manual for designing and facilitating training workshops

Planning for the Health Sector Response to HIV/AIDS: Manual for designing and facilitating training workshops

Draft December 2010 1

WORLD HEALTH ORGANIZATION Planning for the Health Sector Response to HIV/AIDS Manual for designing and facilitating training workshops

DECEMBER 2010

Content 1. Introduction 2. Training objectives

3. Structure of the training course

i. Module 1 Unit 1 Unit 2

ii. Module 2 iii. Module 3 iv. Module 4 v. Module 5 vi. Module 6

3. Proposed five day workshop agenda 4. Preparing for the training workshop

i. Facilitators ii. Assessment of participants prior to the training iii. Adaptation of the standard curriculum iv. Logistics v. Ground rules during workshops vi. Feedback on the workshop vii. Follow up and evaluation of participants

5. Training and learning tips i. Adult learning ii. Meeting expectations of participants iii. Keeping record of contributions

6. Resources

a. Essential reading materials (by Unit) b. Additional references and tools (global & regional)

c. Access to Support

Structure of a Unit • Objectives • Duration

• Content • Methodology • PowerPoint Presentation

• Handouts • Key messages • Essential reading

material



Introduction

Background

National health policies & strategies (NHPS) play a critical role in strengthening health systems and in delivering effective interventions in an integrated approach to accelerate progress

towards the health MDGs and in wider health outcomes. NHPS vary considerably in their scope, quality, relevance, and influence over other Ministries, and partners.

Better health outcomes depend on effective interventions delivered by better health systems. Better health requires coherent policies and a comprehensive approach that also addresses the

social, environmental and economic determinants of ill-health. Outcome, interventions, programmes and systems come together in a robust national health policy & strategy.

Within the health sector the response to HIV and AIDS needs careful strategic planning. HIV and AIDS are still not fully part of the usual, traditional medical and public health services that the

health sector provides. There are large resource differentials, both in terms of supply (available funding) and demand (costs of ART for example) compared with more traditional service delivery programmes such as malaria, family planning, MCH, and in-patient medical

care. This means that HIV/AIDS strategic planning in the health sector must be based on precisely identified results, and be carefully managed to ensure that it fits into, and supports

the implementation of, larger health sector planning frameworks. In addition, it can be difficult to distinguish between HIV-specific services and other health

services: hospital care for AIDS patients is usually a part of overall hospital care – not a separate medical service; similarly for logistics and supply chains for drugs, laboratory services and training of health workers. Thus strategic planning for HIV needs to carefully identify, and

plan for the implementation of specific HIV-related interventions, HIV-related elements in wider health care interventions, health system issues which impact on HIV services, and how

the delivery of HIV services impacts on the ability to provide other services. WHO developed this training course to strengthen the capacity of WHO and national professionals - in the government and non-government sectors - in strategic planning for the health sector response to HIV/AIDS. The course would also benefit national and international technical partners involved in health sector planning. The course is generic and needs to be adapted to the specificities of each region or sub-region. It consist of XX modules and XX Units……XX number of hours The manual is intended for those who will be involved in the planning and facilitation of training workshops in health sector planning for HIV/AIDS. The content of the course is based on the WHO Planning Guide for the Health Sector Response to HIV/AIDS.

Objectives of the course At the end of the course, participants should be able to: 1. Describe the synergies between planning for the national response to HIV/AIDS, planning for

the health sector response to HIV/AIDS and planning for the broader health sector;



2. Describe the key elements of strategic and operational plans including the international attributes of a good strategic plan.

3. Describe how to plan for and make the necessary preparations for strategic planning. 4. Describe the key elements of a situation analysis and why they are important. 5. Describe how to prioritize, define results, set goals and objectives with targets and indicators,

and select interventions based on a given situation analysis. 6. Describe how to monitor and evaluate progress towards results 7. Describe the basic principles of costing and budgeting of strategic plans and how to make a

gap analysis. 8. Describe WHO resources on HIV planning

Structure of the training course The training course consists of five core modules. Each module consists of a number of key Units. The content of the Units is generic and needs to be adapted to the participants’ profiles and the regions they come from.

Module 1 - Setting the scene for planning the health sector response to HIV/AIDS Unit 1 - Introduction Unit 2 - HIV planning in the health sector Unit 3 - Principles of good plans Unit 4 - Planning for results Module 2 - Strategic planning Unit 1 - Overview of the strategic planning process Unit 2 - Preparing for planning Unit 3 - Situation analysis Unit 4 - Setting priorities and defining results Unit 5 - Defining M&E systems for the plan Unit 6 - Defining management and capacity building systems Module 3 - Costing and budgeting Unit 1 - Principles of costing and budgeting Unit 2 - Costing a strategic plan Unit 3 - Resource estimation and gap analysis Unit 4 - Budgeting operational and implementation plans Module 4 - Operational planning Unit 1 - Types of operational plans Unit 2 - Steps in operational planning Module 5 - Management and support systems Unit 1 - Implementation plans Unit 2 - Adjusting for results Module 6 - Role of WHO at country level



Each unit is organized around a lesson plan which includes the following components: a. Learning objectives b. Suggested time frame to deliver the session. This could be modified based on the purpose

and needs of participants; c. Key content to be covered; d. Methodology for managing the session. Where relevant, more than one option is provided; e. Generic power point presentation; f. Key handout(s) to remind the participants of the key content points of the subject; g. Essential reading materials. It is important these are sent to the participants in advance.

Proposed training workshop agenda

Estimated Time # Module Unit

Minutes Hours

1 Introduction ! Workshop objectives ! Structure of the workshop ! Participants introductions ! Tracking learning throughout

the workshop

60

2 HIV planning in the health sector 60

3 Principles of good plans

60

1 Setting the scene for planning the health sector response to HIV/AIDS

4 Planning for results

120

5

1 Overview of the strategic planning process

30

2 Preparing for planning 60

3 Situation analysis 120

4 Setting priorities and defining results

120

5 Defining M&E systems for the plan

120

2 Strategic planning

6 Defining management and capacity building systems

120

1 Unit 1 - Principles of costing and budgeting

180

3 Costing and budgeting

2 Unit 2 - Costing a strategic plan



3 Unit 3 - Resource estimation and gap analysis

4 Unit 4 - Budgeting operational and implementation plans

1 60

2 60

4 Operational planning

3 60

1 Will come from SEARO 120

2

5 Management and support systems

3

7 WHO support and contribution

1 Role of WHO country HIV staff at country level (ref. GLP materials)

180

This manual and the training course materials can be accessed though the WHO HIV website: http://www.who.int/hiv/topics/ppm/training/en/index.html



Preparing for the training workshop

Facilitators It is recommended that one to two persons be in charge of the workshop from beginning to end. These will be referred to as training facilitators. These should be distinguished from technical facilitators who should have good experience in covering the various technical subjects. Sometimes one person could fulfil both roles. Both types of facilitators should work together as a team to ensure a smooth running and learning experience for the participants. Roles of both types of facilitators should be defined during the preparation of the workshop. Facilitators should be well familiar with the existing national health sector HIV plans of the participating countries. In the course of the workshop, in particular during the plenary discussions, there will be important contributions from the participants. Facilitators need to assign someone the task of keeping a record of these contributions. This could be done through typing notes directly on a computer or writing down the key ideas on cards and paste them on a board set aside for this purpose. These contributions could then be taken up in a final session of the day or as appropriate during the various sessions.

Key documents

Prior to the workshop, participants should be provided with the following essential documents:

Planning Guide for the Health Sector Response to HIV/AIDS:

This is the main guidance behind this training course. It sets out basic principles, processes and steps relating to strategic and operational planning for the health sector response to HIV/AIDS. The guide takes into account a number of developments in understanding the response of the

health sector to HIV/AIDS and in development of national health strategies. It should be used alongside various other tools for strategic and operational planning. The guide is in six parts as

follows: Part 1: Overview: Key principles and concepts in strategic and operational planning

Part 2: Planning for results Part 3: Preparing for planning Part 4: Situation analysis and priority setting

Part 5: Setting priorities Part 6: Costing and budgeting

Part 7: Operational planning The Guide is intended to be used by for involved in planning and managing the response of the

health sector to the HIV epidemic at both national and sub-national levels. They include Ministries of Health, other government sectors, nongovernmental organizations, private sector, academic institutions and other civil society organizations. The Guide will also be of value to

donors and international organizations which provide financial and technical support for HIV/AIDS programmes.

http://www.who.int/hiv/topics/systems/en/index.html



WHO guidance on priority interventions: HIV/AIDS prevention, treatment and care in the health sector:

This is the complete set of interventions recommended by WHO to mount an effective and comprehensive health sector response to HIV and AIDS. This document aims to: ! describe the priority health sector interventions that are needed to achieve universal access

to HIV prevention, treatment and care;

! summarize key policy and technical recommendations developed by WHO and its partners and related to each of the priority health sector interventions;

! guide the selection and prioritization of interventions for HIV prevention, treatment and care;

! direct readers to the key WHO resources and references containing the best available information on the overall health sector response to HIV/AIDS and on the priority health sector interventions with the aim of promoting and supporting rational decision-making in designing and delivering HIV-related services.

This document provides detailed information on the interventions which are carried out by the health sector. It provides links to key resources on HIV/AIDS prevention, treatment and care.

http://www.who.int/hiv/pub/guidelines/9789241500234/en/index.html

Draft global health-sector strategy for HIV, 2011–2015 - A sustainable health-sector response to HIV

The Strategy will build on the achievements and experiences of the "3 by 5" initiative and the five

strategic directions of the WHO HIV/AIDS Universal Access Plan 2006-2010;

• take into consideration the broad global HIV, health and development architecture, including the UNAIDS Strategy and Outcome Framework, and existing commitments to achieving Universal Access and the Millennium Development Goals;

• identify existing and agreed global targets to motivate countries to plan for bold HIV/AIDS responses through to 2015;

• provide guidance to countries on how to prioritize their HIV and broader health investments;

• provide a framework for concerted WHO action at the global, regional and country levels

and across all relevant WHO departments.

http://www.who.int/hiv/en/



Assessment of participants The training organizers need to carry out an assessment before and after the training, the purpose is i) to test the participants' level in the technical areas so that the generic course content could be adapted accordingly and ii) to assess the extent the participants benefit from the training and to assess what areas may need further training or follow up Participants should be requested to do the tests anonymously at the beginning of the training and again at the end. Annex 1 includes an example of a Pre- and Post-test in line with the proposed training course.

Learning methods and techniques

A variety of learning techniques are proposed in this training course. Again, these should be reviewed and updated according to the level and profile of the participants. Formal presentations: generic power point slides are included in each Unit. These are not intended to last more than 15 minutes. They cover the basic information on each topic. Depending on the topic, slides could be used as a trigger for a discussion or as conclusion after a general discussion or group work. Some slides might need to be adapted to regional specificities and the profile of participants. Free discussion: some sessions require a less rigid method especially if the purpose is to generate information on technical issues, operational challenges, technical assistance needs, etc. This is effective in getting participants to think constructively while interacting with the rest of the group. The facilitator of the session needs to make sure that participants do not go off on a tangent. If possible, it is advisable to arrange participants to sit around in a wide circle close to the facilitator. The important thing is to structure the discussions in such a way that will enable the facilitators and participants to draw conclusions from the discussion. The facilitator needs to control the flow of ideas ad keep the discussion within the subject. There should be a clear time frame and some ground rules should be agreed upon (no single statement longer than 2 minutes, no interrupting a participant, no judging of a statement, etc.) Questions & answers: This is not a free discussion. Q&A is particularly useful to have after a presentation which is highly technical or a fairly new subject to the participants. You need to limit the number of questions and time for answers. You can ask the participants to write their questions on cards Group work: this can take many forms. It can be used for reviewing documents. For example, e.g. a part of a national HIV strategic plan) and extracting key messages, analysing the landscape of HIV response in a given country, etc. There are several key issues which have to be observed to get a good result. Some of them are mentioned here:

o Set the task very clearly and cross check whether everybody has understood the task before embarking on the group work.

o Divide the participants into small groups as needed for the exercise. Adjust the size of the group to the overall number of participants and the space available for group work.

o Set a clear time frame. o Agree on a form of presenting the results before starting the group work. Depending on

the time frame this needs to be structured carefully. Participants should be encouraged to use creative ways of presenting their conclusions (using words on cards, drawings, role play, etc).



If participants are going to work together in the same group for a significant amount of time then time needs to be allocated to building a group dynamic – possibly through a ‘getting to know each other’ exercise and by referring to the group by its proper name (a colour, an animal a vegetable, for example). Some competitiveness between groups can be healthy and small prizes can motivate participants. A judgement made in favour of a group with the correct answer can bring greater clarity if there is confusion. Investing in materials (such as coloured paper, hats, etc.) can also help develop group dynamics develop and increase positive results. To help avoid unnecessary conflict, clear instructions should be provided for exercises. During feedback time, it is important to clarify right and wrong answers.

Visualisation in Participatory Programme (VIPP): this could be used in conjunction with any of the above methods. It is very helpful in case of with large numbers of participants where interaction becomes more complex and the participation of any one individual decreases. Most commonly is when it is used before or after a presentation to generate knowledge from the participants and to facilitate interaction. VIPP is based on the premise that each participant comes with experience and knowledge, which can be released in plenary or group processes to contribute to collective knowledge. This method allows everyone to take part in the process of arriving at a consensus. Less talkative participants find a means of expression and those who might normally dominate a group lose control and are forced to let others have their say. Participants are provided with colour cards. The basic rules include: ! Writing one idea on each card (maximum of three lines) ! Writing down a full sentence (using both capital and lower case letters) The role of the facilitator is to collect the cards as they come, post them on a board, sort them out under categories and make sure that everybody is involved. Detailed guidelines on this technique is given in this document http://portals.wi.wur.nl/files/docs/ppme/VIPP_Unicef.pdf Energizers: it is important to use these it is felt that the participants are getting restless, tired or losing interest during a session. The facilitators need to stop the session and carry out an energizing exercise that will bring energy back in the room. It is recommended to use up to three energizers per day especially after long plenary discussions or to break the monotony of group work presentations. The link below provides a wide range of energizing exercises to chose from. http://www.teampedia.net/wiki/index.php?title=Main_Page

http://wilderdom.com/games/Icebreakers.html

Materials needed in the workshop

! summary of the progress of participating countries towards MDGs and universal access; ! regional strategic frameworks and national strategic and operational plans of participating

countries; ! laptops and beam projector; ! flip chart boards and markers; ! cards of different colours for writing down the participants' feedback on a certain topic; ! a digital camera in order to keep a record of group work presentations an take photos of the

participants; ! CDROMs which include training materials and resources to provide to the participants at the

end of the workshop.

Annex 2 includes general training tips.



Module1. Setting the scene for

planning the health sector response

to HIV/AIDS

Unit 1: Introduction to the training course

Objectives: 1. To create a team spirit for the duration of the training and beyond. 2. To clarify the rationale and objectives of the training and ensure that they match the

participant's expectations

60 min

Content Introduction of participants

One challenge in a training workshop is how to create a team spirit among facilitators and participants who usually come from different countries, cultures and backgrounds. They might know each other, some might not. As there are a good number of participants an introduction is needed and it has to be an introduction which allows participants to interact and get acquainted with their colleagues. At the same time the introduction can be used to focus the minds of the participants on the subject of the course. There are many ways of doing this introduction, here is suggestion: Option 1: arrange an informal reception the evening before the start of the workshop. Provide name tags and let participants mingle with each other. This way, you will not need to spend much time on introductions the morning of the workshop. You can only ask each participant to just their name and where they are based. Option 2 - ask the participants to form pairs and let them introduce each other briefly to the whole group by telling the name and the country they are working in Option 3 - ask the participants to say their name and duty station and tell to the whole group what they would like to do when they retire. Option 4 - each participant state in one word what makes a planning exercise a success and fruitful one. Explaining the purpose of the training

Facilitators need to consider the following points when introducing the rationale/purpose of the training:



! The global response to HIV/AIDS is guided by a number of momentous international

commitments. The most important among them is the Millennium Development Goals (MDGs), formally adopted by all Member States of the United Nations through the Millennium Declaration of 2000 and General Assembly resolutions of 2001 and 2005. The MDGs provide a blueprint for efforts to reduce poverty and improve the quality of life of poor communities worldwide. Slowing and reversing the HIV/AIDS epidemic through Universal Access to HIV prevention, treatment, care and support is recognized as a crucial component of global efforts to achieve the MDGs.

• In addition to global commitments, numerous regional commitments related to HIV have been adopted to highlight specific challenges and priorities (mention regional examples here). To bring about meaningful change these international and regional commitments must be incorporated and translated into priorities and action at national.

• In the early stages of the epidemic countries were encouraged to develop short term and medium term plans. These plans were developed by Ministries of Health and included contributions of other sectors. Subsequently, HIV/AIDS planning became more broad-based and multisectoral to reflect the expanded response to HIV/AIDS. This multisectoral response required a common national strategic framework to which all concerned sectors contribute. Strategic and operational planning have always been an integral part of the response to HIV/AIDS and approaches to AIDS planning have evolved over the years.

• The conceptualization of the health sector contribution to the multi-sectoral response to HIV/AIDS has significantly evolved over the years and clear elements need to be reflected in national strategic plans.

• WHO is putting great emphasis on integration of HIV strategies into the broader health sector plans. This explains the importance of briefing and training WHO staff and national health professionals in the principles and modalities of strategic and operational planning for the health sector response to HIV/AIDS.

Handouts ! H1: Glossary of terms

Slides

Essential reading materials

! Progress report 2010 http://www.who.int/hiv/pub/2009progressreport/en/index.html

! WHO HIV Global Strategy 2011-2015

http://www.who.int/hiv/aboutdept/strategy_consultation/en/index.html





to HIV/AIDS

Unit 2 - Planning for HIV in the health sector

Objectives 1. To understand the importance of planning in achieving the desired results in the health sector

response to HIV/AIDS. 2. To have a good understanding of the context of planning for the heath sector response to

HIVA/IDS. 3. To identify the key commitments in the response to HIV/AIDS at global and regional levels. 4. To understand the complexities and the linkages between the health sector priorities to

HIV/AIDS and the other health and development priorities.

90 min

Content Better health outcomes depend on effective interventions delivered by better health systems. Better health requires coherent policies and a comprehensive approach that also addresses the social, environmental and economic determinants of ill-health. Outcome, interventions, programmes and systems come together in a robust national health policy & strategy. National health policies & strategies (NHPS) play a critical role in specifying outcomes, interventions and programmes, and in strengthening health systems to deliver effective interventions in an integrated approach to accelerate progress towards the health MDGs and in wider health outcomes Within the health sector the response to HIV and AIDS needs careful strategic planning. The global response to HIV/AIDS is guided by a number of international commitments. The most important among them are the Millennium Development Goals (MDGs). In addition numerous regional commitments related to HIV have been adopted to highlight specific challenges and priorities; as well as broader national development priorities, typically described in a National Development or Poverty Reduction Strategy. The overall national response to HIV/AIDS is generally guided by a multisectoral strategic framework or National AIDS Plan which reflects contributions of all sectors in addition to health. Delivery of HIV/AIDS services should therefore, wherever possible, be closely linked to the delivery of other health services. Strengthening and maximizing synergies between HIV/AIDS and other programmes should result in more efficient use of resources, more consistent delivery of related services, improved patient experience, and improved overall health outcomes.

Methodology

1. Presentation for 20 min (pptM1U2)



2. Group reflection by country (10 min): "How far do the two figures in the handout reflect the situation in your country?" which umbrella fits the country planning situation? Hand in a card for each country to describe and post on the board. 3. Feedback by country (15 min). 4. General discussion for 45 min.

Handouts ! H2: MDGs 4, 5 and 6 ! H3: Linkage between planning frameworks

Key messages

• National health policies & strategies (NHPS) play a critical role in strengthening health

systems and in delivering effective interventions in an integrated approach to accelerate

progress towards the health MDGs and in wider health outcomes.

• Better health outcomes depend on effective interventions delivered by better health systems.

• Programming for the health sector response to HIV/AIDS must be based the wider NHPS in a

manner that reinforces national health priorities and maximizes synergies with other health

programmes.

• The global response to HIV/AIDS is guided by a number of international commitments.

• The Global Health Sector Strategy for HIV/AIDS 2011-2015 is a framework for health sector

efforts on HIV/AIDS for reaching the MDGs.

• The overall national response to HIV/AIDS is generally guided by a multisectoral strategic

framework or National AIDS Plan which reflects contributions of all sectors in addition to

health.

• Delivery of HIV/AIDS services should, wherever possible, be closely linked to the delivery of

other health services.

Slides

Essential reading materials ! Planning Guide for the Health Sector Response to HIV/AIDS – Chapters 1 and 2





to HIV/AIDS

Unit 3 – Principles of good plans

Objectives 1. To understand the purposes of strategic planning 2. To become familiar with the IHP+ ‘attributes’ of a good strategic plan

60 min

Content A national plan for HIV/AIDS should serve as a key tool through which resources can be applied to achieve results at the level of institutions, individuals and the population. National strategies and plans should therefore aim to achieve the following:

• Identify strategic priorities, based upon epidemiological, social, economic and political imperatives;

• Operationalize these as a set of strategies (goals, objectives and interventions) to be applied to achieve the desired results;

• Determine the indicators and monitoring framework through which achievement of these goals, objectives or results can be assessed;

• Describe governance structures and institutional frameworks through which implementation is coordinated and supported, and accountability established;

• Describe the resource envelope required for implementation, through ‘costing’ spending and feasibility assessments.

A set of "attributes" that should characterize national strategies has recently been described by The Working Group on Strategies and Plans of the International Health Partnership (IHP+) recently identified a set of "attributes" that should characterize national health strategies and plans.

Methodology

Option 1:

1. Presentation for 10 min (pptM1U2) on IHP+, JANS and attributes. 2. Country Group exercise (20 mins) - using the JANS attributes from Annex 1 of the planning

guide:



! Review your country’s current strategic plan against the attributes; how does it score? ! What are the reasons for low scores or gaps? ! Do you feel these ‘attributes’ are appropriate?

3. Group feedback and general discussion (30 mins). Option 2: 1. Group discussion (20 min) – what does your group think are the attributes of a good strategic

plan?

2. Group feedback and general discussion leading to a consensus (20 mins).

3. Comparison of consensus and IHP+ list of attributes (20 mins).

Handouts ! H5: Attributes of sound national health strategies and plans

Key messages

• A national plan for HIV/AIDS should serve as a key tool through which resources can be applied to achieve results at the level of institutions, individuals and the population.

• A good national strategic plan should reflect a strong understanding of the epidemic, contain appropriate solutions and describe effective systems for management and accountability.

• A set of "attributes" that should characterize national strategies has recently been described by The Working Group on Strategies and Plans of the International Health Partnership (IHP+).


! Planning Guide for the Health Sector Response to HIV/AIDS – Chapter 1 Overview and

Annex 1

Slides





to HIV/AIDS

Unit 3 – Planning for results

Objectives 1. To understand what planning for results means 2. To understand the different kinds and levels of results and how they form a logic chain of

necessary and sufficient changes that underlies the strategic framework 3. The understand the importance of strategic coherence around the strategic framework in

strategic planning

180 min

Content Planning to achieve results is the essence of good strategic planning. A programme exists to

produce specific results - products and services leading to certain outcomes, which in turn impact

on people's lives. Results are normally classified in different levels. Impact is the highest level of

results that a programme can be achieved. This means demonstrable change occurring at

population level in terms of quality of life and absence of ill-health. The next level of results is

outcomes, followed by outputs, and so on. A good plan must always be clear about the level of

results being addressed. It needs to have its primary focus on higher level results and ensure that

all the lower level efforts eventually go to contribute to achieving the higher level results in a

logical chain.

At the core of the strategic plan is the strategic framework: what the plan hopes to achieve in

terms of outcomes and impact. The Situation Analysis is the basis on which priorities are

identified. The priorities are translated into a strategic framework which includes definition of

goals, objectives and interventions. The M&E framework defines how the goals, objectives and

interventions will be quantified and measured. The financial framework defines the costs of the

strategic elements and how they will be financed. The operational framework defines how

planning will be translated into action on the ground.

Methodology Option 1:



1. Presentation for 20 min (pptM1U3) 2. Group work (60 mins): in mixed groups participants sort through a set of ‘results’ written

on cards deciding what level of results they are, how they form part of a logic chain, and what results are missing from the logic chain.

3. Feed back from groups (60 mins)

4. General discussion (20 mins)

5. Final presentation of Strategic Coherence (20 mins).

Option 2:

1. Presentation for 20 mins 2. Group work (60mins): in mixed groups review a sample results framework to assess

how well the various levels of results are determined, how sound the logic chain is, and what gaps there are in the logic chain

3. Feed back from groups (60 mins) 4. General discussion (20 mins) 5. Final presentation of Strategic Coherence (20 mins).

Handouts ! H6: Planning for results

Key messages 1. A logical results chain is essential for good strategic planning 2. Results are at different levels 3. Results must be necessary and sufficient to achieve the chain 4. All elements of the strategic plan must be linked together in strategic coherence

Essential reading materials Planning Guide for the Health Sector Response to HIV/AIDS – Chapter 2

Slides



Module 2. Strategic Planning

Unit 1 - Overview of the strategic planning process

Objectives

1. To be familiar with the various steps and processes involved in strategic planning

30 min

Content Effective Strategic Planning depends upon not only on managing the content and substance of

the strategic plan, it also requires managing the process of strategic planning itself. It thus

involves a series of inter-related activities. Key steps in developing a strategic plan are as follows;

1. Preparing for planning

2. Involving stakeholders

3. Conducting situation analysis

4. Setting priorities

5. Defining M&E framework

6. Defining implementation arrangements

7. Costing the plan

8. Finalizing the plan

These steps do not always occur consecutively but can take place simultaneously. The process

of involving stakeholders, ensuring support and buy-in, needs to be followed throughout the entire

strategic planning process – even from the preparation stage. Similarly, identification indicators

should be done as soon as priorities are identified to make sure that the things planned can be

monitored, and to think about how. In the same way, costing can both inform and follow

identification of priorities to ensure that the programme is affordable and feasible. The strategic

planning process should be managed in such a way that all the steps complement each other.

Methodology Option 1

1. Presentation for 15 min (pptM1U4) followed by a general discussion Option 2



1. Group work: Groups have a set of cards with the various steps written on them and have to arrange them in the 'correct' order. 2. General discussion raising the issues of simultaneous steps rather than strictly consecutively, also making sure the 'buy-in' steps don't get left out.

Handouts

! H8: Strategic planning at a glance

Key messages

• There is a series of key steps that must be followed for effective strategic planning. • These steps do not always occur consecutively but can take place simultaneously.

Essential reading materials ! Planning Guide for the Health Sector response to HIV/AIDS – Chapter 1 Overview

Slides



Module 2. Strategic planning

Unit 2 - Preparing for planning

Objectives 1. To describe the preparations required before embarking on the strategic planning process. 2. To understand the elements and steps which go into the strategic planning process and the

development of a strategic plan 3. To understand the need for full involvement of stakeholders

60 min

Content Key elements in preparing for planning include the following: 1. Define how the planning process will be managed: Establishing effective structures for leading and managing of the process for strategic planning are essential to achieving legitimacy, ownership and efficiency for the exercise is a critical part of the preparation. 2. Define the methods and approaches to be used: It is important to define and get consensus for the approach, methods and processes to be used as early as possible. A number of strategic planning tools have been developed to assist the planning process 3. Identify and compile the required information: Information gathered in the process of planning provides the evidence base on which to make planning decisions. Consequently, much of planning time will usually be taken up in collecting and analysing the necessary information. It is useful to carry out, in the preparatory phase, a thorough review of the types of information that will be required for the planning 4. Develop a work plan and budget for planning: a road-map or work plan is needed that identifies the various steps in the strategic planning process, timeframes for the different steps, roles and responsibilities, and a budget. The road-map should provide information on when broader consultation will take place so that stakeholders can be informed of these dates well in advance. 5. Involve stakeholders: The essence of a strategic plan is that it provides an overall framework within which all players can find their appropriate roles and make their appropriate contribution. It is thus essential that as many stakeholders and players as possible are involved in developing the plan to ensure legitimacy, ownership and commitment to the plan.

Methodology Option 1

1. Presentation for 15 min (pptM3U1)



2. General discussion (45 mins). Questions to guide the discussion include: ! Looking at recent planning in countries, what were the steps that were weak and needed

improvement? ! Among those who experienced a recent planning exercise, how many would say were

satisfied with the process? Option 2 1. Group work (15 mins): draw up a list of all the things that are necessary for preparing for a strategic planning exercise 2. General discussion (45 mins): review the groups' lists against the list in the planning guide.

Handouts

Key messages ! Good preparation for strategic planning will ensure effective participation, save time, use

resources well, and help focus. ! Ensuring agreement on the management of the process, as well as the methods to be used,

is vital. ! It is essential that as many stakeholders and players as possible are involved in developing

the plan to ensure legitimacy, ownership and commitment to the plan.


! Planning guide for the Health Sector Response to HIV/AIDS – Chapter 3 ! Guide to the strategic planning process for a national response to HIV/AIDS

http://data.unaids.org/publications/IRC-pub05/jc441-stratplan-intro_en.pdf

Slides




Unit 3 – Situation analysis

Objectives 1. To describe the information and data required for developing a sound national plan for the

health sector response to HIV/AIDS. 2. To understand the different approaches and methods used for situation analysing.

120 min

Content

Situation Analysis is about identifying the problem. It describes the extent of the epidemic, who is affected, what is driving it and what is being done to address it. The plan must be based

on evidence and the situation analysis provides the evidence base for priorities and strategies identified in the plan. A situation analysis should highlight the following areas:

a) Socioeconomic context, which identifies the social determinants, vulnerabilities and

drivers of the epidemic, which impact on the health sector response.

b) Epidemiological analysis, which describes how HIV transmission is occurring, the associated risk factors, who is affected, who requires treatment and care.

c) Response analysis, which looks at what has been done so far by the health sector in

responding to the epidemic. It includes assessment of results, achieved so far, in terms of coverage and outcomes of services. It also assesses the strengths and weaknesses of

the health sector response. d) Stakeholder analysis, which identifies the key players in the health sector response to

HIV/AIDS. It also assesses who has an interest in the response, what their interest is,

what contribution they are making, what can be expected of them. e) Programmatic gap analysis, which aims to define the unmet need for HIV prevention,

treatment and care. It also identifies programmatic gaps, policy gaps and system weaknesses in the health sector response.

Methodology

1. Presentation for 15 min (pptM3U2) 2. Mixed group work (60 mins): ! Provide each group with a scenario describing a real/virtual situation analysis (scenarios are

extracted from GF proposals or current strategic plans). ! Task 1: groups review the scenario to see how far the 5 areas are covered (20 mins). ! Task 2: groups try to identify ‘the HIV problem’ the scenario is addressing and determine how

far better analysis in any or all of the five areas would have helped – paying particular attention to how far the health sector response is covered in the scenario (40 mins).



3. Feedback and general discussion (45 mins).

Handout ! H9: List of issues to be considered in a situation analysis


! Planning guide for the health sector response to HIV/AIDS - Chapter 4

Key messages

! An accurate situation analysis must form the basis for identifying priorities, targets and

strategies contained in the plan. It makes the plan relevant to the real situation in a country or region. For the situation analysis to serve that purpose it utilize the best available information and evidence.

! The Situation Analysis must cover a) the Socio-economic context, b) an Epidemiological analysis, c) the Response analysis, d) a Stakeholder analysis, and e) a Programmatic gap analysis.

Slides




Unit 4 – Setting priorities and identifying results for the

health sector response

Objectives 1. To know how to identify priorities and targets for the strategic plan of the health sector

response based on the situation analysis.

120 min (Optional, additional 120 minutes for the results based planning exercise)

Content

Prioritization is the essence of any planning exercise. Prioritization means deciding what should be done against what should not be done, identifying what should be done first against what

should be done later, and identifying where to place most efforts among all the things being done.

Key considerations in setting programme priorities are:

• Base it on situation analysis. It is important that priorities must be based on the

prevailing context of the epidemic as identified in the situation analysis. The situation analysis should directly inform the selection of priorities for responding to the epidemic.

• Draw from other national priorities. Priorities for the health sector response to HIV/AIDS must also be informed by other related national priorities. Where HIV priorities have been clearly defined in a national development plan, the national health

plan and the national AIDS plan, they should become the priorities of the plan. • Define the results to be achieved. Priorities should in the first place identify the

results to be achieved over the period covered by the plan. It is important to identify the desired changes, in logical sequence, beginning at the level of impact and proceeding to lower levels.

• Identify how best to achieve the results. Priorities should identify ways in which the results will be best achieved.

Goals, objectives, interventions and targets In a strategic plan, the programme priorities are reflected in the results at various levels and

constitute the strategic framework. They are expressed as goals, objectives, interventions and targets.

Goal(s): A goal is a broad statement of a desired impact of the programme during the period of the plan. It describes desired change at the population level in terms of HIV infections and quality of life. The goal(s), although broad in scope, still need to be quantifiable and include

targets. Objectives: Objectives define what is to be done for the goals of the programme to be

achieved. One or more objectives directly contribute to achieving a goal. Objectives describe the changes that should take place the level of institutions and individuals; and often relate to



change in behaviour or institutional development. Objectives should be specific, measurable, achievable and time-bound (SMART). They should also have clearly defined baselines and

targets. Outputs: Outputs are what will be produced through activities; a number of outputs combine

together to achieve the objective. They are the products and services which the programme establishes in order to achieve the objectives/outcomes. It is essential to ensure that all necessary and sufficient outputs are identified to achieve an objective/outcome. Interventions: Interventions are packages of services intended to bring about specific changes - outputs. There are a number of considerations that can be made in choosing interventions. The most important consideration is whether the particular intervention is appropriate for the

condition that it is addressing. Other considerations in selecting interventions include feasibility, acceptability and affordability. WHO has identified effective interventions for the

health sector response to HIV/AIDS (citation). Targets: Each of the programme goals, objectives and key interventions must have targets. This is a way of quantifying what is to be achieved at each level. Targets should be quantifiable.

Basic population and epidemiological approaches are used to determine the coverage of selected intervention needed to achieve the outcome/objective and impact that is being planned for. Many countries use MDG, UNGASS and Universal Access targets.

Methodology

1. Presentation for 15 min (pptM3U3) followed by group work and discussion as follows: 2. Group work ! Use the same groups as in Unit 3. ! Provide each group with the same Situation Analysis scenario(s) used in Unit 3. ! Task 1: Ask the groups to define the priorities for the health sector response for their scenario

(30 mins). ! Task 2; Ask each group to identify the results required for the scenario, they should then

specify these as SMART goals, objectives and outputs grouped as interventions, so including targets (55 mins).

3. General discussion (20 mins). Results based planning Option: 1. Additional presentation on planning for results (30 mins) 2. Group work (50 mins): groups are provided with sample results matrices and asked to review them:

• Are the levels of results appropriate (impact, outcome, output)? • Is the logic chain strong? • Are the results SMART?

3. Feedback from groups and general discussion (40 mins).

Handout ! H10: Considerations in priority setting by epidemic type ! H11: Goals, objectives and interventions ! H12: examples of objectives and interventions




Planning Guide for the Health Sector Response to HIV/AIDS – Chapters 1, 2 and 5

Key messages • Setting appropriate priorities and turning them into results is the most critical step in planning

as it defines the direction of the response in the given period. • Framing a robust results matrix to reflect the priorities is the fundamental success factor in

planning. • The goal indicates what should be the overall long-term outcome and/or impact of the health

sector response to HIV/AIDS. It must state clearly what needs to change by the end of the five year strategic cycle and by what order of magnitude.

• Objectives describe the changes that should take place at the level of institutions and individuals’ behaviour in order for the goals to be achieved.

• Outputs are the products and services produced through activities; a number of outputs combine together to achieve the objective. It is essential to ensure that all necessary and sufficient outputs are identified to achieve an objective/outcome.

• Interventions are packages of services intended to bring about specific changes – outputs.

Slides




Unit 5 – Defining M&E systems for the strategic plan

Objectives 1. To have a good understanding of what needs to be measured in the health sector strategic

plan. 2. To describe the types of indicators used in the health sector strategic plan. 3. To know how to define indicators for monitoring and evaluation of the health sector strategic

plan based on the set objectives and interventions.

120 min

Content ! Monitoring looks into the progress of programme implementation; it tracks inputs and outputs

to assess whether the programme is performing according to plan. ! Evaluation looks at what difference the programme is making; it assesses what has been

achieved and the effect the programme is having. It analyses inputs in relation to intended outcomes.

! During the strategic planning process, indicators must be selected to measure goals, objectives and interventions.

! As part of the strategic cycle, reviews are undertaken to assess the performance of the programme against expectations.

! During the operational planning process, indicators must be selected to measure implementation of activities, using process indicators.

Methodology Group work and discussion as follows: 1. Use the same groups as in Unit 4. 2. Continuing from the previous group work, ask the groups to propose indicators for the defined

goals, objectives and interventions. 3. Ask each group to present/share briefly the challenges they had in defining indicators. Were

there any controversies?

! Present a summary on the subject, 15 min (pptM3U5)

Handout ! H17: defining M&E indicators ! ! Panel 2: Checklist of features of a good M&E system (M&E guide). ! Panel 3: Framework for monitoring and evaluation of AIDS programmes (M&E guide).



! Panel 5: Overview of indicators by programme areas, tools for measurement, and priority for different epidemic states.

! M&E framework !


! Planning guide for the health sector response to HIV/AIDS – Chapter 1 ! National AIDS programmes A guide to monitoring and evaluating HIV/AIDS care and support

M&E guide http://www.who.int/hiv/pub/me/pubnapcs/en/index.html ! Programme review guide

Key messages ! M&E systems track what is being done and whether the programme is making a difference. ! M&E systems allow managers and implementers to make corrections, changes, re-allocations

during programme implementation to respond to progress towards results

Slides



Module 3. Costing and budgeting

Unit 1 – Principles of costing and budgeting

Objectives 1. To understand the principles of costing and budgeting and the difference between them for

strategic planning; 2. To know the basic concepts and approaches to estimating costs 3. To become familiar with tools available to cost strategic and operational plans.

60 min

Content

A budget is an itemized forecast of expected expenditures for a given period along with estimated financing for those expenditures. Developing a budget therefore requires an accurate assessment of i) the cost of implementing the various elements of the plan; and ii) the resources that will be available to implement the plan. Cost estimations provide valuable input into the planning process. They reinforce priority-setting by highlighting resource constraints. They provide guidance to decision-makers on the financial implications of approving the plan and choosing the most cost-effective options. Perhaps most importantly, cost estimates can be matched to available funds to identify funding gaps and mobilize additional resources from the national budget or international sources. The process of estimating the costs of implementing a plan is referred to as "costing" the plan; when the costs have been estimated we can say that we have a "costed" plan. Costing a plan is a complex process. It requires careful consideration of both direct and indirect costs, capital and recurrent expenditures, and proper attribution of costs to each planning element. Costs can be estimated at the level of goals or objectives through a top-down approach, or they can be built up from detailed inputs at the activity level. Several tools are available to cost plans at both the strategic and operational levels. The Resource Needs Model (RNM) is often recommended for cost estimation in strategic planning. When unit costs are not available at the objective or intervention level, countries may wish to use the Activity Based Costing (ABC) Model developed by the World Bank for ASAP (AIDS Strategic and Action Planning). Expected income can be estimated through a process known as resource estimation. This process estimates the amount of resources that will be available for each planning element. The costs and available resources are compared with one another though a gap analysis, which highlights where adjustments need to be made or additional resources need to be found.

Methodology

1. Presentation 40 min (pptM3U1)



2. General discussion (20 min)

Handout ! Example of budget used in a strategic plan (if available)


! Planning Guide for the Health Sector Response to HIV/AIDS – Chapter 6

Key messages ! The development of an accurate and realistic budget is an essential part of the strategic

planning process. The budgeting process can help planners focus on priorities and identify weaknesses in the plan.

! A budget should contain forecasts of both planned expenditures and expected income. ! Planned expenditures can be estimated through a process of "costing" the plan. This is

simply the process of estimating how much it will cost to implement the plan. ! Plans can be costed using different methods and approaches. Different approaches may yield

very different cost estimates. ! There are a number of basic economic principles to keep in mind when costing a plan,

including direct and indirect costs, average and marginal costs, recurrent and fixed costs, etc. ! A number of tools exist to help countries do cost estimates, including the Resource Needs

Model (RNM) and the Activity-Based Costing (ABC) model

Slides




Unit 2 – Costing a strategic plan

Objectives 1. To understand how to cost a strategic plan

75 min

Content Strategic plans are most often costed using a top-down approach. Strategic plans can be costed at the level of either the goals, objectives or interventions, depending on availability of data and preferences of the country. However, if possible, costing should be done at the intervention level, as this is where differentiation occurs between the various inputs needed to reach an objective. The intervention level provides the most specific targets and should result in the most accurate costing. Costing a strategic plan is normally done using data on the target population, coverage targets, and the average cost of providing one standardized unit of an intervention (unit cost). Total costs are then derived by multiplying the target population by the coverage target, and then by the unit cost. Thus, C = P*T*U where: C = total cost P = population T = coverage target and U = unit cost. A complete costing exercise needs to take account of changes in the three variables mentioned above over the life of the plan. Populations in need can change over time as the epidemic evolves. Coverage targets also evolve as a country advances towards the ultimate coverage targets for the planning period. Changes in unit costs can occur for a number of reasons, including economies of scale as programmes are expanded, or broader economic changes such as inflation, exchange rate changes, rising salaries and so on. Accurate unit costs are vital to the costing process, but difficult to obtain. Unit costs are the average cost of producing one "unit" of an output, and should include both direct and indirect costs such as overhead, programme management and so on. Unit costs can be derived from expenditure data, expert opinion, special costing studies, examples from similar countries, or estimated from what is known about the resources used in delivering an output

Methodology

1. Presentation 20 min (pptM3U2) 2. General discussion (10 min) 3. Group work and discussion as follows: (45 mins)

• Use the same groups as in Module 2.



• Provide each group with a simple budget scenario for one element of a strategic plan. Ask each group to cost the proposal through the strategic cycle (year 1 to year 5).

• Ask one or two groups to present their costing scenario.

• Initiate a general discussion about the challenges faced at country level in costing.

Handouts ! Group work scenario ! Template for costing an intervention


! Planning Guide for the Health Sector Response to HIV/AIDS – Chapter 6

Key messages ! Strategic plans are normally costed using a top-down approach. ! Costs are estimated using population in need, coverage targets, and unit costs. ! Unit costs are the average cost of providing on "unit" of an output such as a service or

intervention. ! Accurate unit costs are vital to the costing process, but difficult to obtain. ! Unit costs can be derived from expenditure data, expert opinion, examples from similar

countries, or estimated from what is known about the resources used in delivering an output.

Slides




Unit 3 – Resource estimation and gap analysis

Objectives 1. To know how to estimate available resources and allocate them to planning elements 2. To understand how to do a financial gap analysis and a cash-flow projection.

75 min

Content

An important objective of developing a strategic budget is to ensure that adequate funds exist to implement the plan. Where the estimated cost of a plan exceeds the resources available, countries may wish to engage in additional resource mobilization. A strategic budget is an essential tool for such resource mobilization. A good strategic budget can show what the country needs to achieve, how much it will cost, and what resources are already available to achieve the planned objectives. It will also show which objectives can NOT be achieved due to insufficient resources. The first step is to estimate how much funding will be available, from what sources, and what restrictions (earmarking) may apply. This information can be compiled through a resource estimation process. Once resources have been estimated and allocated against expected expenditures, a financial gap analysis can be done. This is simply an analysis of where expected expenditures exceed expected income in the strategic budget. The gap analysis identifies where additional resources may be needed. It is also useful as an indicator of whether or not the plan is realistic and financially feasible. A realistic plan will have resources that are well matched to planned interventions, with a manageable gap. If the gap is too large, it may be necessary to review the plan and reduce its scale and/or scope to bring the budget down to a more realistic level. The gap analysis should contain an explanation of how resources were allocated and why gaps occur where they do. It should also contain an analysis of the probable effects of the gaps not being - i.e. what will be the likely consequences of an incompletely funded plan.

Methodology

Group work and discussion as follows:

1. Presentation, 20 min (pptM3U3) 2. General discussion (10 min)



3. Group exercise building on the costing exercise completed in Unit 2 (45 min) ! Distribute additional data on expected resources, including earmarking ! Ask groups to allocate resources against the planned expenditures ! Ask groups to combine income and expenditures into the budget and do a gap analysis ! Ask groups to do a cash-flow analysis ! Ask one or two groups to present their results. ! Initiate a general discussion on the challenges of resource estimation and gap analysis.

Handouts ! Scenario exercise ! Table showing the elements of a budget and gap analysis ! Table showing how to do a cash-flow analysis


! Planning guide for the health sector response to HIV/AIDS – Chapter 6

Key messages ! Resource estimation and allocation is an essential part of the budgeting process. ! A gap analysis compares available resources against expected expenditures and identifies

where additional resources may be needed. This can form the basis of a resource mobilization strategy.

! A gap analysis is also a good indicator of whether or not the plan is financially feasible and may indicate where the plan needs to be adjusted.

Slides




Unit 4 – Budgeting Operational and implementation

plans

Objectives 1. To understand how to cost operational and implementation plans

75 min

Content National operational plans are taken directly from the strategic plan. They normally take a one or two year "slice" of the strategic plan and break the yearly budgets and targets down to individual implementing agencies. Since the operational plan is based on the strategic budget figures, a separate operational budget is not required. Implementation plans consist of a set of activities designed to meet a target in an operational planning period - normally one year. Normally the implementation budget is broken down into months or quarters to allow for better planning over the course of the year. Budgets for implementation plans should also contain forecast of both expected costs and income. The principles of costing, resource estimation and GAP analysis also apply to implementation plans. Since an implementation plan is made up of activities, it must be costed at the activity level. This implies a bottom-up costing approach. Such an approach normally constructs costs at the activity level on basis of costing the inputs that will be necessary to implement the activity and/or sub-activities. This requires a clear definition of the unit of measurement, sot per unit, number of input units, and the frequency of the activity or sub-activity.

Methodology

1. Presentation 20 min (pptM3U4) 2. General discussion (10 min) 3. Group work and discussion as follows: (45 min)

• Use the same groups as in Modules 2 & 3.

• Provide each group with a simple scenario for an implementation plan containing a few activities (probably based on the exercise in units 2 & 3).

• Ask each group to cost the plan through the operational cycle

• Ask one or two groups to present their costing scenario.

• Initiate a general discussion about the challenges faced at country level in costing.



Handouts ! Scenario exercise ! Table showing the elements of an implementation plan


! Planning Guide for the Health Sector Response to HIV/AIDS – Chapters 6 and 7

Key messages ! Operational plans exist a several different levels ! A National Operational Plan provides a national framework in which the targets and budgets

in the strategic plan are broken down for 1-2 years and assigned to implementers. ! Implementers develop their own plans, which are called "implementation plans". ! A NOP does not require a separate costing exercise. ! Implementation plans are usually costed from the bottom up at the activity level.

Slides



Module 4. Operational planning

Unit 1 – Implementation planning

Objectives 1. To identify the key issues involved in making strategic plans operational. 2. To identify the key issues involved in implementation planning 3. To understand the differences between the levels of operational planning (e.g. national, state,

district etc.).

60 min

Content

Operational or implementation plans must be linked to the strategic plan. They define the actions that should be taken to produce outputs in a specified period of time as defined by the

strategic plan. Operational/implementation plans should identify the resources required, activities to be carried out and those involved in and responsible for carrying them out. Operational, or implementation plans translate the various parts of the strategic plan into a

discrete set of activities that must be implemented over a specified operational time period to achieve the overall outcomes and impact of the strategic plan.

There are often several different kinds of operational and implementation plan: A National Operational Plan would show how all the national efforts (including all partners/stakeholders)

will be organized to implement the strategic plan in a specified period. Institutional Implementation Plans for each institution involved in implementing the programme based on the national operational plan. Other implementation plans can also be developed for specific

interventions or sub-systems, such as for provider initiated testing and counselling (PITC) or for procurement and supply management, etc. A grant or project implementation plan shows what is being done by aspect of the programme that share the same funding source or other

common considerations.

Development of an operational plan generally involves the following steps – Review current status of implementation – Identify the results to be achieved during the operational period

– Define main activities to be carried out – Specify the timing and sequencing of the activities

– Determine costs of activities and allocate resources – Name the responsible entity/persons – Develop indicators and milestones to assess progress

Methodology



1. Present a summary on the subject, 15 min (pptM4U1) followed by a general discussion on the challenges weaknesses of current operational planning in the countries.

Handout ! H7: Strategic and Operational Plans ! H14: Operational plans ! H15: Operational planning: definition of activities

Essential reading materials ! Planning guide for the health sector response to HIV/AIDS – Chapter 7

Key messages 1. The Strategic Plan provides a set of overall results (with specific SMART targets) and costs,

for the whole country response – these are the impact, outcome and higher level output results

2. An Operational Framework provides more details of the results, targets and costs for a specific year (or two) – these are OUTPUT results.

3. Each Implementer has to make their own Implementation Plan with details of their planned activities, inputs, budget and results.

4. The sum of the Implementation Plans is the Operational Framework; the sum of 5 years’ Operational Frameworks is the Strategic Plan.

Slides



Module 4. Making the strategic plan

operational

Unit 2 – Adjusting for results

Objectives 1. To identify the need to adjust results as implementation proceeds 2. To understand how to manage this.

60 min

Content

The kind of monitoring for results described in the Module 2 Unit 5 should indicate whether sufficient progress is being made at all levels of the results chain to achieve the objectives fully. That is, if the logic of the results chain is strong, and all annual outputs are achieved, the higher level output will be achieved, and there is a strong likelihood that objectives will be achieved. Similarly, failure to achieve some annual results should mean that higher level outputs cannot be achieved, and that objectives will not be achieved. Since planning is an inexact science, and implementation is challenging, this frequently happens. So adjustments to the results framework need to be made. Managing adjustments means constantly monitoring results, and the logic of the results chain, and deciding how to adjust the results framework to still ensure the long-term impacts/goals are met. Three kinds of adjustments will generally need to be made:

1. Revising targets to adjust to achievement or not of annual outputs. The targets may need to be revised at all levels of the results chain; or perhaps only at annual level if shortfalls in one year can be made up by enhanced implementation the following year. As implementation of long-term (5-yrear) strategic plans proceeds targets often need to be revised: because they were too ambitious to start with, or because of shortfalls in expected resources; or because of sudden emerging challenges that were not anticipated (such as floods, drought, civil unrest, etc). Equally, some targets may be reached earlier than planned; these also need to be adjusted.

2. Revising the logic chain: as implementation proceeds gaps, overlaps or duplications in the logic chain may emerge that were not anticipated in the original planning. The logic chain then needs to be adjusted: this may mean that resources need to be re-allocated; or additional resource required. This is usually fairly easy to deal with at the output level; but it can become very complicated if the logic chain at the outcome/objective level is faulty; and needs to be adjusted. Then the whole results framework may need to be reviewed and adjusted.

3. Revising results for SMART-ness and adjusting indicators: monitoring for results often reveals that the results was not stated as SMART-ly as necessary, or the indictor selected was inappropriate. Again, this is a common problem, and usually fairly easy to



adjust. The danger comes if adjusting the SMART-ness of the results starts to change the result itself, and thus lead to distortions in the logic of the results chain.

While this managing of adjustment is strictly speaking part of implementation, and not fully part of the planning process, the mechanisms through which it will be done should be spelled out in the strategic plan document. And if changes need to be made in the results framework during the period of the plan, they may need to be incorporated in a revised strategic plan document.

Methodology Short Presentation and general discussion with key questions:

• What is involved in revising targets? How can it be done? • What is involved in revising the logic chain? How can it be done? • What is involved in revising results?

Handout

Essential reading materials ! Planning guide for the health sector response to HIV/AIDS – Chapter 7

Key messages Three kinds of adjustments will generally need to be made during implementation of a strategic paln: • Revising targets to adjust to achievement or not of annual outputs. • Revising the logic chain: as implementation proceeds gaps, overlaps or duplications in the

logic chain may emerge that were not anticipated in the original planning.

• Revising results for SMART-ness and adjusting indicators: monitoring for results often reveals that the results was not stated as SMART-ly as necessary, or the indictor selected was inappropriate.

Slides



Module 5. Management & support

systems

Unit 1 - Building blocks

Objectives

120 min

Content Since the health sector response to HIV/AIDS is implemented through the health system, a strong health system is necessary to deliver HIV services. On the other hand, HIV services must contribute to and be well integrated with the rest of the health system. WHO has defined six building blocks of a health system. Strengthening these building blocks based on the principles of Primary Health Care will ensure development of capacity necessary to implement the strategic plan and will contribute to strengthening the health system. These building blocks are:

• Service delivery. Ensure that delivery of HIV services is, to the extent possible, to peripheral levels so as to be closer to people that need them and to have wider

coverage. HIV services should also, as far as is possible, be integrated with other related health services to maximize synergies.

• Human resources. Define the human resources necessary to deliver on the priorities

and interventions defined in the plan. The plan should also define strategies such as recruitment, incentives, task shifting, and training necessary to develop the human resource capacity to deliver on the plan.

• Financing. Ensure that financial resources will be available to implement the plan. Describe the local and external sources of financing for HIV services.

• Medicines, commodities, diagnostics. Identify the drugs, commodities, diagnostics and other medical supplies that will be needed in delivering the interventions in the plan. It will also be necessary to define how these supplies will be procured, stored,

distributed, used and how their quality will be assured. Aspects of the procurement and supply chain that need to be strengthened should be identified.

• Information. Define how information with respect to the HIV response will be managed. It is also important to define how HIV-specific information systems are linked to the national health information system. Aspects of information management that require

to be streamlined and strengthened should be identified. • Leadership and stewardship. Describe mechanisms for political, technical and

managerial leadership for the health sector response. The plan should also spell out the

mechanisms for ensuring specific and collective accountability for the response.

Decentralization levels The decentralization levels in a country are a critical consideration in defining implementation arrangements and need to clearly described in the plan. The health district is often a key

element in delivering health services in a country. Ensuring that district plans are aligned to



the national plan and that districts have the necessary capacity to deliver on the national plan are important considerations in determining implementation arrangements.

Methodology Group work and discussion as follows:

1. Use the same groups as in Unit 4 and 5. 2. Task 1: Continuing from the previous group work, ask the groups to propose appropriate

management and coordination mechanisms for the defined goals, objectives and interventions.

3. Task 2: Continuing from the previous group work, ask the groups to propose appropriate systems capacity building that might be required for the defined goals, objectives and interventions.

4. Ask each group to present/share briefly the challenges they would anticipate in establishing or strengthening these. Were any controversies?

5. Present a summary on the subject, 15 min (pptM3U5)

Handout ! H17: Coordination, management and support ! H??


! Planning Guide for the Health Sector Response to HIV/AIDS – Chapter ?? ! National AIDS Programme Management : Module 7 – Managing the AIDS Programme

http://www.searo.who.int/LinkFiles/Publications_NAP_Module7.pdf

Key messages ! Effective management and coordination is essential for the health sector response; and

needs to be spelt out in the Strategic Plan ! Roles and responsibilities of all partners for implementing the strategic plan must also be

clearly spelt out. ! Addressing specific needs in the 6 health system 'building blocks' is also a key element of the

strategic plan. ! The decentralization levels in a country are a critical consideration in defining implementation

arrangements ! The health district is a key element in delivering health services in a country. Ensuring that

district plans are aligned to the national plan and that districts have the necessary capacity to deliver on the national plan are important considerations in determining implementation arrangements.

Slides



Module 5. Support systems

Unit 2 – Procurement and supply management

Objectives 1. To know how to estimate available resources and do a gap analysis necessary for adequate

funding of the strategic plan. 2. To become familiar with the principles of the Global Fund national strategy applications.

60 min

Content

A well functioning supply system in the context of HIV/AIDS prevention, care and support is of critical importance in the HIV/AIDS programme. A such systems must ensure un-interrupted supply of ARVs, medications for co-infections, opportunistic infections, diagnostics, prevention supplies such as condoms and syringes and medications for the management and treatment of underlying conditions such as injecting drug use. It is difficult to address all procurement and supply management (PSM) issues during the implementation if they were not well identified and costed in the planning phase. To strengthen the availability of supplies it is necessary to ensure that all the steps in the procurement and supply cycle are addressed.

1. Product selection 2. International and national laws 3. Quantification and Forecasting 4. Procurement planning 5. Quality assurance systems 6. Storage



7. Management Information Systems capacity 8. Distribution 9. Ensuring rational use of medicines 10. Financial coverage 11. Policy, Coordination and programme management

Methodology

1. Present a summary on the subject, 15 min 2. ????????

Handout


! Planning guide for the health sector response to HIV/AIDS (Draft October 2009) – Section 5.8 ! Guide to Writing the Global Fund Procurement and Supply Management (PSM) Plan

http://www.theglobalfund.org/documents/psm/EN-PSM_Template.doc

Key messages ! !

Slides



Module 5. Support systems

Unit 2 – Management and coordination

Objectives 1. To describe the attributes and skills required for management of the AIDS programme. 2. To outline strategies for strengthening and supporting multisectoral partnerships. 3. To describe the elements that support good governance of the AIDS programme.

60 min

Content Leadership: AIDS programmes operate in a dynamic environment that presents some particular challenges for the managers. This dynamic environment requires a range of leadership qualities and management skills: ! They deal with some controversial and sensitive areas – sex, drugs, morality and culture. ! They rely on cooperation between a wide range of sectors and groups, not health alone. ! Their work involves, or has the potential to involve, large sums of money. ! They attract great interest from the media and often cause bitter debate in communities. ! Their decisions may have life-and-death consequences. ! They have to deal with a wide range of competing interests and lobby groups. ! They have to be aware of debates, nationally and internationally, about which approaches to

adopt. ! In view of rapid and frequent advances in knowledge and evidence, they should be able to

regularly review, reflect and change their approaches or priorities. Partnerships: Strategies that can be used to strengthen partnerships between sectors and groups: ! Have a national AIDS policy and strategy in place that refers to the need for partnership.

Including all sectors in the preparation of the national policy and strategy establishes them as partners and is more likely to ensure their ongoing participation.

! Set out what is expected from each partner. It is important to specify who needs to be involved and what contribution they can make to the partnership. It is also important to provide partners and other stakeholders with a clear sense of how the various sectors will work together to achieve HIV prevention and care outcomes.

! Multisectoral partnership is an attempt to acknowledge that the needs of people at risk for and those with HIV infection cut across a number of sectors and are better addressed if these sectors work in collaboration.

! Pay attention to issues of power. Not all partners are equal. However, try to make sure that partners can participate effectively by ensuring that they have the resources and authority to participate.

! Foster leadership within each sector. Use the strategies outlined in the previous section to promote leadership within each sector.

! Foster participation and open communication. Find ways to promote discussion and communication across the partnership.



The AIDS programme is strengthened by good governance. Elements of good governance for AIDS programmes include: ! Participation of groups and sectors in decision-making, policy and programme development,

monitoring and evaluation. ! Justice with freedom from corruption and effective mechanisms for complaints and conflict

resolution. ! Transparency in the workings of the programme. ! Consensus building on approaches and policies among people. ! Equity in internal and external processes including recruitment of staff, awarding of contracts,

major decisions, participation of women, and access to education, health services and other programmes, and opportunities.

! Effectiveness and efficiency in the use of its resources. ! Accountability of the programme to all stakeholders with transparent financial processes. ! Strategic vision in the work of the programme. Risk Analysis and Contingency Planning: Risk analysis and contingency planning are powerful planning tools. Once a set of initial activities have been described, risk analysis can help planners to adjust these activities to address potential risks and plan for contingencies. Risk analysis can be done using the Potential Problem Analysis (PPA) method. This approach consists of analyzing potential problems for each action step. Possible prevention steps are then elaborated for each problem to proactively prevent the problem from occurring. Next, a set of contingency steps are identified to address the problem should it occur despite the prevention steps. These prevention and contingency steps are then built back into the action step (e.g. activity) to safeguard against the problems identified. The steps involved in conducting a PPA are not visible in the operational plan. The analysis is done separately from the plan. However, the results of the analysis should be visible in the detailed planning that goes into each intervention and activity. This planning should include positive prevention and contingency measures to ensure the most effective implementation. PPA can be done at both the strategic and operational levels. However it is most usefully done at the level of activities and sub-activities, because this is where concrete action is taken.

Methodology Option 1:

Present a summary on the subject, 15 min (pptM3U9). Follow with a plenary discussion on the challenges confronted by NAPMs in managing and coordinating the health sector programme.

Option 2:

Ask participants to brainstorm on the challenges which face NAPMs for managing and coordinating the health sector programme. This could be done by handing two coloured cards to each participant and ask them to write the two most important challenges. Ask participants to help organizing the challenges into categories.

Handout



! Template illustrating potential problem analysis (PPA)

Essential reading materials 1. National AIDS Programme Management : Module 7 – Managing the AIDS Programme

http://www.searo.who.int/LinkFiles/Publications_NAP_Module7.pdf 2. Planning guide for the health sector response to HIV/AIDS (Draft October 2009) – Section

Key messages !

Slides



Module 6. WHO support and

contribution

Unit 1 – Role of WHO in health sector planning Need to include modules from the GLP course (this will be ready by first week of September 2010)

Objectives 1. To understand the role of HIV country staff with regard to national strategic planning vis-à-vis

the broad health sector and HIV/AIDS. 2. To know how to access technical resources related to strategic and operational planning

120 min

Methodology

Essential reading materials ! GLP materials ! A guide to WHO’ s role in sector-wide approaches to health development (2006)

http://www.who.int/countryfocus/resources/guide_to_who_role_in_swap_en.pdf ! WHO Country Presence 2007

http://www.who.int/countryfocus/resources/who_country_presence_2007.pdf

Key messages !

Slides



Annex 1. Pre and post test

questionnaires

Please select the best answer to each question. 1. What is the most important global commitment guiding national HIV/AIDS responses?

a. UNGASS b. The Three Ones c. The World Health Assembly d. The MDGs

2. Which of these statements do you agree with?

a. The HIV/AIDS programme in the health sector should be one part of the National Health Policy and Strategies (NHPS)

b. The HIV/AIDS programme in the health sector can be a stand-alone programme because HIV/AIDFS is such an urgent priority.

c. The HIV/AIDS programme in the health sector should develop its own service delivery structures to supplement the services defined by National Health Policy and Strategies (NHPS).

d. The National Health Policy and Strategies (NHPS) must adjust to accommodate the multi-sectoral National AIDS Strategy.

3. Which set of relationships best describes the context of the Health Sector Response to HIV/AIDS?

a. Where the National AIDS Framework and the National Health Plan overlap within the National Development Plan.

b. Where the National Development Plan overlaps with the National AIDS Plan.

c. Where the National Development Plan and the National AIDS Plan overlap within the National Health Plan.

d. Where the National Health Plan is within the National AIDS Plan under the National Development Plan.

4. The IHP+ has developed a set of __________ for assessing the soundness of National Strategic Plans.

a. terminologies b. attributes c. compacts d. projects

5. What are the 5 categories of attributes of a good national strategy?

a. Situation Analysis and Programming, Process, Finance and Auditing, Implementation and management, Results, monitoring and review

b. Process, Management, Finance, Auditing, Participation

c. Process, Participation, M&E, Implementation, Resource mobilization

d. Situation Analysis, Results, Finance and Auditing, Implementation, Monitoring 6. Which is the correct sequence of results?

a. Input - Output - Intervention - Result

b. Output -Result - Outcome - Objective



c. Intervention - Output - Objective - Goal

d. Input - Intervention - Goal - Result 7. A results____ is the connection or linkages between the different levels of results.

a. chain b. matrix c. logframe d. situation analysis

8. ___are changes in state or condition derived from a cause and effect relationship. a. Analyses b. Outputs c. Interventions d. Results

9. The ___________ is the medium-term effect of an intervention’s outputs responding to national priorities and local needs.

a. goal b. outcome c. result d. input

10. ____________ is the action taken or work performed through which inputs, such as funds, technical assistance and any other types of resources are mobilized to produce specific outputs.

a. Input b. Process c. Result d. Activity

11. Which is the best sequence of steps in the strategic planning process?

a. Preparing for planning - Conducting situation analysis -Setting priorities - Costing the plan - Defining M&E framework

b. Preparing for planning - Involving stakeholders - Conducting situation analysis -Setting priorities - Defining M&E framework - Defining implementation arrangements - Costing the plan - Finalizing the plan

c. Conducting situation analysis - Setting priorities - Defining M&E framework - Defining implementation arrangements - Costing the plan - Involving stakeholders.

d. Conducting situation analysis -Setting priorities - Defining M&E framework - Costing the plan - Defining implementation arrangements.

12. Involvement of all stakeholders in strategic planning is important because:

a. UNAIDS and WHO demand it. b. It ensures that all stakeholders feel some ownership of the plan. c. It is an international health regulation. d. Resource mobilization will be impossible without it.

13. Which of these are essential for a good Situation Analysis? a. Epidemiological analysis b. Stakeholder analysis c. Analysis of programme strengths and weaknesses d. All of the above.




a. Stakeholder analysis is not necessary for HIV/AIDS as it is primarily a problem for health services to solve.

b. Socio-economic analysis can help us to understand the underlying causes and effects of the HIV epidemic.

c. Socio-economic analysis will not contribute anything of value to the situation analysis.

d. The epidemiological analysis is the most important part of the situation analysis. 15. The Situation Analysis tells us: a. What the problem is. b. What the programme has achieved c. Where we are going. d. What we should be doing. 16. _______(1)________ are defined to reflect strategic ___(2)______.

a. (1) Results (2) Outcomes b. (1) Priorities (2) Results c. (1) Goals (2) Outcomes d. (1) Results (2) Priorities

17. Objectives describe ____________ a. The changes we hope to bring about as a result of our programme. b. The services we hope to deliver to achieve our programme. c. The development of services to face new situations. d. The strategies we will use to provide effective services. 18. What does the statement “interventions must not only be necessary but also must be sufficient” mean?

a. The planned interventions must cover the totality of the budget b. The results must be achieved with a minimum package of interventions c. The sum of results must add up to the higher level result d. Sufficient resources must be allocated for priority interventions

19. SMART Indicators are necessary for: a. Only Goals and Objectives. b. Outputs only c. Interventions only

d. All results in the strategic framework.


a. Goals are defined by the priority interventions selected.

b. Description of Objectives depends on the selection of appropriate interventions.

c. Interventions are the results that achieve goals.

d. Interventions are packages of activities which produce the outputs necessary to achieve the objectives.

21. M & E is primarily important to….. a. satisfy the donor that progress is being made. b. establish a baseline for all interventions. c. establish whether progress is being made towards expected results. d. provide feedback for policy decisions. 22. What does the 'M' in SMART stand for?



a. Memorable

b. Motivational

c. Measureable

d. Meaningful 23. Which of these is NOT one of the six 'building blocks' of the health system?

a. Management and Coordination

b. Service delivery

c. Human resources

d. Information 24. 'Costing' a strategic plan means:

a. Estimating what resources are available to cover the expected intervention described in the plan.

b. Estimating the gap between what resources are available and the resources that will be required.

c. Determining unit costs for all activities in the plan.

d. Estimating what resources are require to fully implement the strategic plan. 25. Which of these best describes the difference between strategic and operational planning?

a. Strategic planning describes where we want to be, operational planning describes how we will get there.

b. Strategic planning describes how we will achieve a goal, operational planning describes what goal we want to achieve.

c. Strategic planning describes the 'how to', operational planning describes the 'by whom and when'.

d. Strategic planning describes what the context is; operational planning describes what the objective is.



Annex 2. General training tips

Clarity of content

For a learner to have a clear understanding of the content and value of a training course, they need to know where they are going, how they will get there and the benefits of getting there. These three pieces of information need to be given at the outset and make an excellent introductory statement. If at all possible, make this ‘map of the learning journey’ or ‘map of the process’ available visually.

An overview at the beginning of a training and a full set of correct and consistent handouts is fundamental to success – particularly the use and retention of the knowledge in the future, which will be the indicator of true success.

Clarity also comes through deciding on a set of key messages and repeating them, showing their use and relevance, and giving the group exercises in which they use these key ideas. This also means that facilitators and presenters need to be prepared to indicate when something is right or wrong (is consistent with the key messages or not).

An important aspect of clarity is the understanding that the training does not have to cover everything – the handouts or manual can do that. The training has to instil the meaning of terms and definitions, the value and relevance of the process and introduce the concepts of the process. Prioritizing messages increases their clarity and supports learning mechanisms that give sufficient time to the priority subject areas to maximize the benefit of the training.

The pre-training assessment and the results of the first definition exercise will indicate how much more work needs to be done on the definitions side, before moving on to more complex issues. It is important neither to underestimate the importance of understanding of definitions nor to overestimate the ability of participants to move to a new way of doing things (this can be very difficult).

Accuracy

The use of flipchart posters on the walls around the room helps to remind people of key definitions, to enable facilitators to move people’s attention back to the definitions easily, etc. The manual can include wording for these posters and thus increase accuracy among the participants and among the training team.

A couple of quick exercises around definitions can go a long way to increasing their retention and use, such as card sort races and definition poster-making (these can then be left on the walls to remind people).

The handouts need to be thoroughly checked before distribution. In the trial run, there were many errors, ranging from the omission of ‘inclusive’ from the list of attributes of a plan, to errors in definitions and processes. The handouts will exist for longer than any actual training event and need to be perfect.

Relevance

For adults to learn best, the material needs to be relevant to their world – particularly when it is work-based. Therefore, examples are very important in making information relevant to the individual. WHO has access to relevant examples from across the world; so it is important for the manual to contain examples from different regions and from areas with different types and levels of HIV epidemic, in order for every user to find a relevant example.



Examples do not have to be full blown case studies; rather they ought to be short, easily remembered stories that can be placed within presentations. In the trial run, the story of the Emperor’s Talking Horse, of experiences from Rwanda, Guatemala and Ethiopia all stuck in the minds of participants. While some effort is required to find and include the examples, the journalistic approach to this aspect has a major impact on the adult learning mechanism.

The Sudan strategic plan review exercise was a good example of making knowledge relevant.

Dividing up agenda time to maximize learning

Time spent on lecturing, reading and audiovisual activities should account for no more than 35% of the total training time. It is acknowledged that this is not easy and is contrary to the desire to give participants all the information they will ever need as quickly as possible. However, given the efficiency with which learning takes place, this approach is necessary in order to ensure that participants gain an understanding of the key concepts.

Applying the guidance in this chapter (particularly on prioritization of messages) will help to reduce the length of lectures and will build confidence in the learning mechanisms of demonstration, discussion, practice-by-doing and teaching others/immediate use, resulting in a much more effective agenda. This approach requires:

! Identification of key building blocks that need to be understood. These usually fall under the headings of definitions, motivations and process/linkages;

! Transformation of these building blocks into retainable and usable messages that are both presented within the 35% of lecture time and reinforced and expanded upon through the other learning activities.

Participants tend to be best able to learn from lectures at the beginning of the day. The session after lunch needs to be the most active as this is the period when most people are sleepiest. These timings need to be respected in the development of the agenda.

Improving presentations to be included in the manual

A good trainer is clear about what needs to be done and how it will be done. The presentations need to fit to the following format if they are to maximize the learning opportunities of participants.

An overview slide that summarizes the process gives a big boost to people’s understanding.

When writing presentations, remember that people get the messages in three ways:

! 7% of the message is taken in from what you say (verbal);

! 38% of the message is taken in from the tone of your voice (sound/aural) – hence the need to change pace and emphasis;

! 55% of the message is taken in through what they see (visual) – hence the need to ensure that PowerPoint presentations are concise, consistent, legible and include visual elements.

Despite these facts, speakers tend to concentrate all their efforts on planning what they are going to say – this accounts for 7% only of what an audience understands. Speakers need to think about how to vary the tone of their voice and use visual methods as well.

Prioritization

Once it is clear how long the presentation is going to last, it is possible to decide what participants must/ should/ could know. This helps to prioritize messages. If it is then necessary reduce the presentation to fit the allotted time, cut out what they ‘could’ know and then what they ‘should’



know, leaving what they ‘must’ know. Prioritizing the messages is very important and helps to make the structure clear to the participant and to the speaker.

Structure

This approach works best for longer presentations rather than for very short ones. Basically, the aim is to:

1. Tell them what they are going to learn about

2. Tell them what they must know, and possibly what they should and could know

3. Repeat the key points (remind them what they have just been told).

Of the total presentation, 20% should be spent telling them what they are going to learn about; 60% on telling them the important information; and 20% on repeating the key points.

Whatever is said, it is important to use links between points: “I am going to give you five reasons for…” or “We are going to move through four stages…” This helps the audience understand where they are and where they are going, and helps the presenter to plan what is going to be said.

Adult learning

There are three types of approach and they should all be used, even if the training is only a half-day long.

1. Telling participants what they need to know (this should be no more than about 30% of content)

2. Helping participants understand something they already know (this should be no more than about 30% of content)

3. Supporting participants finding out for themselves (this should be no more than about 30% of content)

The remaining 10% should be spent on introductions, ice breakers, name learning exercises and energizers – some of which can be addressed within the same activity. (Monitoring and evaluation needs to be included across all areas, taking up about 5% of total time).

There are a number of different exercises that can be used for each of these approaches. Good practice requires that all three approaches be used. The trial run focused only on lectures and group work. The VIPP card exercise and the Sudan group work were good but the use of a wider variety of learning mechanisms would have been better for the participants.

You will also need to be very careful to link what you say to what the audience already knows, the problems they face and the goals they have. You will also need to make everything you say have a relevance and value to their lives. This means you will need to know a lot about their circumstances.

People learn best when they:

! can control how it happens

! can learn by doing

! can develop skills through practice

! have no fear of censure

! use touch, smell, taste, sight, and sound

! are able to retain their self-esteem.



So, you can make a presentation or combine this approach with guided tutorials or seminars. However you do it, you must expect to answer questions. Always be honest – say if you don’t know and promise to get back to them later with an answer. Don’t be afraid to say that a question is outside the scope of the particular focus.

There are many other exercises that can be used to help reinforce the learning mechanism and capture the bigger learning efficiencies in the learning pyramid.

Examples include:

! For definitions – card sorts and posters

! For how to use strategic planning and operational planning in reality – role play

! Where there is ambiguity or a likely clash of ideas, with governments perhaps, use a debate with two teams arguing for and against a ‘this house believes’-type statement. Hold the debate in plenary.

! To get people to think about how and why something happens – brainstorm.

There are many others that can be easily mastered and are useful for the participants. Professional trainers and facilitators know how to present these types of exercises but the manual should also detail them in ‘recipe’ format.

Training of trainers is of enormous value to everyone involved in training activities. Without proper training, it can seem that the more someone knows about their specialist subject, the worse trainer they are! An ability to perform a task is not an indication of an ability to transfer skills to others. Too often, those that have knowledge of a subject or senior status are assumed to also have teaching skills and are presented to an eager or otherwise group and expected to transfer their knowledge to them. This is not a simple process and, unfortunately, senior knowledgeable people often cannot admit they have any difficulty with it. There is much debate around whether teaching and training are the same – it is most likely that what is needed in our daily work is a bit of both.

Whether a trainer is trained in a group or in a private environment, the goal should be:

! to increase the confidence of those carrying out training activities, including addressing specific habits and concerns;

! to increase the range of skills that can be called upon during training exercises.

manual for designing and facilitating training workshops

Documents