areas, and not all of these offerings use an applied approach designed to address the specific knowledge sets and skills required in the role of District AIDS Coordinator.

b. Build new offerings for integration into existing training institutions

Integrating a new DAC orientation training curriculum into an existing training institution (such as the Botswana Public Service College) would provide an institutional home for the

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training for sustainability, and take advantage of existing training infrastructure and trainers. However, the number of DACs seeking training on an annual basis is limited, and the challenge of releasing staff to attend an institutional offering remains.

c. Applied training within Ministry of Local Government. Designing a new offering for integration into Ministry of Local Government would require investment into curriculum development and identification and support of master trainers. However, it could be targeted specifically to DACs in an applied manner, structured to allow for DAC release to attend, and include elements of mentorship, and follow up. Trainers could be identified from within MLG and related institutions.

The participants recommended that the key points of the discussion be included within this report.

The agenda and minutes for the meeting is described in Appendix E. Stakeholder Meeting Agenda and Minutes

FINDINGS

As shown in the graph below, the respondents range in the number of years they have been DACs, with the Ministry of Local Government (MLG), and in the field of HIV/AIDS. For example, the results revealed that 48% (11/23) of the respondents have been employed as DACs for less than 2 years and only 4% (1/26) of all respondents have less than 2 years of work experience in the field of HIV/AIDS.

0

2

4

6

8

10

12

<2 3-5 6-10 11-15 16-30

Nu

mb

er

of

Re

spo

nd

en

ts

Years

Figure 1: Respondents (N=27) Years of Experience as DACs, with MLG and in the HIV/AIDS Field

Employed as a DAC

Employed with MLG

Worked in HIV/AIDS


A. Workforce Development Issues: Findings from the self-assessment questionnaire showed the following as the job duties and functions of the DACS identified as highest priority. Note that the priority activities from the needs assessment questionnaire are indicated only if the respondents rated them highly in both the open and close-ended items, as shown in tables 3 and 4, a method employed to focus attention on the highest priority job duties and functions, as follows:


• Decision making




• Supervision In response to the question in Section 1, “What are your key management job duties/functions?” the DACs checked items they thought were most important. The number of DACs checking each job duty/function is shown in the middle column with the percentage expressed in the third column. * Please see Appendix B for a copy of the findings from the Self-Assessment Questionnaire.*

Table 3: Key Management Job Duties/Functions (Highlighted items represent the duties/functions listed among the respondents’ top 12 and

listed in both the open-ended and closed-ended items, as shown in Tables 3 and 4.)

Item #1. Key Management Job Duties/Functions (close-ended item) Question: What are your key management job duties/functions? Place a check mark only by answers that apply.

Number of Responses

Responses in Percentages

1. Decision Making 27/27 100%

2. Collaboration & Partnering 26/27 96%

3. Supervision/Supervising 26/27 96%

4. Team Building 26/27 96%

5. Time Management 25/27 93%

6. Financial Planning/Budgeting 25/27 93%

7. Strategic Planning 24/27 89%

8. Oral Communication 24/27 89%

9. Program Planning 22/27 81%

10.Problem Solving 22/27 81%

11.Written Communication 21/27 78%

12.Monitoring & Evaluation 20/27 74%

13.Data Analysis 18/27 67%

14.Project Management 16/27 59%


Item #1. Key Management Job Duties/Functions (close-ended item) Question: What are your key management job duties/functions? Place a check mark only by answers that apply.

Number of Responses

Responses in Percentages

15.Training 13/27 48%

16.Policy Development 7/27 26%

17.Staffing 6/27 22%

18.Marketing 5/27 19%

19.Curriculum Development 2/27 7%

20.Grant Writing 1/27 4%

Table 4 shows the DACs’ responses to the request to rank their top 5 job duties/functions in priority order.

Table 4: Top Job Duties as Rated by DACs (Highlighted items represent the duties/functions listed among the respondents’ top 12 and

listed in both the open-ended and closed-ended items, as shown in Tables 3 and 4.)

Item #2. Top 5 Job Duties/Junctions (open-ended item) Instruction: Please rank your top 5 job duties/functions in priority order.

Weighted Score

1. Strategic Planning, Program Planning, and Planning & Priority Setting 104

2. Supervision/Supervising 34

3. Project Management 29

4. Collaboration/Partnering 24

5. Coordination 23

6. Monitoring and Evaluation 23

7. Financial Planning/Budgeting 21

8. Written/Oral Communication 15

9. Secretariat 14

10. Data Analysis 13

11. Decision Making 10

12. Resource Mobilization 8

13. Assessment 5

14. Functionality of VMSACs 4

15. Team Building 4

16. Reports 4

17. Organizing 3

18. Advocacy 2

19. Guide DMSAC 2

20. Time Management 2

21. Capacity Building 1

22. Delegation 1

23. Policy Interpretation 1

24. Training 1


In the structured conversations, respondents identified many of the same job duties and functions as the DACs identified in the self-assessment questionnaire. Structured conversation respondents additionally identified related skill needs in:

• using data to identify planning and implementation priorities and for decision making:

• identifying needs for and overseeing special studies to inform planning and implementation activities; and

• using computer skills for word processing, spreadsheets, making presentations, and searching for information.

*Please see Appendix D for a summary of the structured conversation findings.* Synopsis of Workforce Development Results Table 5: Key Competencies and Associated Skill Gaps provides a synopsis of the results from both the questionnaire and structured conversations as they align to the management competencies determined in the Literature Review.

• Column 1 and 2, Competencies and Definitions, as determined in the Literature Review. NOTE:

Competencies that the DACs rated as either a priority and/or a key duty are double-starred.

• Column 3, Expected Tasks, lists the DACs’ tasks as they were determined from the job

descriptions, the DAC Terms of Reference, and existing Botswana National Guidelines.

• Column 4, Assessment Results, shows the percentage of DACs who perceived their skills as low

or medium. The highlighted text represents cases in which 40% or more of the respondents

rated their skill levels low or medium. These can be perceived as “gaps” between skills in

expected tasks and current skill levels that need to be addressed.

• Column 5, Skills DACs Need as Identified in Structured Conversations, notes the skill areas

respondents perceived to be important for DACs to carry out their responsibilities, as expressed

in the structured conversations.

In Table 5, the competencies that were rated most important on the self-assessment questionnaire are identified with two asterisks (**). The checkmarks in the last column indicate these skills were also identified in the structured conversations as skills DACs need to possess. Finally, items highlighted in yellow indicate tasks on which the DACs most frequently rated their skills levels as low or medium (with over 40% giving one or the other of those two ratings). The tasks with the biggest gaps (highlighted in yellow) for the competencies rated most important (with two asterisks) are skills that most critically need to be addressed.


Table 5: Key Competencies and Associated Skill Gaps

Competency Definitions Expected Tasks Assessment Results

(Low/Med Skill)

Skills DACs need as Identified in Structured Conversations

Competency 1: Planning**

Develop, articulate, and implement strategic plans and program plans that leads the organization toward accomplishing its vision and mission

Competency 1 a. Plan Development:

Translate national policies/strategies into district/sub-district HIV/AIDS response activities.

50% ✓

Plan activities to ensure HIV/AIDS priorities are being met.

29% ✓

Develop a comprehensive plan with key partners from sector and civil society organizations across units.

33% ✓

Make detailed program, unit, and/or district/sub-district plans that include task assignments, scheduling, funding, and resource allocation.

43% ✓

Competency 1 b. Prioritization:

Define activities and tasks in order to prioritize program activities and workload for staff.

48% ✓

Competency 1 c. Logistics:

Manage contracting of equipment, facilities, supplies, and services.

48% ✓

Mobilize resources (including funding) for the district/sub-district response.

31% ✓

Mobilize communities for the formation of Village Multi-Sectoral AIDS Committees (VMSACs).

36% ✓

Competency 2: Coordination



(Low/Med Skill)


Integrate the work of

different groups to pursue

common goals

Develop operational procedures on facilitating DMSAC and sub-committee meetings and reporting for partners.

29% ✓

Coordinate and guide stakeholders and/or district partners in compiling information for the Evidence Based Planning (EBP) district profile.

36% ✓

Coordinate HIV/AIDS response activities in district/sub-district.

14% ✓

Competency 3: Decision Making**

Make timely decisions

based on available facts,

constraints, and

anticipated consequences

Use evidence-based data to develop culturally sensitive interventions.

48%

Competency 4: Communication **

Speak and write clearly, adapting communication styles and methods that are appropriate for the needs of the intended audience

Competency 4a. Information Dissemination:

Translate evidence-based information for public health decision makers and partners.

57% ✓

Provide interviews or written articles to the media (TV, radio, and/or newspaper.)

64%

Competency 4b. Oral Communication:

Make oral presentations to community groups, health professionals, and/or political groups.

34% ✓

Report committee/sub-committee data in a timely manner at DMSAC meetings.

28%

Facilitate effective meetings that align with prepared agendas.

23% ✓



(Low/Med Skill)


Competency 4c. Written Communication:

Prepare documents (agendas, minutes, etc.) for distribution to DMSAC and TAC/TMT members for review

23% ✓

Competency 5: Collaboration and Partnering **

Establish and maintain relationships to achieve organization goals Or Develop networks and builds alliances; collaborates across boundaries to build strategic relationships and achieve common goals

Competency 5a. Partnership Development:

Establish strategies for identifying and/or involving community organization participants regarding identified needs and interest.

57% ✓

Develop partnerships with key stakeholders (colleagues, public-and private-sector representatives, and/or government officials) to achieve objectives in a synergistic fashion.

40% ✓

Engage community leaders to help advocate for the availability, accessibility and utilization of HIV testing and other national programs in the community.

59% ✓

Facilitate the formation of VMSACs/WMSACs at the community level for the enhancement of HIV/AIDS response activities.

26% ✓

Competency 6: Monitoring and Evaluation **

Process for tracking activities and assessing the performance of those

Competency 6a. Data Collection:

Set clear, well-defined outcomes for work activities. 67% ✓



(Low/Med Skill)


activities, and/or using assessment results to reassess program activities

Coordinate with Monitoring and Evaluation Officers to design data collection tools, surveillance systems, and materials.

74% ✓

Create schedules for committee/sub-committee members to submit data and content for reports.

24% ✓

Competency 6b. Monitoring:

Ensure sectors/organizations implement activities that align with pre-identified priority areas and national goals.

37% ✓

Manage response activities by tracking progress in a database.

69% ✓

Competency 6c. Evaluation:

Analyze epidemiologic service and program data to measure effectiveness of district/sub-district programs/activities to determine the impact on HIV/AIDS.

92% ✓

Make recommendations based on evidence and data. 45% ✓

Present results and lessons learned to stakeholders. 61% ✓

Competency 7. Human Resource Management **

Acquire, maintain, and retain human resources

Competency 7a. Employee Management:

Assess current and future staffing needs based on the program’s goals and budget realities.

75%

Ensure roles and responsibilities are clearly defined. 38% ✓



(Low/Med Skill)


Ensure reporting lines are clearly outlined. 41%

Coordinate with staff to establish objectives and work plans, based on program goals.

47% ✓

Competency 7b. Capacity Building Training:

Conduct training needs assessments to identify the skills gaps of DMSAC, NGOs, CBOs, and capacity building members.

61% ✓

Analyze available resources to determine the needed resources.

53%

Apply adult learning theory to develop curricula, course materials, and lesson plans.

78%

Implement a training program based on gaps identified in the needs assessment to build the capacity of the DMSAC and VMSAC/VWSAC members and other stakeholders in the community.

73%

Competency 7b .Performance Evaluation:

Monitor and appraise performance of staff. 26%

Competency 7c. Team Building:

Work with team members to establish and implement useful guidelines for team interactions.

45%

Competency 7d . Conflict Resolution:

Facilitate effective resolution of conflicts within the unit, community, and/or regulated parties.

57%

Competency 8a. Financial Management



(Low/Med Skill)


Estimate, justify, and manage appropriate finding levels to support mission accomplishments

Competency 8a. Budgeting:

Manage district/sub-district budgets to guide, monitor, and report resource use.

42% ✓

Advise management of budget problems identified. 35%


Table 6: Key Competencies and Assessment Results Based on Years of Experience as DACs provides a synopsis of the results from the self- assessment questionnaire based on the number of years (less than 2 or greater than 3) of experience as DACs.

• Column 1 and 2, Competencies and Definitions, as determined in the Literature Review. NOTE:

Competencies that the DACs rated as either a priority and/or a key duty are double-starred.

• Column 3, Expected Tasks, lists the DACs’ tasks as they were determined from the job

descriptions, the DAC Terms of Reference, and existing Botswana National Guidelines.

• Column 4, Assessment Results for participants with less than 2 years of experience as DACs,

shows the percentage of DACs who perceived their skills as low or medium. The highlighted text

represents cases in which 40% or more of the respondents rated their skill levels low or

medium. These can be perceived as “gaps” between skills in expected tasks and current skill

levels that need to be addressed.

• Column 5, Assessment Results for participants with greater than 3 years of experience as DACs,

shows the percentage of DACs who perceived their skills as low or medium. The highlighted text

represents cases in which 40% or more of the respondents rated their skill levels low or

medium. These can be perceived as “gaps” between skills in expected tasks and current skill

levels that need to be addressed.


Table 6: Key Competencies and Assessment Results Based on Years of Experience as DACs

Competency Definitions Expected Tasks <2 of Experience as DACs (N=10)

Low/Medium Skills

>3 of Experience as DACs (N=12)

Low/Medium Skills Competency 1: Planning**

Develop, articulate, and implement strategic plans and program plans that leads the organization toward accomplishing its vision and mission

Competency 1 a. Plan Development:


70% 33%


20% 33%


30% 33%


60% 33%

Competency 1 b. Prioritization:


40% 33%

Competency 1 c. Logistics:


50% 50%


30% 33%


30% 58%

Competency 2: Coordination


40% 42%



Low/Medium Skills


Low/Medium Skills Integrate the work of

different groups to pursue

common goals


40% 33%


10% 8%

Competency 3: Decision Making**

Make timely decisions

based on available facts,

constraints, and

anticipated consequences


40% 50%

Competency 4: Communication **

Speak and write clearly, adapting communication styles and methods that are appropriate for the needs of the intended audience

Competency 4a. Information Dissemination:


50% 58%


50% 67%

Competency 4b. Oral Communication:


30% 50%


40% 25%


30% 17%

Competency 4c. Written Communication:

Prepare documents (agendas, minutes, etc.) for distribution to DMSAC and TAC/TMT members for review

10% 33%



Low/Medium Skills


Low/Medium Skills Competency 5: Collaboration and Partnering **

Establish and maintain relationships to achieve organization goals Or Develop networks and builds alliances; collaborates across boundaries to build strategic relationships and achieve common goals

Competency 5a. Partnership Development:


60% 58%


50% 42%


50% 67%


20% 50%

Competency 6: Monitoring and Evaluation **

Process for tracking activities and assessing the performance of those activities, and/or using assessment results to reassess program activities

Competency 6a. Data Collection:

Set clear, well-defined outcomes for work activities. 80% 58% Coordinate with Monitoring and Evaluation Officers to design data collection tools, surveillance systems, and materials.

60% 83%


20% 25%

Competency 6b. Monitoring:



Low/Medium Skills


Low/Medium Skills Ensure sectors/organizations implement activities that align with pre-identified priority areas and national goals.

20% 58%


60% 83%

Competency 6c. Evaluation:


80% 75%

Make recommendations based on evidence and data. 30% 67% Present results and lessons learned to stakeholders. 80% 58%

Competency 7. Human Resource Management **

Acquire, maintain, and retain human resources

Competency 7a. Employee Management:


40% 67%

Ensure roles and responsibilities are clearly defined. 40% 42% Ensure reporting lines are clearly outlined. 30% 58% Coordinate with staff to establish objectives and work plans, based on program goals.

60% 50%

Competency 7b. Capacity Building Training:


50% 67%


60% 67%



Low/Medium Skills


Low/Medium Skills Apply adult learning theory to develop curricula, course materials, and lesson plans.

40% 75%


50% 92%

Competency 7b .Performance Evaluation:

Monitor and appraise performance of staff. 20% 33% Competency 7c. Team Building:


70% 50%

Competency 7d . Conflict Resolution:


60% 58%

Competency 8a. Financial Management

Estimate, justify, and manage appropriate finding levels to support mission accomplishments

Competency 8a. Budgeting:


50% 33%

Advise management of budget problems identified. 50% 33%


The structured conversations provided additional insights into the specific needs DACs have for the skills in the various competencies, see Table 7 below.

Table 7: Additional Insights on Skills Gaps from Structured Interviews

Competency Additional Insights about Needs

Planning o Developing operational plans (identified in self assessment as “program, unit, sub-district plans”), & IP/implementation monitoring

Decision Making o Using available data for planning and management decisions, and accurately using and reporting data where forms/systems are not harmonized

Communication o Making effective presentations

Collaboration and Partnering

o Stakeholder, VMSACs and CSO mobilization, and increasing mainstreaming across ministries

Monitoring and Evaluation

o Financial monitoring, management (including project budgeting), procurement and any necessary contracting

o Assessing plan implementation and effectiveness (and in understanding the epidemiologic data

Supervision o Employee management, including team building, delegation, establishing work plans, and conflict resolution

B. Organizational/Structural Development Issues: Apart from skills needed, the following are organizational/structural issues identified as areas for improvement in the structured conversations:

Table 8: Organizational / Structural Needs

Item Description

Orientation for new DACS Consistent and comprehensive orientation to job, role, key partners, expectations, basic computer use and reporting skills, etc.

Physical working conditions – office space, equipment, access to transportation, access to MLG office support

Working conditions may not support staff needs or reflect importance of HIV effort, affecting ability to engage others

Filling vacant DAC and other DAC Office positions on a timely basis

Positions are sometimes vacant for extended periods; Transfer may occur without advance notice

Ongoing training to maintain and expand DAC skills, as needed

Current training efforts are episodic

DAC position level is relatively junior and career progression path is not defined

The relatively junior position level may add to the DAC’s difficulty in engaging higher level DMSAC participants; it may also contribute to DAC turnover, and make it more difficult for others to work consistently with the DAC Office


STRENGTHS/LIMITATIONS: Throughout the development, implementation, and analysis of the self-assessment and structured conversation tools and/or data, strengths and limitations have been identified as inherent in the tools and their administration, and in the analysis of the structured conversations. A. Written Self-Assessment Questionnaire Strengths and Limitations

The written questionnaire strengths include:

• Easy to administer, with minimal time requirement.

• Ability to gather information from individuals who would be difficult to include in other assessment methods.

• Results reflect the DACs’ level of confidence in their skill to perform the tasks/duties expected.

The written questionnaire limitations include:

• Results could be affected by the terms used to describe the tasks/job duties/functions and how they were interpreted by respondents.

• Results reflect the DACs’ self-reported perceptions of their skills, which may not accurately reflect their actual skills in these areas.

B. Structured Conversations Strengths and Limitations The structured conversations strengths include:

• The personal interview could be directed to individuals with personal observation of and interaction with DACs and/or the reports they produce.

• The interview was more likely to receive a response, and a more complete response, than a mailed questionnaire.

• The interviewer could respond to questions about what was being asked or clarify responses, as needed.

• The conversational format potentially invited a more in-depth discussion than a self-administered questionnaire.

The structured conversations limitations include:

• Conversations required considerable interviewer time to administer.

• Conversations were subject to potential interviewer errors in administration (omitting questions, etc.) and in recording responses to interviews.

• Group conversations were vulnerable to a single respondent’s diverting the direction of, or monopolizing, the discussion, not all of which could be remedied by interviewer intervention.

34 | C o n c l u s i o n s a n d R e c o m m e n d a t i o n s

• The terms respondents used to identify skills varied widely, and the same terms appeared to mean different things to different respondents and the interviewerResponses reflected the individual’s perceptions of DAC responsibilities and skills rather than the DACs’ actual responsibilities and skills.

• Some responses appeared to reflect the respondent’s personal and programmatic priorities rather than DAC Terms of Reference and national frameworks.

• Analysis of responses to the open-ended questions was time-consuming, and classifying responses into categories was a subjective and potentially imprecise process.

CONCLUSIONS AND RECOMMENDATIONS

The following recommendations address both Workforce Development and Organizational/Structural needs of DACs currently in place and those newly entering DAC positions, in order to help them function most effectively: A. Workforce Development Needs Providing Pre-service and/or In-service Training for the skill gaps and key competency areas identified from the needs assessment as follows:


• Decision making




• Supervision The expected tasks identified as skill gaps are listed in Table 9: Examples of Applied Training Strategies to Address DAC Skill Gaps. During the stakeholder meeting, participants agreed that an applied training within the Ministry of Local Government should be pursued (as explained on page 17). Thus, Table 9 also outlines an applied training approach that includes a list of sample strategies/exercises (column 2) and potential NASTAD and SMDP course curricula (column 3) that can be used to address the specific needs of the DACs. While further consultations with MLG and stakeholders should be conducted to decide on an appropriate capacity strengthening intervention and/or training program design with the below information considered:

• The training should be located within MLG, and a core training of trainers should be delivered for master trainers recruited from MLG as well as from other agencies.


• Two curricula, or a hybrid curriculum needs to be developed that both provides orientation for new DACs, and provides ongoing in-service training for existing staff focused on individual needs o The training could be developed as a modular training and accompanying toolkit,

which would allow for selection of high priority modules to focus on individual needs of existing staff

o DACs would likely need to be stratified according to their longevity as employees for training participation

• The training could be designed as a two week induction/short course with individual applied projects (based on individual needs and tied to MLG priorities and national initiatives). The training should be coordinated with District Health Management Training programs

• DACs would likely need to be stratified according to their longevity as employees for training participation

• Annual Meetings of DACs should be considered, to provide for peer-to-peer experience sharing, peer support and perhaps delivery of highlighted training modules.

• The role of mentors in the training curriculum should be considered, including assigning experienced DACs to entering DACs.


Table 9: Examples of Applied Training Strategies to Address Identified Skill Gaps

Expected Tasks Low/Med Skill (%)

Skill Needs per

Conversations

Applied Training Strategies Existing Training Strategies

Plan Development: SMDP Course Curriculum:

• Building Health Programs that Work – Participants learn to assess and analyze public health needs; define a goal and objectives for a public health program; determine a program strategy and intervention; set specific and measureable objectives for a public health intervention; and develop an evaluation plan to monitor program progress.

• Project Management – Participants learn to write a project work plan; generate a work breakdown structure; develop a network diagram and schedule; track and manage the project; and close-out and conduct post project reviews to ensure continuous learning.

NASTAD Course Curriculum:

• DMSAC Evidence Based Planning Toolkit.(Botswana) - Participants are led through a step-by-step standardized process for the


50% ✓ Add in desk top exercise utilizing

national policies to guide development of a model district plan, using skills and approaches described in “Building Health Programs that Work”


43% ✓

Use district health team ToR and annual district funding streams to DACs to develop a project work plan, using skills and approaches described in “Project Management”

Prioritization:


48% ✓

Exercises on prioritizing work activities with staff based on DAC-generated examples of situations in their offices. Include approaches to prioritizing one’s own activities when not in control of one’s schedule – predicting patterns in demands based on calendar, others’ routine schedules, etc.

Logistics:



Skill Needs per

Conversations



48% ✓

Exercises using actual examples of situations when DACs would need to solicit, establish (or recommend establishing), and monitor contractual arrangements.

development of the Botswana Annual District HIV plan; steps cover assessment, gap analysis, prioritization, and plan development; tools, formats, a timeline, and instructions for completion are provided

• Developing a State Model for HIV Prevention and Care.(Nigeria) - Participants articulate the country-specific roles and responsibilities of federal, state and community in developing a comprehensive HIV response, identify state level needs and gaps, and develop a TA and advocacy plan.

Decision Making: SMDP Course Curriculum:

• Putting Data to Work – Participants learn to apply a five step method for using data to make decisions; organize and present data effectively; and use data to align program activities and decisions with organizational or national strategies.

• Values-Based Decision Making – Participants learn to conduct dialogue with stakeholders to

Use evidence and data to identify planning and implementation priorities and to facilitate decision making.*

Not Asked ✓ Provide descriptive data for a

hypothetical district. Conduct a planning exercise to assess and prioritize activities proposed by IPs, looking to reduce service duplication and/or more clearly focus on local problems. Develop clear recommendation(s) to the DMSAC about how to proceed. Follow-on to above exercise with case(s) addressing how one might



Skill Needs per

Conversations


work with the affected IP(s) to provide, guide, and/or identify sources of Capacity Building assistance (use this exercise to familiarize DACs with any potentially available resources).

identify important values for making a decision; identify the potential unintended and negative consequences of a decision; and communicate decisions using a decision summary form.


• Data for Decision Making (India) – Participants learn about sources of national and local data, how to use within local settings, and using case studies and field assignments, learn what kinds of data need to be collected and applied in order to solve local public health problems

• Working with Surveillance Data (Haiti) – Participants use existing data sets and case studies to develop epidemiologic profiles


48%



Skill Needs per

Conversations


Information Dissemination: SMDP Course Curriculum:

• Writing Success Stories: Impact and Value – Participants learn to use success stories to support a public health program; determine the audience for your success story; describe the components of a good success story; and create an outline for a success story.

• Effective Presentation Skills – Participants learn to develop and organize presentation content; prepare and deliver a more effective presentation; and use visual aids and supportive materials effectively.

• Crisis Communication – Participants learn to anticipate communication needs based on the crisis communication lifecycle; build credibility with six emergency message components; identify populations who may require a specific message; and handle difficult behaviors in a crisis.

• Public Health Advocacy – Participants learn to write an


57% ✓

Provide situational examples and ask teams of DACs to review evidence provided and formulate recommendations. Explore ways to substantiate, communicate, and present recommendations.


64%



Skill Needs per

Conversations


‘elevator’ speech; identify partners to help your program succeed; identify sources for public health funding; and develop an advocacy work plan.


• Health Communications and Advocacy (India) – This week long course uses case studies, desktop exercises and field assignments to provide participants understanding on how to work with the media to achieve public health goals, basic principles of social marketing, coalition building and other methods of advocating for policy change. Participants develop skills in different methods of communication- story telling, narrative; writing press releases; conducting press conferences; and in writing proposals and advocating for funding.

Partnership Development: SMDP Course Curriculum:

• Stakeholder Analysis – Participants learn to define the steps in conducting a stakeholder analysis;

Establish strategies for identifying and/or involving community organization

57% ✓



Skill Needs per

Conversations


participants regarding identified needs and interest.

identify the key elements to include in a stakeholder profile; list the steps in a Ladder of Participation; and identify categories and methods of participation for each stakeholder.


• Community Planning (Botswana, Ethiopia, Cambodia, Caribbean) - Participants learn methods for involving, empowering and retaining community partners to contribute to development and implementation of jurisdictional HIV plans


40% ✓

Use case example(s) of how a DAC might use local data to encourage IPs to report (reasonably) accurate data on a timely basis, even if they’re not funded by DMSAC.


59% ✓



Skill Needs per

Conversations


Data Collection: SMDP Course Curriculum:

• Process Improvement – Participants learn to define a process; measure process performance; analyze causes of variation; generate and plan improvement ideas; implement changes; study the results of changes; and act according to the results of the study.


• Epidemiologic Data Use (EDU) (Zambia) – Participants learn strategies to strengthen the quality of health data collection and reporting, and are afforded opportunities to develop plans for collaboration and interaction among provincial and district-level staff on provincial/district level epidemiologic profiles and M&E plans in support of national strategic frameworks

Set clear, well-defined outcomes for work activities.

67% ✓


74% ✓

Monitoring:


69% ✓

Evaluation:


92% ✓

Make recommendations based on evidence and data.

45% ✓

Provide cases with pertinent and non-pertinent HIV-related data and other programmatic evidence for teams of DACs to review and formulate recommendations.



Skill Needs per

Conversations


Include instances where additional data may need to be requested. Discuss approaches to formulating, substantiating, and presenting recommendations.

• District Monitoring and Evaluation (Zambia) – Participants are introduced to national HIV monitoring and evaluation requirements and learn how to collect, assure quality of, and report district level data to provincial and national counterparts. Participants also learn how to use district level data to inform district HIV planning and coordination processes

Present results and lessons learned to stakeholders.

61% ✓

Provide cases with realistic examples of program activities (government and CSO). Have teams of DACs review, extract lessons learned, and make presentations to a mixed group of governmental and non-governmental stakeholders for review and critique. Consider having DACs develop a mini data summary/profile to show the situation in their districts and/or villages, and perhaps call to attention any reporting problems), to present to the DDC, VDCs, and Councilors.

Employee Management: SMDP Course Curriculum:

• Team Building – Participants learn to how to create more effective working relationships among team members; articulate methods for creating positive and productive team agreements and norms; select specific skills and tools when creating alignment within diverse


75%

Ensure reporting lines are clearly outlined.

41% Exercises on managing staff and defining roles. Involve NACA staff who place program staff in DACs’ Offices in role playing exercises



Skill Needs per

Conversations


(NACA staff playing DACs) so that the potential conflicts also become clearer to them. Include providing constructive and objective, evidence-based feedback to staff, as well as potential capacity building strategies/resources.

teams; choose effective responses to resolve common problem behaviors present in teams; and identify ways to develop productive working relationships within teams.

• Conflict Management – Participants learn to identify common causes of conflict; recognize conflicting priorities and personalities within a work team or between a manager and employee; use productive strategies to resolve conflict; and describe ways to prevent conflict

• Coaching and Mentoring – Participants learn to use key principles and skills when coaching and mentoring others; choose appropriate coaching and mentoring methods when fostering professional development in others; and develop a brief action plan to facilitate their further development of coaching and mentoring skills.

• Manage Your Time: Manage Your

• Stress (Time Management) – Participants learn to prioritize daily


47% ✓

Provide cases with DAC-generated examples. Use role playing and develop work plans in these exercises.

Capacity Building Training:


61% ✓

Provide descriptive data for a hypothetical district. Conduct a planning exercise to assess and prioritize activities proposed by IPs, looking to reduce service duplication and/or more clearly focus on local problems. Develop clear recommendation(s) to the DMSAC about how to proceed. Follow-on to above exercise with case(s) addressing how one might work with DMSAC in priority setting/proposal assessment, and with the affected IP(s) to provide, guide, and/or identify sources of



Skill Needs per

Conversations


Capacity Building assistance (use this exercise to familiarize DACs with any potentially available resources).

tasks; and use methods to minimize interruptions.


• Leadership and Management (India) - This week long course uses case studies, desktop exercises and field assignments to impart knowledge, competencies/skills, and influence attitudes in the following areas: use of organizational assessment using tools like SWOT; Plan procedures/system to manage individual, project, and institutional needs/gaps; evaluate and revise existing HR SOPS with reference to: organizational chart, job descriptions, recruitment policies, retention strategies, and replacement preparedness; Recall and practice principles of effective team work; List and practice effective leadership characteristics; Practice effective time management tools and principles; Identify strategies to resolve conflict when confronted with a team conflict


53% To Be Determined





Team Building:



Conflict Resolution:


57% Exercises and role playing using DAC-generated examples of conflicts encountered in their work. Employ different approaches to resolving conflicts (successfully and unsuccessfully) and include



Skill Needs per

Conversations


examples of when assistance from higher authorities is appropriate.

situation; Recognize barriers and facilitators to change within a team/project/program

• Leadership Development (South Africa) The Programme Administration - module in this tool-kit provides instructions and tools for readers to address: Self-assessment of management skills, team work, supervision, staff development, budget and resource management, communication, rules and regulations, departmental policies, staff roles and responsibilities, office management and professional etiquette

Budgeting: SMDP Course Curriculum:

• Introduction to Grant Writing – Participants learn the grant application process; main sections of a grant application; and roles on a grant writing team.


• Leadership and Management – Financial Management (India) - Using lecture, case studies and field assignments, this session provide


42% ✓

Financial management exercises to track/monitor funding obligations and expenditures, and expenditures of funds by IPs (relate expenditures to activities expected during that time period). Introduce use of spreadsheets, if appropriate. Stress conducting timely monitoring and any needed intervention, direct field observation of activities, timely



Skill Needs per

Conversations


reviews of reports, timely auditing of IP financial records, and providing timely and constructive feedback.

participants an overview of ways to monitor and manage project finances; an understanding of the budget’s potential as a dynamic management tool, supporting project planning, implementation, and evaluation and skills for budget development and revision.

• Contract Management (South Africa, Ethiopia) - NASTAD tools and training provide participants with understanding of the purpose of an RFA, a bidding process, responding to and review proposals, developing contracts with successful applicants, as well as providing skills for management and monitoring of contracts.

• Proposal Writing Workshop (Nigeria) - Participants maximize tools and skills needed to submit a functional proposal to an international AIDS organization. During the workshop participants generate the elements of a sample proposal develop a structure and format for writing requests for proposal and learn to critique written proposals regardless of agency or grantor



Skill Needs per

Conversations


Public Health Knowledge: NASTAD Course Curriculum:

• Introduction to Public Health (India) - Using lecture, case studies and field assignments, participants learn the basic biology of the HIV virus, discuss the core functions of public health with specific application to HIV, are provided with overview of Global HIV Epidemic and address issues of cultural competence and ethics in a public health response to HIV

• Leadership Development Toolkit (South Africa) - This toolkit provides instruction and tools to provincial AIDS directors in South Africa on responding to the South African HIV epidemic. Section one provides an introduction to HIV & AIDS and public health, followed by individual chapters on specific components of a comprehensive HIV & AIDS programme including prevention, care and treatment, sexually transmitted infections and blood safety.

Understand HIV/AIDS and related health conditions.*

Not Asked ✓ Provide basic public health

overview/orientation, using HIV-specific and related health problems (e.g., TB, STD), with definitions, data use examples, and hands-on exercises. .

Understand the organization and functions of the healthcare system.*

Not Asked ✓

Include healthcare system information in applied exercises, above.


B. Organizational / Structural Needs The following recommendations are suggestions for addressing organizational/structural needs to strengthen workforce development, based on findings from the Structured Conversations:

• Familiarize stakeholders (including independent funders and national level office staff) with the roles and responsibilities of the DAC office and its staff. Why? o Funders and other PEPFAR partners are unaware of the DAC’s role of coordinating

all HIV activities in the district, thus limiting their ability to perform their prime function (coordination).

• Incorporate a two- or three-year DMSAC planning cycle instead of a yearly planning cycle. Why? o The current HIV/AIDS planning process is conducted annually through the DMSAC.

A new plan is developed and adopted before the existing plan’s activities have been completed, and the existing plan’s interventions generally are not evaluated. As a consequence, each plan stands alone and doesn’t inform the subsequent plan.

• Harmonize data collection methods and reporting forms. Why? o The DAC reporting tool (BHRIMS) captures different variables, and/or captures some

of the same variables differently, than the tool the District Health Management Team (DHMT) uses to collect and report data to the DMSAC. Not having harmonized forms and consistent variable definitions may contribute to inadvertent DAC misuse of the data in reports, and cause unnecessary and unproductive conflict between the DAC and the DHMT.

o If the DAC M&E Officer assisted the DHMT M&E Officer to collect needed data, the DAC M&E Officer would understand the data more fully and could guide their accurate use within the DAC Office.

• Develop guidelines for communicating across ministries. Why? o Following the DHMT’s organizational relocation to the Ministry of Health (MoH),

communication channels between the DHMT and DAC have become cumbersome. In some districts, the DAC has to go through MoH Administration to contact the DHMT.

*Please see Appendix F for a more detailed list of organizational/structural needs identified, and selected potential approaches, based on findings from the Structured Conversations.*


APPENDICES

A: Self-Assessment Questionnaire

B: Self-Assessment Questionnaire Findings

C: Structured Conversation Questions

D: Summary of Structured Conversation Findings

E. Stakeholder Meeting Agenda and Minutes

F: Applied Public Health Program Management Training Competency Model – Botswana

G: Organizational/Structural Needs Identified in Structured Conversations

51 | A : S e l f - A s s e s s m e n t Q u e s t i o n n a i r e

Appendix A

Self-Assessment Questionnaire

Background/Purpose:

The Ministry of Local Government (MLG) is seeking ways to better prepare and support District AIDS Coordinators (DACs) and their staff for their

increasingly important and complex role in responding to the national HIV epidemic. This survey will provide MLG with the initial information

needed to assist them in designing an appropriate orientation and training for DACS. The information gathered from this needs assessment will be

aggregated by an independent organization (NASTAD), and solely be used for determining systems strengthening needs. No individual identifying

information will be shared with MLG.

Instructions:

Please complete the survey by filling in the blanks and circling the appropriate answers.

Name (Optional):

Name of Organization/Unit: Education (degrees, years of schooling):

How long have you been employed as a District AIDS Coordinator?

How long have you been employed with the Ministry of Local Government?

In general, how long have you worked in the HIV/AIDS field?

What are your key management job duties/functions? Place a check mark only by the answers that apply. Strategic Planning Staffing Monitoring & Evaluation Financial Planning/Budgeting Collaborating & Partnering Problem Solving Marketing Grant Writing Decision Making Policy Development Data Analysis Training Project Management Program Planning Curriculum Development Time Management Supervising Team Building Oral Communication Written Communication


Please list any additional management duties/functions that are not listed above. Please rank your top 5 job duties/functions in priority order.

1.____________________ 2.____________________ 3.____________________ 4.____________________ 5.____________________

CATEGORIES What is your current level of skill to perform this task?

List the tools, support and/or training needed to better perform this task.

Low Medium High Does Not

Apply

DMSAC SECRETARIAT

What percentage of your time is devoted to serving as the DMSAC Secretariat? ___________%

Meeting Planning:

Prepare documents (agendas, minutes, etc.) to be distributed to DMSAC and TAC/TMT members for their review.

1 2 3 N/A

Meeting Facilitation:

Facilitate effective meetings that align with prepared agendas. 1 2 3 N/A

Report Compilation:


1 2 3 N/A


1 2 3 N/A

Comments: Please use the space below to list the challenges you face in performing these tasks.





Apply

PLANNING AND PRIORITY SETTING

What percentage of your time is devoted to planning and priority setting? ___________%

What type of plan(s) are you responsible for developing?

Who is involved in the development and/or approval of the plan(s)?

Plan Development:


1 2 3 N/A

Plan activities to ensure HIV/AIDS priorities are being met. 1 2 3 N/A


1 2 3 N/A

Develop a comprehensive plan with key partners from sector and civil society organizations and across units.

1 2 3 N/A


1 2 3 N/A

Prioritization:


1 2 3 N/A





Apply


MONITORING AND EVALUATION

What percentage of your time is devoted to monitoring and evaluation? ___________%

What monitoring and evaluation activities are you responsible for?

What tools do you use to monitor and evaluate programs/activities (i.e. personnel, software, etc.)?

Data Collection:

Set clear, well-defined desired outcomes for work activities. 1 2 3 N/A


1 2 3 N/A

Monitor:

Ensure sectors/organizations implement activities that align with pre-identified priority areas and the national goals.

1 2 3 N/A

Manage response activities by tracking progress in a database. 1 2 3 N/A

Evaluate:


1 2 3 N/A

Make recommendations based on evidence and data. 1 2 3 N/A





Apply

Present results and lessons learned to stakeholders. 1 2 3 N/A


HEALTH PROMOTION AND DISEASE PREVENTION

What percentage of your time is devoted to health promotion and disease prevention? ___________%

What types of resources are needed for all health promotion and disease prevention activities (i.e. vehicles, staff, etc.)?

Information Dissemination:


1 2 3 N/A


1 2 3 N/A

Provide interviews or written articles to the media (TV, radio, and/or newspaper).

1 2 3 N/A

Disease Prevention:


1 2 3 N/A

Coordinate HIV/AIDS response activities in district/sub-district. 1 2 3 N/A


CAPACITY BUILDING TRAINING

What percentage of your time is devoted to capacity building training of partners? ___________%





Apply

What trainings have you attended in the past year? Who provided the trainings? Please indicate whether you thought the trainings were helpful in your work.

Needs Assessment:

Conduct training needs assessments to identify the skills gaps of DMSACs, NGOs, CBOs, and capacity building members.

1 2 3 N/A


1 2 3 N/A

Curriculum Development:


1 2 3 N/A

Implementation:


1 2 3 N/A


PARTNER COLLABORATION

What percentage of your time is devoted to partner collaboration? ___________%

Who do you partner with to implement programs/activities? What role do they play?

Partnership Development:





Apply

Establish strategies for identifying and/or involving community organizations participants regarding identified needs and interest.

1 2 3 N/A


1 2 3 N/A

Coordination:


1 2 3 N/A


1 2 3 N/A


RESOURCE MOBILIZATION

What percentage of your time is devoted to resource mobilization? ___________%


1 2 3 N/A

Mobilize communities for the formation of Village Multi-Sectoral AIDS Committees (VMSAC).

1 2 3 N/A

Facilitate the formation of VMSACs/WMSACs at the community level for the enhancement of HIV and AIDS response activities.

1 2 3 N/A


HUMAN RESOURCE MANAGEMENT

What percentage of your time is devoted to human resource management? ___________%





Apply

How many staff do you supervise?

What skills does your staff need?

Employee Management:


1 2 3 N/A

Ensure roles and responsibilities are clearly defined. 1 2 3 N/A

Ensure reporting lines are clearly outlined. 1 2 3 N/A


1 2 3 N/A

Performance Evaluation:

Monitor and appraise performance of staff. 1 2 3 N/A

Team Building:


1 2 3 N/A



1 2 3 N/A



LOGISTICS AND PROCUREMENT

What percentage of your time is devoted to logistics and procurement? ___________%

Financial Management:

Manage district/sub-district budgets. 1 2 3 N/A

Advise management of budget problems identified. 1 2 3 N/A

Logistics:


1 2 3 N/A


60 | B: S e l f - A s s e s s m e n t Q u e s t i o n n a i r e F i n d i n g s

Appendix B

Self-Assessment Questionnaire Findings

Prioritization Questions Two questions, one open-ended (item #1) and one close-ended (item #2) were used to determine the respondents’ perceptions of the priority of their job duties and functions. Item #1, the close-ended item, asked participants to select their key management job duties from a list that was developed based on literature reviews around leadership and management competencies. Item #2, the open-ended item, asked participants to write in and rank their top 5 job duties in priority order.

1. Key Management Job Duties/Functions (close-ended item) Question: What are your key management job duties/functions? Place a check mark only by answers that apply.

Number of Responses Responses in Percentages

1. Decision Making 27/27 100%

2. Collaboration & Partnering 26/27 96%

3. Supervision/Supervising 26/27 96%

4. Team Building 26/27 96%

5. Time Management 25/27 93%

6. Financial Planning/Budgeting 25/27 93%

7. Strategic Planning 24/27 89%

9. Oral Communication 24/27 89%

9. Program Planning 22/27 81%

10.Problem Solving 22/27 81%

11.Written Communication 21/27 78%

12.Monitoring & Evaluation 20/27 74%

13.Data Analysis 18/27 67%

14.Project Management 16/27 59%

15.Training 13/27 48%

16.Policy Development 7/27 26%

17.Staffing 6/27 22%

61 | B : S e l f - A s s e s s m e n t Q u e s t i o n n a i r e F i n d i n g s

18.Marketing 5/27 19%

19.Curriculum Development 2/27 7%

20.Grant Writing 1/27 4% *The highlighted text represents the duties/functions (among the first ten responses) that were identified and/or selected in item #1 and #2.

2. Top 5 Job Duties/Junctions (open-ended item) Instruction: Please rank your top 5 job duties/functions in priority order. Results: Each answer was weighted using the following method: 1st choice multiplied by 5, 2nd choice multiplied by 4, 3rd choice

multiplied 3, 4th choice multiplied by 2, and 5th choice multiplied by 1.

Weighted Score

1. Strategic Planning, Program Planning, and Planning & Priority Setting 104

2. Supervision/Supervising 34

3. Project Management 29

4. Collaboration/Partnering 24

5. Coordination 23

6. Monitoring and Evaluation 23

7. Financial Planning/Budgeting 21

8. Written/Oral Communication 15

9. Secretariat 14

10. Data Analysis 13

11. Decision Making 10

12. Resource Mobilization 8

13. Assessment 5

14. Functionality of VMSACs 4

15. Team Building 4

16. Reports 4

17. Organizing 3

18. Advocacy 2

19. Guide DMSAC 2

20. Time Management 2

21. Capacity Building 1

22. Delegation 1

23. Policy Interpretation 1

24. Training 1 *The highlighted text represents the duties/functions (among the first ten responses) that were identified and/or selected in item #1 and #2.


Skill Level Self-Ratings

The below percentages show how the participants rated their skill level - - low, medium or high - - for each task listed. The top 12 job duties/functions that the respondents identified as high priority (from one or both lists in items #1 or #2) are noted with an asterisks (*).

DMSAC Secretariat Question: What percentage of your time is devoted to serving as a DMSAC Secretariat? 65.76%

Meeting Planning: Low Skill Level Medium Skill Level High Skill Level


0% 23% 77%

Meeting Facilitation:


0% 23% 77%

Report Compilation:


0% 24% 76%

Report committee/sub-committee data in a timely manner at DMSAC meetings

1% 27% 72%

Planning & Priority Setting (*) Question: What percentage of your time is devoted to planning and priority setting? 62.38%

Plan Development: Low Skill Level Medium Skill Level High Skill Level


0% 50% 50%


0% 29% 71%


5% 34% 61%

Develop a comprehensive plan with key partners from sector and civil society organizations and across units.

0% 33% 67%


2% 41% 57%


Prioritization:


0% 48% 52%

Monitoring & Evaluation (*) Question: What percentage of your time is devoted to monitoring and evaluation? 42.41%

Data Collection: Low Skill Level Medium Skill Level High Skill Level

Set clear, well-defined desired outcomes for work activities.

7.4% 59.3% 33.3%


17% 57% 26%

Monitor:


1% 36% 63%


16% 53% 31%

Evaluate:


27% 65% 8%

Make recommendations based on evidence and data. 2% 43% 55%

Present results and lessons learned to stakeholders. 2% 59% 39%

Health Promotion and Disease Prevention Question: What percentage of your time is devoted to health promotion and disease prevention? 55%

Information Dissemination: Low Skill Level Medium Skill Level High Skill Level


0% 57% 43%


1.5% 32% 66%


Provide interviews or written articles to the media (TV, radio, and/or newspaper).

27.2% 36.4% 36.4%

Disease Prevention:


1.7% 57.6% 40.6%


0% 14% 86%

Capacity Building Training Question: What percentage of your time is devoted to capacity building training of partners? 36.59%

Needs Assessment: Low Skill Level Medium Skill Level High Skill Level

Conduct training needs assessments to identify the skills gaps of DMSACs, NGOs, CBOs, and capacity building members.

13% 48% 39%


14% 39% 47%

Curriculum Development:


41% 37% 22%

Implementation:


23% 50% 27%

Partner Collaboration (*) Question: What percentage of your time is devoted to partner collaboration? 51.95%

Partnership Development: Low Skill Level Medium Skill Level High Skill Level

Establish strategies for identifying and/or involving community organizations participants regarding identified needs and interest.

3.6% 53.6% 42.9%

Develop partnerships with key stakeholders (colleagues, public-and private-sector representatives, and/or

3% 37% 60%


government officials) to achieve objectives in a synergistic fashion.

Coordination:


6.3% 22.2% 71.4%


0% 36% 64%

Resource Mobilization Question: What percentage of your time is devoted to resource mobilization? 51.6%

Resource Mobilization: Low Skill Level Medium Skill Level High Skill Level


5% 26% 69%

Mobilize communities for the formation of Village Multi-Sectoral AIDS Committees (VMSAC).

6.6% 29.5% 63.9%

Facilitate the formation of VMSACs/WMSACs at the community level for the enhancement of HIV and AIDS response activities.

6.6% 19.7% 73.8%

Human Resource Management Question: What percentage of your time is devoted to human resource management? 46.8%

Employee Management: Low Skill Level Medium Skill Level High Skill Level


19% 56% 25%

Ensure roles and responsibilities are clearly defined. 3.4% 34.5% 62.1%

Ensure reporting lines are clearly outlined. 2% 39% 59%


2% 45% 53%


Monitor and appraise performance of staff. 0% 26% 74%

Team Building :



2% 43% 55%



3.6% 53.6% 42.9%

Logistics & Procurement Question: What percentage of your time is devoted to logistics and procurement? 41.33%

Financial Management (*): Low Skill Level Medium Skill Level High Skill Level

Manage district/sub-district budgets. 0% 41.8% 58.2%

Advise management of budget problems identified. 4.6% 30.8% 64.6%

Logistics:


6.9% 41.4% 51.7%

67 | C : S t r u c t u r e d C o n v e r s a t i o n Q u e s t i o n n a i r e

Appendix C Structured Conversation Questionnaire

Structured Conversation Format Interviewer: ask the following questions and explore, discuss, probe, as needed, the following topic areas: 1. Please describe how you interact with the DAC/DAC’s Office OR your role within the DACs Office (for those who work in DACs Office) 2. What do you view as the most important purposes and end products/outputs of DAC Offices? 3. What is your vision of an optimally functioning DAC Office? (for example, one that develops a sound District Plan on time, helps providers and consumers work together effectively, manages data, manages budgets, etc.) 4. What skills are most important for a DAC to be effective? (probe for specific individual factors such as administrative skills, leadership, data interpretation ability, ability to build staff capacities, political astuteness, etc.)

5. Do all of the necessary skills need to reside in the DAC or can staff working under the DAC possess the specialty training (with less specialization residing in the DAC)? 6. What is working well in the current situation?

7. What in the current situation do you think could be strengthened? 8. What are potential ways to measure how well a DAC Office is functioning (what might be good indicators)?

9. Who are the key partners that contribute to optimal DAC Office performance? (Probe for details about governmental and non-governmental entities)

10. Are there other questions I should have asked you or areas on which you would additionally like to comment?

68 | D : S u m m a r y o f S t r u c t u r e d C o n v e r s a t i o n F i n d i n g s

Appendix D Summary of Structured Conversation Findings

Skill Area Skill Indicators Identified Gaps Identified

Group Identifying Gaps

MLG

/DP

HC

S

Lead

ers

MLG

Oth

er

NA

CA

DC

& D

O

DH

MT

S &

CD

CSO

DA

C O

ffic

e

BO

TUSA

Leadership

Express strategic vision for district consistent with NSF

Leadership; role clarity X X X X X X X

Identify key people for planning and intervention activities; Bring everyone together; Synergize efforts; Engage and, motivate key people to participate in EBP; Present information effectively in order to engage people

Mainstreaming; Motivating/supporting DC & other leaders to prioritize HIV; Proactively reaching out to community & IPs; Motivating IPs with outside funding to report their data

X X X X X

Understand & be able to explain data and their implications; Use available data to guide planning and implementation

Information unpacking, distilling & interpreting

X X X X

Advocacy X X

Mobilize & help solicit resources; Reach out to funders; Resource IPs

Some areas within districts over- or under-resourced; DACs sometimes have to implement activities

X X X X X X X X

Policy dissemination, analysis, & interpretation

X X

Management

Organizational skills X X

Manage financial interactions to effectively guide, monitor, and report on resource use; Employ basic accounting; math, and budgeting skills;Iidentify resources needed for activities

Financial skills; Financial management; Procurement; Transparency in use of funds

X X X X X X X

Assure activities are implemented as planned, on time, and for population intended; Oversee active project monitoring and M&E activities; Enter/analyze data & complete reports in absence of M&E Officer; Identify issues/problems & their causes, and address

Management/project management; M&E/monitoring; Managing IPs jointly with DHMT; Providing constructive monitoring feedback to CSOs and other IPs

X X X X X X X X

Oversee project assessment & evaluation; assess IP activities for effectiveness, communicate findings effectively

X X


Planning

Manage EBP process for district, observing national guidance and priorities to produce evidence based district activity plan through DMSAC; Identify & address DMSAC & subcommittee needs for capacity building

Quality of evidence used in EBP sometimes questionable; Training skills

X X X X X X X X X

Coordinate planning and implementation of services and activities in district and villages to maximize resources; Share issues and identify village solutions jointly with villages

Minimizing duplication and/or gaps; Resourcing IPs; All stakeholders working together; Poor administrative support for DACs; Mobilizing and motivating VMSACs

X X X X X X X X X

Coordinate data acquisition, analysis, presentation, interpretation, and use to support planning & resource allocation to address needs

Data analysis & use; Data collection forms & reporting formats not harmonized

X X X X X X

Motivate and coordinate key individuals’ and sectors’ full participation in and reporting to DMSAC , Assure sector representation

Motivating people to attend DMSAC meetings

X X X

Manage DMSAC, TAC, & subcommittee meeting schedules; Participate in and facilitate constructive DMSAC interactions; Prepare clear and accurate DMSAC records and minutes

X X X X

Mobilize community and proactively generate community interest & involvement in HIV/AIDS Stimulate stakeholders’ development of

proposals for needed interventions;

Serve as a focal point for linkages and

systems strengthening

X

X

X

X

Review and assess proposals, making clear recommendations to DMSAC and being prepared to challenge proposals, where needed

Proposal writing skills X

Develop project plans/budgets and funding proposals

Project planning; Budgeting; Resource mobilization

X X X X

Oversee assessment/evaluation of annual plan to determine activities’ effectiveness; Use this information to inform new plan

Overall plan is never evaluated, as new planning cycle begins prior to its completion

X X X X X

Coordinate data acquisition, analysis, presentation, and interpretation to support resource allocation and Identify problems; be strategic in efforts, use data appropriately in reports

Data collection tools inconsistent with each other and with reporting formats

X X X X X X


Communication

Explain clearly and effectively communicate information and issues to IPs and community, as well as to national level

Communication between DAC & DHMT through Divisional channels is cumbersome

X X X X X

Identify important issues that need to be preferentially addressed, and communicate this effectively to national level and others, as appropriate

Problems not always communicated to national level for help in addressing them

X X X X X

Effectively provide feedback to community and partners

X

X X X X X

Possess writing skills sufficient to clearly describe and explain situations and data

Writing skills X X X

Take representative and constructive meeting minutes

Writing skills X

Assure required & needed reports are completed accurately and on time

Writing skills; Identifying and reporting implications from observations

X X X X X X

Possess skills to write proposals and funding applications

Writing proposals & funding applications

X X

Possess computer skills needed to prepare and submit reports; Computer literacy

Using BHRIMS correctly X X X X X X X X

Possess presentation skills and computer skills necessary to make effective presentations using PowerPoint or similar software

Making effective presentations

X X X X X

Share information and policies effectively; Archive historical information for ongoing access

X X X X

Interpersonal skills

Interact effectively with diverse cross section of people & partner organizations, especially DHMT, to lead, plan, manage, communicate, supervise, and monitor IPs effectively

X X X X X X X

Network with all of those who need to be involved and create linkages among organizations

Maintaining strong stakeholder linkages

X X X X X

Serve as a bridge between government and NGOs; Develop coalitions with CSOs and partner with NGOs to address a variety of needs and strengthen communities

X X X


Public Health perspective and skills with data

Identify & interpret data and disease trends

X X X X X

Understand and explain statistics X X X X X

Understand HIV/AIDS disease processes and related health issues

X X X X X X X

Understand the health care system X X X X X

Supervision of subordinate staff

Guide office personnel and their activities effectively; Assess and address capacity building needs

Communication from higher levels on staffing issues not always timely; DAC may not fully understand staff specialties; Training skills

X X X X X X

Provide constructive feedback to personnel on their performance

X

Delegate appropriately to personnel Some staff on limited term contracts, making it difficult to rely on them

X X

Research skills

Interpret research findings to community

X X

Identify need for and request special studies to inform activities, Oversee conduct of studies & research

X X X X

Community knowledge

Know what's going on in community, including what NGOs are doing and if within guidelines; Serve as an entry point to community for those developing programs

X X X X X X

Bridge people with programs; Create a service inventory; Link DHMT with those in community

X X X X X

Miscellaneous

Possess psychosocial skills to deal with emotional/sensitive issues

X X

Possess basic life skills and common sense

X

Possess ability to work under pressure

X

Possess behavior change skills to change mindsets within community

X X

Proactivity, creativity, dynamism Actively reach out to others

X

Be educated

X

Infrastructure, personnel, and financial resource support not always adequate

X

X X X X


Key to Respondent Categories: MLG Leaders – Director and Deputy Director, Primary Care Services (Ministry of Local Government, national level) and Director, Department of HIV/AIDS Prevention & Care (Ministry of Health, national level, and formerly Director, MLG Primary Health Care Services) MLG Other – other officials within the Ministry of Local Government, Primary Health Care Services, national level NACA – officials overseeing programs within the National AIDS Coordinating Agency DC & DO – District Commissioners or the senior district administrative officers supervising District AIDS Coordinators (Ministry of Local Government, district level) DHMT – heads and staff members of District Health Management Teams (Department of HIV/AIDS Prevention & Care, district level) S & CD – heads and staff members in Social and Community Development Offices (Ministry of Local Government, district level) CSO – Civil Society Organization staff members, including local Community-Based Organizations and local branches of national Non-Governmental Organizations DAC Office – DACs and staff members in District AIDS Coordinators’ Offices (Ministry of Local Government, district level) BOTUSA – officials with the Botswana-US Centers for Disease Control and Prevention An X marked in a box under a Respondent Category indicates one or more of the individuals interviewed in that category identified the skill/skill indicator and/or gap associated with the respective box.


Appendix E Stakeholder Meeting Agenda and Minutes

Table 3. Stakeholder Meeting Agenda

Thursday March 8th 2012

Time Topic Lead Person

8:30am -9:00am Registration All

9:00am 9:05am Opening Prayer Volunteer

9:05am-9:15am Introductions All

9:15am-9:20am Welcome Remarks Ag. Director – Department of Primary Health Care Services

9:20am-9:45am Background to the Assessment Ministry of Local Government

Background to the Assessment (2) NASTAD (Matsae Balosang)

9:45am-10:35am

Summary of Approach to the Assessment

• Methodology

• Analysis

SMDP (Dacia Davis)

10:35 am –10:45am Discussions All

10:45am - 11:35am Key Findings and Recommendations

• Findings from the Questionnaire

• Structured Conversations

• Recommendations

NASTAD (Wendy Craytor)

11:35am- 11:50am Discussions All

11:50am- 12:15pm Best Fit Response:-

• Thoughts on a customized Applied Public Health Program Management Training Competency Model

NASTAD (Lucy Slater)

12:15pm-12:25 Discussions All

12:25pm-12:40pm Next Steps NASTAD and MLG

12:40pm to 1:00pm Wrap-up:

• Finalization of Report


DAC Skills Assessment

Stakeholder Feedback Meeting Minutes 08/03/03

Mr. Ludick asked for a volunteer to open the meeting with a prayer. All present were asked to introduce themselves. Mr. Ludick then offered welcoming remarks to set the context in which the DAC skills assessment was conducted. He noted that assessment findings will contribute to efforts to empower the district response to HIV/AIDS. This is the right time for a high impact intervention. The epidemic has matured. Responses are no longer in a crisis mode and can be made systematically. Additionally, resource constraints mandate the District AIDS Office must mobilize existing community resources. Additionally, Mr. Ludick noted that, over the past 7-10 years, the number of players involved has increased considerably. DACS require certain competencies to collaborate with other governmental departments, CSOs, NGOs, and the private sector. It is necessary to address DAC capacity building needs in order for them to respond to national and MLG strategies. This meeting is intended to present and foster discussion of the DAC skills audit, and to solicit input from key stakeholders about the assessment and its findings. This input will further assist MLG to move forward strategically to address the DAC capacity building needs identified through the audit. Ms. Balosang noted that DACs are working very hard and DAC Offices are functioning. There have, however, been many changes to DAC responsibilities over the years, as well as entry of a number of new individuals into service as DACs. These factors contribute to broad capacity building needs, and these needs must be addressed for DACs to proceed confidently in carrying out their responsibilities. Ms. Maapatsane stressed the importance of the District Multi-Sectoral AIDS Committee (DMSAC), to which the DAC is integral, and provided a history of how and why the position of DAC was introduced. She noted that individuals becoming DACs in recent years may have different educational and professional backgrounds, as well as different exposure to inservice training on the job, than the earlier cohort of DACs. She also highlighted the nature of the coordinative role DACs fill in engaging the diverse group of current stakeholders and guiding their activities toward a common purpose in their districts’ responses to HIV/AIDS. DACs mobilize and manage community resources. Ms. Davis presented the methodology and analysis approaches the NASTAD/SMDP group used in conducting the skills audit. She additionally reviewed comparative information about locally available training programs. No questions were raised by discussants. Ms. Craytor presented the skills audit findings and NASTAD/SMDP recommendations for new employee orientation, ongoing inservice training, and needs for system/structural changes (as outlined in the draft report previously circulated to those present). It is recommended that applied training


approaches be adopted and training carefully tailored to the situations DACs encounter on a regular basis. Considerable discussion followed among all participants about the nature of the competency gaps identified, the orientation and training previously and currently provided to DACs, the nature of the DAC position responsibilities, and the background training and education of those individuals becoming DACs. It was suggested that the assessment data on competency gaps be further stratified by duration of service as a DAC. A large proportion of current DACs have been in their positions less than two years. The HIV/AIDS and MLG experience of these individuals also appears to be less extensive than those of DACs in service for longer periods of time. This additional analysis will indicate whether the preponderance of needs is among the newer DAC cohort, and will assist in guiding capacity building efforts. Ms. Slater presented several options for a “Best Fit” Response as well as the NASTAD/SMDP customized Applied Public Health Program Management Model for developing needed DAC competencies. There are number of strongly supportive characteristics/advantages in adopting this training and mentoring model and only two identified disadvantages (it requires development of curricula and is impacted by the current shortage of human resources at MLG headquarters). A brief discussion followed. Mr. Ludick then led an extensive discussion of potential Next Steps. Participants introduced additional information about characteristics of locally available training:

• management capacity building is planned for DHMT, to be conducted by the Ministry of Health;

• CCEP uses MLG and MoH trainers, although turnover has reduced the number of trainers actually available;

• the DMI Project (District Management Improvement) has provided training in the districts (ToT and training materials);

• prior capacity building efforts for DHMT were provided by Norway;

• a hybrid approach might select individual pieces from multiple existing training programs to improve sustainability; are trainings conducted in district offices?;

• SMDP trains M&E Officers;

• a two-year field epidemiology and lab training program covering outbreak investigation and surveillance has been proposed by CDC-Botswana; CDC is currently doing an assessment so they can offer the program here. In the meantime, they are conducting a two-week short course that allow includes a trainee-conducted project with individual mentoring. Each trainee shares his/her completed project with the overall group in order to receive feedback; and

• some prior training was done by a Work Improvement Team (WITs). Possible approaches/training models were identified through brainstorming:


• provide individual mentoring to the individuals trained (“executive coaching”), with additional support from the MLG national office;

• if MLG retains control over training, it will be much easier to schedule employee release time and to plan training for appropriate periods during the year (given MLG’s annual calendar and commitments);

• modules could be prepared to support individually-directed learning with access, as needed;

• a modular approach could be supplemented with individual mentoring; mentors could assess individual needs and guide activities to address them;

• DACs could be sponsored to go to existing institutions once per year;

• training could involve other sectors in addition to MLG in the trainee audience, such as community health nurses, home based care personnel, etc. This might foster additional buy-in;

• a toolkit could be developed to support new DACs;

• if an institutional approach is chosen, it will be important to select an institution with a well-established program and also capacitate them to monitor and mentor/coach trainees;

• retention and turnover are issues for DACs – people receive training then they leave (the M&E program has experienced this);

• include the DHT in training on certain issues – this might also improve communications between the DAC Office and the DHMT;

• some inservice training could be provided at DAC meetings, which were held or are scheduled three time this year; meetings could also include peer-to-peer technical assistance (“dinosaurs” helping new DACS) and opportunities to share experiences and learn from each other’s successful/unsuccessful approaches;

• an orientation package for new employees might be developed fairly rapidly;

• the leadership induction course could be condensed to ½ day for DACs; and

• it would be useful to inquire whether the Public Service College would be interested in institutionalizing an added curriculum.

Additional points related to the training model include:

• if a curriculum is developed, piloted with 5-10 DACs, and the outcomes are evaluated as being successful, the probability of government buy-in is improved;

• any customized training effort would need to be branded and differentiated from other trainings; and

• a training model will need to identified before a curriculum is piloted so that the pilot will guide implementation.

Next steps include, at Mr. Ludick’s request:

• NASTAD/SMDP branding of the program (the ways it differs from other training programs) plus

• development of an advocacy strategy to help secure buy-in. Support for moving forward may potentially be provided by NASTAD (CDC-Atlanta funds), CDC-Botswana, and MLG. Potential CDC participation will require further prior discussion. Meetings scheduled for late this week should provide additional information about CDC-related support. It was


noted that NACA is shifting the strategic focus to the district level (requiring district capacities to be enhanced) -- how will NACA support this effort? Ms. Slater wrapped up the discussion. NASTAD/SMDP will proceed immediately with discussions exploring financial support for this effort. Today’s discussion, plus those to take place tomorrow and soon thereafter, should assist NASTAD/SMDP/MLG to also identify the desired training model within the next two weeks. NASTAD/SMDP agreed to incorporate information stakeholders have provided in today’s meeting into the draft assessment report, and finalize the report within the next few weeks. Mr. Ludick thanked all of those present for attending and actively participating in the meeting. He had hoped for feedback on the DAC skills assessment and ways to address competency gaps, and participants certainly have provided this. Participants have also clearly acknowledged the importance of this issue. The meeting closed with a prayer and was adjourned.

78 | E : A P H P M T C o m p e t e n c y M o d e l - B o t s w a n a

Appendix F Applied Public Health Program Management Training Competency Model – Botswana

Competency Definition


Identified Skills Needed by DACs


Planning** Develop, articulate, and implement strategic plans and program plans that leads the organization toward accomplishing its vision and mission

Plan Development:

SMDP Course Curriculum:

• Building Health Programs that Work – Participants learn to assess and analyze public health needs; define a goal and objectives for a public health program; determine a program strategy and intervention; set specific and measureable objectives for a public health intervention; and develop an evaluation plan to monitor program progress.

• Project Management – Participants learn to write a project work plan; generate a work breakdown structure; develop a network diagram and schedule; track and manage the project; and close-out and conduct post project reviews to ensure continuous learning.


• DMSAC Evidence Based Planning Toolkit.(Botswana) - Participants are led through a step-by-step standardized process for the


50% ✓ Add in desk top exercise utilizing national policies to guide development of a model district plan, using skills and approaches described in “Building Health Programs that Work”


29% ✓


33% ✓ Exercise where DACs review, critique, and score sample plans to get ideas of good models to use.“Capstone” exercise where groups of DACs develop limited-scope (evidence-based) plans and are scored by group of DCs, MLG HQ staff, and NACA M&E staff according to pre-developed criteria.


43% ✓ Use district health team ToR and annual district funding streams to DACs to develop a project work plan, using skills and approaches described in “Project Management”

Prioritization:


48% ✓ Exercises on prioritizing work activities based on DAC-generated examples of situations in their offices. Include

Literature Review Self-Assessment Structured Interviews Implementation






approaches to prioritizing one’s own activities when not in control of one’s schedule – predicting patterns in demands based on calendar, others’ routine schedules, etc.

development of the Botswana Annual District HIV plan; steps cover assessment, gap analysis, prioritization, and plan development; tools, formats, a timeline, and instructions for completion are provided

• Developing a State Model for HIV Prevention and Care.(Nigeria) - Participants articulate the country-specific roles and responsibilities of federal, state and community in developing a comprehensive HIV response, identify state level needs and gaps, and develop a TA and advocacy plan.

Logistics:


48% ✓ Exercises using actual examples of situations when DACs would need to solicit, establish, and monitor contractual arrangements.


31% ✓ Exercises to explore what different funders are seeking and what their interests are, involving funding agency representatives, if outside sources are being sought.


36% ✓






Coordination Integrate the work of different

groups to pursue common

goals


28.5% ✓ Exercises using DAC-generated examples of situations they have encountered and, if available, procedures and approaches they have employed (successfully and unsuccessfully).


• DMSAC Evidence Based Planning Toolkit. (Botswana) - Participants are led through a step-by-step standardized process for the development of the Botswana Annual District HIV plan; steps cover assessment, gap analysis, prioritization, and plan development; tools, formats, a timeline, and instructions for completion are provided


36% ✓


14% ✓

Decision Making**

Make timely decisions based

on available facts, constraints,

and anticipated consequences

Use evidence and data to identify planning and implementation priorities and to facilitate decision making.*

Not Asked ✓ Provide descriptive data for a hypothetical district. Conduct a planning exercise to assess and prioritize activities proposed by IPs, looking to reduce service duplication and/or more clearly focus on local problems. Develop clear recommendation(s) to the DMSAC about how to proceed. Follow-on to above exercise with case(s) addressing how one might work with the affected IP(s) to provide, guide, and/or identify sources of Capacity Building assistance (use this exercise to familiarize DACs with any potentially available resources).

Additional possible scenario: The DMSAC’s intervention priorities have been selected by vote in past years and the #1 priority has been reducing teen pregnancy. There is a large need in the district, and especially in smaller surrounding villages, for HIV counseling


• Putting Data to Work – Participants learn to apply a five step method for using data to make decisions; organize and present data effectively; and use data to align program activities and decisions with organizational or national strategies.

• Values-Based Decision Making – Participants learn to conduct dialogue with stakeholders to identify important values for making a decision; identify the potential unintended and negative consequences of a decision; and communicate decisions using a decision summary form.







and testing, and there is a CSO who does VCT that could potentially operate in the remote areas. You cannot support both types of activities. What will you recommend, why, and how will you proceed?

• Data for Decision Making (India) – Participants learn about sources of national and local data, how to use within local settings, and using case studies and field assignments, learn what kinds of data need to be collected and applied in order to solve local public health problems

• Working with Surveillance Data (Haiti) – Participants use existing data sets and case studies to develop epidemiologic profiles


48%

Recognize issues, problems, or opportunities to determine when action is needed.*

Not Asked ✓ Provide case scenario (with data) that includes important issues and those less so. Request DACs to identify what issues should be presented to DC and prepare a briefing memo to do so.

Communication** Speak and write clearly, adapting communication styles and methods that are appropriate for the needs of the intended audience

Information Dissemination:


• Writing Success Stories: Impact and Value – Participants learn to use success stories to support a public health program; determine the audience for your success story; describe the components of a good success story; and create an outline for a success story.

• Effective Presentation Skills – Participants learn to develop and organize presentation content; prepare and deliver a more effective presentation; and use visual aids and supportive materials effectively.

• Crisis Communication – Participants learn to anticipate communication


57% ✓ Provide situational examples and ask teams of DACs to review evidence provided and formulate recommendations. Explore ways to substantiate, communicate, and present recommendations.


64%

Disseminate polices and archive information for public access. *

Not Asked ✓

Oral Communication:


34% ✓ Exercises involving presentation to groups using basic and available computer software, providing basic instruction and pointers on effective use.







28% needs based on the crisis communication lifecycle; build credibility with six emergency message components; identify populations who may require a specific message; and handle difficult behaviors in a crisis.

• Public Health Advocacy – Participants learn to write an ‘elevator’ speech; identify partners to help your program succeed; identify sources for public health funding; and develop an advocacy work plan.


• Health Communications and Advocacy (India) – This week long course uses case studies, desktop exercises and field assignments to provide participants understanding on how to work with the media to achieve public health goals, basic principles of social marketing, coalition building and other methods of advocating for policy change. Participants develop skills in different methods of communication- story telling, narrative; writing press releases; conducting press conferences; and in writing proposals and advocating for funding.


23% ✓ Exercises on how to organize and facilitate meetings (with approaches to accommodating different types of participants and scheduling conflicts), consensus building techniques, and ways to record/report minutes (e.g., use of Executive Summary to help improve probability that DC or other leaders will read the minutes, especially if not direct participants)

Written Communication:


23% ✓ If not already in existence, develop electronic library of sample formats for documents, such as routine reports to highlight relevant issues for district and/or national level attention, meeting planning checklists, meeting minutes, IP and program activity inventories, internal office functions (calendaring, organizing, scheduling required staff assessments, etc.), formats for reporting special studies, PowerPoint tools that report/display routine data, etc. Use in case examples to assure DACs can access and use on their own when at the office.

Complete required reports accurately and on time, using the appropriate software.*

Not Asked ✓ Exercise involving using existing reports/formats and entering data into BHRIMS (electronic and paper formats, as needed), selectively including variables where data are not collected (e.g., cause for OVC being orphaned), and those






where data collected by DHMT are different in definition or aggregation than those needed for BHRIMS. (May involve DHMT as trainers.) Seek consensus from NACA first about how to report these variables. If BHRIMS has functions to allow DACs to produce reports, use in exercises. Demonstrate through cases applications identification of common reporting pitfalls (data entry errors, omissions, checking to see if the value matches expectations and common sense, and if not, why not, etc.)

Advocacy:

Ensure support from upper management and key stakeholders for program/project plans and activities.*

Not Asked ✓

Collaboration & Partnering** Establish and maintain relationships to achieve organization goals Or Develop networks and builds alliances; collaborates across boundaries to build strategic relationships and achieve common goals

Partnership Development:


• Stakeholder Analysis – Participants learn to define the steps in conducting a stakeholder analysis; identify the key elements to include in a stakeholder profile; list the steps in a Ladder of Participation; and identify categories and methods of participation for each stakeholder.


• Community Planning (Botswana, Ethiopia, Cambodia, Caribbean) -


57% ✓


40% ✓ Use case example(s) of how a DAC might use local data to encourage IPs to report (reasonably) accurate data on a timely basis, even if they’re not funded by DMSAC.

Engage community leaders to help advocate for the availability, accessibility and utilization of HIV

59% ✓






testing and other national programs in the community.

Participants learn methods for involving, empowering and retaining community partners to contribute to development and implementation of jurisdictional HIV plans


26% ✓

Monitoring & Evaluation**

Process for tracking activities and assessing the performance of those activities, and/or using assessment results to reassess program activities

Data Collection:


• Process Improvement – Participants learn to define a process; measure process performance; analyze causes of variation; generate and plan improvement ideas; implement changes; study the results of changes; and act according to the results of the study.


• Epidemiologic Data Use (EDU) (Zambia) – Participants learn strategies to strengthen the quality of health data collection and reporting, and are afforded opportunities to develop plans for collaboration and interaction among provincial and district-level staff on provincial/district level epidemiologic profiles and M&E plans in support of national strategic frameworks

• District Monitoring and Evaluation (Zambia) – Participants are

Set clear, well-defined outcomes for work activities.

67% ✓


74% ✓


24% ✓

Monitoring:


37% ✓


69% ✓

Evaluation:


92% ✓






Make recommendations based on evidence and data.

45% ✓ Provide cases with pertinent and non-pertinent HIV-related data and other programmatic evidence for teams of DACs to review and formulate recommendations. Include instances where additional data may need to be requested. Discuss approaches to formulating, substantiating, and presenting recommendations.

introduced to national HIV monitoring and evaluation requirements and learn how to collect, assure quality of, and report district level data to provincial and national counterparts. Participants also learn how to use district level data to inform district HIV planning and coordination processes Present results and lessons learned

to stakeholders. 61% ✓ Provide cases with realistic examples of

program activities (government and CSO). Have teams of DACs review, extract lessons learned, and make presentations to a mixed group of governmental and non-governmental stakeholders for review and critique.

Human Resource Management** Acquire, maintain, and retain human resources

Employee Management:


• Performance Management – Participants learn to develop a positive work environment that encourages high performance; align and motivate work teams to a common purpose; adapt management style based on individual needs; set and communicate clear expectations and objectives; provide effective and timely feedback to both reinforce and improve performance; address behavioral and performance problems with employees in a constructive way;


75%

Ensure roles and responsibilities are clearly defined.

38% ✓ Exercises on managing staff and defining roles. Involve NACA staff who place program staff in DACs’ Offices in role playing exercises (NACA staff playing DACs) so that the potential conflicts also become clearer to them. Include providing constructive and objective, evidence-based feedback to staff, as well as potential capacity building strategies/resources.

Ensure reporting lines are clearly outlined.

41% See above exercises.







47% ✓ Provide cases with DAC-generated examples. Use role playing and develop work plans in these exercises.

and conduct a performance appraisal.

• Team Building – Participants learn to how to create more effective working relationships among team members; articulate methods for creating positive and productive team agreements and norms; select specific skills and tools when creating alignment within diverse teams; choose effective responses to resolve common problem behaviors present in teams; and identify ways to develop productive working relationships within teams.

• Conflict Management – Participants learn to identify common causes of conflict; recognize conflicting priorities and personalities within a work team or between a manager and employee; use productive strategies to resolve conflict; and describe ways to prevent conflict

• Coaching and Mentoring – Participants learn to use key principles and skills when coaching and mentoring others; choose appropriate coaching and mentoring methods when fostering professional development in others; and develop a brief action plan to facilitate their further

Capacity Building Training:


61% ✓ Provide descriptive data for a hypothetical district. Conduct a planning exercise to assess and prioritize activities proposed by IPs, looking to reduce service duplication and/or more clearly focus on local problems. Develop clear recommendation(s) to the DMSAC about how to proceed. Follow-on to above exercise with case(s) addressing how one might work with DMSAC in priority setting/proposal assessment, and with the affected IP(s) to provide, guide, and/or identify sources of Capacity Building assistance (use this exercise to familiarize DACs with any potentially available resources).


53%


78%


73%







Monitor and appraise performance of staff.

26% development of coaching and mentoring skills.

• Manage Your Time: Manage Your Stress (Time Management) – Participants learn to prioritize daily tasks; and use methods to minimize interruptions.


• Leadership and Management (India) - This week long course uses case studies, desktop exercises and field assignments to impart knowledge, competencies/skills, and influence attitudes in the following areas: use of organizational assessment using tools like SWOT; Plan procedures/system to manage individual, project, and institutional needs/gaps; evaluate and revise existing HR SOPS with reference to: organizational chart, job descriptions, recruitment policies, retention strategies, and replacement preparedness; Recall and practice principles of effective team work; List and practice effective leadership characteristics ; Practice effective time management tools and principles; Identify strategies to resolve conflict when confronted with a team conflict situation; Recognize barriers and facilitators

Team Building:


45%



57% Exercises and role playing using DAC-generated examples of conflicts encountered in their work. Employ different approaches to resolving conflicts (successfully and unsuccessfully) and include examples of when assistance from higher authorities is appropriate.






to change within a team/project/program

• Leadership Development (South Africa) The Programme Administration - module in this tool-kit provides instructions and tools for readers to address: Self-assessment of management skills, team work, supervision, staff development, budget and resource management, communication, rules and regulations, departmental policies, staff roles and responsibilities, office management and professional etiquette

Financial Management Estimate, justify, and manage appropriate finding levels to support mission accomplishments

Budgeting:


• Introduction to Grant Writing – Participants learn the grant application process; main sections of a grant application; and roles on a grant writing team.


• Leadership and Management – Financial Management (India) - Using lecture, case studies and field assignments, this session provide participants an overview of ways to monitor and manage project finances; an understanding of the budget’s potential as a dynamic management tool, supporting project planning, implementation,


42% ✓ Financial management exercises to track/monitor funding obligations and expenditures, and expenditures of funds by IPs (relate expenditures to activities expected during that time period). Introduce use of spreadsheets, if appropriate. Stress conducting timely monitoring and intervention, direct field observation of activities, timely reviews of reports, auditing IP financial records, and providing timely and constructive feedback.

Advise management of budget problems identified.

35%

In exercise above, include case where situation indicates need to inform higher authorities (e.g, large over- and under-






expenditures compared with stage of project, suspected misappropriation of funds, etc.)

and evaluation and skills for budget development and revision.

• Contract Management (South Africa, Ethiopia) - NASTAD tools and training provide participants with understanding of the purpose of an RFA, a bidding process, responding to and review proposals, developing contracts with successful applicants, as well as providing skills for management and monitoring of contracts.

• Proposal Writing Workshop (Nigeria) - Participants maximize tools and skills needed to submit a functional proposal to an international AIDS organization. During the workshop participants generate the elements of a sample proposal develop a structure and format for writing requests for proposal and learn to critique written proposals regardless of agency or grantor

Public Health Knowledge Understand the health status of populations, determinants of health and illness, factors contributing to health

Understand HIV/AIDS and related health conditions.*

Not Asked ✓ Provide basic public health overview/orientation, using HIV-specific and related health problems (e.g., TB, STD), with definitions, data use examples, and hands-on exercises.


• Introduction to Public Health (India) - Using lecture, case studies and field assignments, participants learn the basic biology of the HIV






promotion and disease prevention, and factors influencing the use of health services

Understand the organization and functions of the healthcare system.*

Not Asked ✓ Include healthcare system information in applied exercises, above.

virus, discuss the core functions of public health with specific application to HIV, are provided with overview of Global HIV Epidemic and address issues of cultural competence and ethics in a public health response to HIV

• Leadership Development Toolkit (South Africa) - This toolkit provides instruction and tools to provincial AIDS directors in South Africa on responding to the South African HIV epidemic. Section one provides an introduction to HIV & AIDS and public health, followed by individual chapters on specific components of a comprehensive HIV & AIDS programme including prevention, care and treatment, sexually transmitted infections and blood safety.

91 | F : O r g a n i z a t i o n a l N e e d s I d e n t i f i e d i n S t r u c t u r a l C o n v e r s a t i o n s

Appendix G

Organizational/Structural Needs Identified in Structured Conversations

The 51 individuals included in structured conversations spoke about multiple facets of the DAC’s position and responsibilities. In addition to questions about skills important to effective DAC Office functioning, participants were asked, “What is working well in the current situation?” and “What in the current situation do you think could be strengthened?” They were also offered an opportunity to make any additional comments they felt were relevant at the end of the conversation. Respondents expressed opinions about changes to existing systems or practices they felt would, directly or indirectly, strengthen DAC Office work outcomes, improve the DAC’s working environment, and/or facilitate DAC interactions with the respondent’s department or organization. A number of themes were recurrent across respondent categories. The general themes identified are described below. If these reported perceptions are accurate, they offer some insight into system operations and may indicate areas where remedial action could be taken. Potential approaches to some of the identified issues are suggested and might require only limited resources. DAC role clarity Issues identified include:

• Not all stakeholders/players understand the DAC Office’s role. Independent funders or even the national-level offices may not work through the DAC and the NGOs/CSOs they fund may duplicate other efforts in the district. This can result in “over-resourcing” certain districts and having relatively few in others. If donors directly fund entities, this can also result in problems for the DMSAC in getting these entities’ data for planning purposes.

• In some districts, DACs may end up implementing rather than coordinating activities. This is particularly difficult to prevent in remote districts, where CSOs may not exist or may lack the capacity to implement. If the DAC implements part of the District Plan’s activities, this diverts time from necessary coordination and monitoring activities. Additionally, a DAC can’t effectively monitor activities s/he is implementing.

Potential approaches include:

• MLG has proposed updates to the DAC job description. These changes could be introduced as a logical part of a larger effort to share information about the DAC’s role widely with stakeholders.

• DACs could be reminded by national MLG and supported by their DCs to try to avoid implementation activities (even though others may continue to encourage such activities).


Planning cycles and processes Issues identified include:

• The current HIV/AIDS planning process is conducted annually through the DMSAC. The new plan is developed and adopted before the existing plan’s activities have been completed. The existing plan and its interventions are not evaluated to determine how well the activities went -- each plan stands alone and doesn’t inform the subsequent plan.

• The District Health Management Team (DHMT) planning process located within Botswana’s Ministry of Health (MoH) is parallel to but separate from, and on a different cycle than, that of the DAC/DMSAC. Additionally, the DMSAC reporting path goes from DMSAC to MLG to the National AIDS Coordinating Agency (NACA), so DMSAC plans are not readily available to MoH staff when they do their planning. The two plans may not complement each other as fully as might be the case with greater information sharing.


• A two or three year DMSAC planning cycle would be more streamlined and would allow for better evaluation of intervention activities than does the current annual planning cycle. It would also offer a consistent direction over multiple years that DHMT could complement in their plans, if they so chose.

• If DMSAC plans remain annual, DAC and DHMT offices might do some or all of their planning together. This could help their activities better complement each other. If joint planning is not practical, the DMSAC plan could be formally shared with the DHMT (since the DHMT is represented on the DMSAC, informal sharing can occur now). The following was offered as an example: “The DAC and DHMT serve the same target populations and sometimes have the same IPs (Implementing Partners). The DHMT also implements activities. If there were no DMSAC funding available for a certain activity, MoH might be able to fund or implement it.”

Data collection, reporting, and interpretation Issues identified include:

• The DAC reporting tool (BHRIMS) captures different variables, and/or captures some of the same variables differently, than the tool the DHMT uses to collect data and report to the DMSAC. Not having harmonized forms and consistent variable definitions may lead to inadvertent misuse of the data in DAC reporting, and cause unnecessary and unproductive conflict between the DAC and the DHMT.


• MLG and MoH ideally would jointly harmonize data collection tools and required reports, potentially reducing the number of different tools in use. Until this was completed, or alternatively if harmonization is not now possible, higher level personnel could jointly identify consistent ways for DACs to handle data in those areas where problems are most frequently encountered.


• The DAC M&E Officer could work closely with the DHMT M&E Officer to help collect the needed data. This would assist the DAC M&E Officer to more fully understand the data and guide their accurate use within the DAC Office.

DAC-DHMT communication Issues identified include:

• Since the DHMT was organizationally relocated to MoH, the communication channel between the DHMT and DAC has become cumbersome, as the DAC has to go through MoH Administration to contact the DHMT.


• Areas of communication where DAC and DHMT personnel should communicate directly and those where personnel should work through formal administrative channels could be jointly outlined by the DC and DHMT head and shared with the affected staff.

DAC skills Issues identified include:

• DACs need to understand health issues and terms in order to effectively work in HIV/AIDS, and need to understand the health system to work most effectively with the DHMT and others.

• The DAC needs to have credibility with district administrators and to command sufficient personal authority to bring the necessary people to meetings. Such credibility is supported by being well-oriented and trained.

• Specialized technical skills can be represented across the combined DAC Office staff, but the DAC needs to understand all technical areas sufficiently to guide the staff responsible for them as well as to submit reports in the absence of specialized personnel.


• A comprehensive orientation conducted soon after a DAC enters his/her new position, covering the DAC’s key partners, resources, expectations, roles, and a minimum package of skills, would help prepare new DACs to function at a basic level of competency.

• A comprehensive training program would ideally provide refresher training for existing personnel, basic skills for new DACs, and ongoing training to increase DACs’ skills to address a changing environment. The training model needs to be sustainable and training needs to be available on a continuous basis to accommodate high turnover in DAC positions.

DAC retention Issues identified include:

• It is difficult for a new DAC to perform at a high level right away. If a DAC is not well-prepared to confidently carry out his/her job responsibilities, the resulting frustration may lead him/her to leave the position before the needed skills are acquired.


• High turnover in the DAC Office makes it more difficult for the people who interact with the DAC to work with them. They have to learn how to work with a new partner each time there is a change, and different people’s priorities may differ.

• There is no defined career path/progression or promotion available to DACs, other than the few central office MLG positions at the national level. This situation was cited as one contributor to DAC turnover.


• Supplementing new DAC orientation and ongoing training efforts will increase participants’ levels of confidence in their job abilities and potentially support higher retention rates.

• A lack of career progression opportunities is not unique to the DAC position. Former DACs now occupy many positions of significant responsibility in other areas of government. The training and experience gained while they were DACs appear to have served them well.

Other The areas listed below were also mentioned and are presented for informational purposes, only:

• DAC Offices in some areas are not fully staffed and positions may remain vacant for extended periods.

• The DAC’s relatively junior position can make coordination more difficult, as higher level individuals may not respond to the DAC alone. The District Commissioner (DC) needs to actively support the DAC, but turnover among DCs is high, they have many competing priorities, and their offices may lack capacity to fully support the DAC. The DAC needs to help the DC see HIV as a cross-cutting issue that can bring people together.

• Some DAC Offices lack sufficient space, equipment, access to administrative support, and access to transport. These situations can interfere with DAC Office work and may lead others to conclude HIV is considered unimportant.

• Some staff (e.g., M&E Officers) are on contracts so the DAC can’t directly rely on them.

• DHMT personal development plans (PDP)s don’t include DMSAC participation.

• HIV/AIDS is multi-sectoral but the other departments vary in their involvement and don’t have HIV mitigation in their PDPs/job descriptions. They conduct HIV/AIDS activities as they have time. The person assigned to HIV is often very junior, and these AIDS Coordinators may not feel a need to report to the DAC/DMSAC.

• The DMSAC ToR lists which stakeholders should be DMSAC members. DMSAC composition often needs to be more flexible to respond to local circumstances, as stakeholders may differ in different districts.

• The DMSAC is HIV/AIDS only. The District Development Committee is a second structure but often involves the same people as the DMSAC. This is duplicative – why not streamline the DMSAC into the community so the DMSAC doesn’t “own” HIV?

• Village Multi-Sectoral AIDS Committees (VMSACs) can be a helpful link to take services to the village level. VMSAC members are volunteers. Some other committees, such as the Village Development Council, offer allowances and people may therefore choose to serve on them rather than on the VMSAC. Some villages are very small and one person may serve


on seven committees. Why not combine the VMSAC and the Development Committee and/or the Health Committee?

• It is sometimes asked where the DMSAC should be based. They’re now in local government under the district’s local authority. Is a line of authority with NACA more appropriate?

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