Taking the pulse of policy: strengthening national HIV policy implementation in Central America
L. Merino1, C. Quinto1, A. Jorgensen2, A. Bhuyan3, S. Sharma3
1Futures Group, PASCA, Guatemala City, Guatemala, 2Centre for Development and Population Activities (CEDPA), Health Policy Initiative, Washington, United States, 3Futures Group, Health Policy Initiative, Washington, United States
Issues: Even the best HIV policies can encounter implementation barriers. Attention to policy issues should not end with the policy´s adoption, which is only the beginning of the policy-to-action continuum. Policies are "living documents" that need leadership, resources, monitoring, and other inputs to achieve their goals. The USAID | Health Policy Initiative (HPI) designed the Policy Implementation Assessment Tool (PIAT) and guide to assist government and civil society advocates to "take the pulse" of policies. The tool helps stakeholders understand policy dynamics and identify recommendations for translating policies into action.
Description: PIAT is composed of questionnaires for policymakers and implementers/other stakeholders. Questionnaires explore seven dimensions of implementation: policy, context, leadership, stakeholder involvement, planning and resources, operations, and feedback. HPI and PASCA collaborated with in-country teams to assess national HIV policies and plans throughout Central America (Costa Rica, El Salvador, Guatemala, Panama). Each assessment involved interviews with about 25-35 policymakers and implementers, and has been followed up with policy dialogue and advocacy.
Lessons learned: Assessments identified barriers to policy implementation that hinder HIV program delivery, such as the need to strengthen CONASIDAs, enhance multisectoral engagement, and build NGO capacity to access and use funds. In each country, the tool and dialogue process have inspired renewed commitment and action to support policy implementation. For example, Guatemala established a board to monitor reproductive health and HIV policies, while El Salvador is using the findings to design its new HIV strategic plan.
Next steps: Regular check-ups and renewed commitment can keep policies on track toward achieving goals. The tool brings together partners from various sectors; identifies implementation barriers; encourages dialogue on country-owned solutions; and results in concrete action items to improve implementation and accountability. The tool can be adapted for other countries, at different levels (e.g., state, district), and for various health policy issues.
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