Dr. Paul Zeitz, The Global AIDS Alliance
Laura Ostenso, associate at Innovation Network, spoke with Dr. Paul Zeitz, executive director and co-founder of the Global AIDS Alliance (GAA), about the evaluation of the Campaign to End Pediatric HIV/AIDS (CEPA).
Please tell us about the Global AIDS Alliance and CEPA.
The Global AIDS Alliance (GAA) launched in 2001. At the time, there was strong demand from health and aid advocates internationally for an organization to mobilize advocacy on global AIDS issues. GAA provides a vehicle and a voice for holding governments accountable for ending the global AIDS pandemic. We do our work in collaboration with a broad array of civil society partners, including U.S. and global AIDS advocates, humanitarian and relief agencies, and faith-based organizations.
The Campaign to End Pediatric HIV/AIDS (CEPA) is a transnational advocacy campaign we launched to (1) eliminate parent-to-child HIV/AIDS (PPTCT+) transmission; and (2) increase access and coverage to pediatric HIV/AIDS prevention and treatment services. Currently, governments provide insufficient resources to achieve universal coverage for prevention and treatment services.
We want to increase resources for these services around the world, with an initial focus in six countries: Kenya, Tanzania, Uganda, Zambia, Nigeria, and Mozambique. We are tapping into GAA advocacy networks in these countries, as well as at the regional and global level. Of course, the number of partners around the world who are working with CEPA make it hard to measure our progress! But we are learning all the time about how to do that, and about how to have a greater impact in this arena.
How did you begin to integrate evaluation into your work?
We had always been interested in evaluating our work at GAA. CEPA provided our first opportunity to really integrate or embed evaluation into what we are doing. We wrote monitoring and evaluation (M&E) directly into the funding proposal. When it was approved, our key funder, the Children’s Investment Fund Foundation (CIFF), decided to directly invest in an M&E partner to support the campaign. The M&E partner would also conduct mid-term and final program reviews with oversight by an independent review panel. CIFF requested that GAA conduct a global search for models and approaches that were applicable to transnational advocacy movements. This is how we connected with iScale and learned about their “Impact Planning, Assessment, Reporting, and Learning” (IPARL) approach. iScale appealed to us because their approach is flexible and syncs monitoring and evaluation to our advocacy timeline. Conventional evaluation doesn't fit well with the chaotic nature of advocacy. CIFF agreed that iScale was the best partner to support the CEPA effort.
Another challenge was the scope. The evaluation needed to account for the work occurring at our headquarters in Washington, D.C., and among our large network of regional and in-country advocates, through our local-to-global campaign network. Based on IPARL, we developed a comprehensive theory of change for the campaign. In so doing, the evaluation helped to create synergy among the local, regional, and global partners; it became almost like a connective tissue to ensure that we could develop an aligned agenda and a common approach to learning, course correction, and monitoring advocacy impact.
Can you tell us about the IPARL approach?
The IPARL approach supports our ongoing learning and informs CEPA strategy as it evolves. Its goals are to assess our outcomes and impact, strengthen relationships within the network, sustain credibility and legitimacy, and educate our key stakeholders.
One of the first things we did in planning the evaluation was to identify the outcomes we are trying to achieve. Our campaign is focused on achieving interim outcomes in three years that will meaningfully contribute to our long-term goal of reducing cases of pediatric HIV/AIDS overall. CEPA’s interim outcomes include, for example, raising awareness among policymakers, constituents, and the media about the need for increased pediatric HIV/AIDS services.
Some of our methods for tracking those outcomes are:
Scorecards that illustrate our progress in attaining key performance indicators that link to our interim outcomes (such as affecting policy decisions and/or documents, and increasing media coverage of CEPA issues)
Evidence of change journals that document evidence of advocacy impacts, such as when, who, and with what information a policymaker, member of the press, or network partner calls to request information about CEPA.
Comparative case studies that examine which advocacy strategies worked and how they worked in different contexts (e.g.., in different countries and with different partners).
Most importantly, the IPARL approach helps us to keep our focus on what we need to do to achieve people-level impact. By this, I mean that even though that one aspect of our advocacy work is aimed at securing funds, we are ultimately trying to help real people who are most in need of treatment and prevention services in our focus countries.
To have people-level impact, we must look at potential “bottlenecks”that can prevent our outcomes from being achieved. We monitor two types of bottlenecks—implementation and policy. Implementation bottlenecks include, for example, a lack of local skilled health care professionals to provide pediatric care. Policy bottlenecks include things like an overreliance on external funding for antiretroviral medications, or funding shortfalls and delays in disbursement from both domestic and international sources.
Using monitoring and evaluation to help us keep our focus on what we need to do to have people-level impact instills integrity into our work. We aren't just securing funds for parent-to-child transmission and pediatric treatment programs for the sake of it. We are ensuring the funds are used to treat and prevent pediatric HIV/AIDS on the ground. Watching for bottlenecks also allows for continuous learning because we monitor our work to ensure that we overcome these barriers.
What has surprised you, if anything, about the CEPA evaluation?
The most exciting thing is that IPARL has moved us away from basing our monitoring and evaluation efforts primarily on activities and outputs. We now focus on outcomes. The whole process of clarifying those outcomes (which happened across all of our 40-50 partner organizations!) changed our thinking and got us on the same page. It had a ripple effect and helped us take rapid steps forward on our advocacy.
The system we developed is fairly elaborate and required a great deal of refinement. We even edited it live and voted on it. In the end, when there was consensus, we had a seven-part advocacy agenda, which we call the CEPA Nexus, which was agreed by all of the national, regional, and global partners. (The agenda focuses on integrating specific HIV/AIDS guidelines into policies, increasing funding allocations to pediatric HIV/AIDS programs, and overcoming implementation barriers such as lack of trained health professionals in focus countries.)
Really, it is fascinating, because agenda setting is the cornerstone of strategic advocacy and IPARL streamlined that process. The process of planning our monitoring and evaluation brought us to consensus on what we are trying to achieve, and now makes us accountable. It felt almost like marriage—we truly committed to achieving our agenda.
What lessons about evaluation would you pass on to other advocates?
CEPA’s use of IPARL has shown us that evaluation can help us improve our advocacy results. Even the process of planning the evaluation was useful. It is our moral responsibility to do this work to the best of our ability because it affects people. This requires that we be accountable, and thus responsible to adapt, learn, and then apply what we have learned to complex global challenges.
I would also say that the monitoring and evaluation game has changed in two ways: There is less money for advocacy and evaluation, while at the same time there is more demand for accountability. It is challenging, but there are common denominators that make evaluation like IPARL really important for advocacy. They include:
Instilling Integrity. IPARL has helped us know that we are making progress and know that our advocacy is achieving results. We are keeping our word on achieving our goals.
Optimizing what we already have. We have many mechanisms (such as the United Nations’Millenium Development Goals) for trying to reduce global health problems like malaria, HIV/AIDS, and even pediatric HIV/AIDS.But, we do not optimize these mechanisms as much as we could. We have urgent problems, and evaluation helps us to be adaptable in solving complex global challenges.
Moving money into people-level impact. Advocacy needs to achieve people-level impact in the long run. We have to focus on what is realistic to achieve in the timeframes we are working in, but our work and our evaluations must keep the focus on real results for real people.
Dr. Paul Zeitz earned his medical degree from the Philadelphia College of Osteopathic Medicine and completed an M.P.H. and a preventive medicine residency at Johns Hopkins University.
He has nearly two decades of experience as a public health specialist in developing nations, and has held positions with the World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention.
For more detailed information on CEPA’s transnational network advocacy, including its evaluation, download the July 2010 report, Accelerating National-Level ACTION to End Pediatric HIV/AIDS: An Advocacy Toolkit.
