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UNICEF's contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis.
Globalization and Health. 2018 Jun 1; 14(1):55.BACKGROUND: Between 2011 and 2013, global and national guidelines for preventing mother-to-child transmission (PMTCT) of HIV shifted to recommend Option B+, the provision of lifelong antiretroviral treatment for all HIV-infected pregnant women. METHODS: We aimed to analyse how Option B+ reached the policy agenda, and unpack the processes, actors and politics that explain its adoption, with a focus on examining UNICEF's contribution to these events. Analysis drew on published articles and other documentation, 30 key informants interviews with staff at UNICEF, partner organisations and government officials, and country case studies. Cameroon, India, South Africa and Zimbabwe were each visited for 5-8 days. Interview transcripts were analysed using Dedoose software, reviewed several times and then coded thematically. RESULTS: A national policy initiative in Malawi in 2011, in which the country adopted Option B+, rather than existing WHO recommended regimens, irrevocably placed the policy on the global agenda. UNICEF and other organisations recognised the policy's potential impact and strategically crafted arguments to support it, framing these around operational considerations, cost-effectiveness and values. As 'policy entrepreneurs', these organisations vigorously promoted the policy through a variety of channels and means, overcoming concerted opposition. WHO, on the basis of scanty evidence, released a series of documents towards the policy's endorsement, paving the way for its widespread adoption. National-level policy transformation was rapid and definitive, distinct from previous incremental policy processes. Many organisations, including UNICEF, facilitated these changes in country, acting individually, or in concert. CONCLUSIONS: The adoption of the Option B+ policy marked a departure from established processes for PMTCT policy formulation which had been led by WHO with the support of technical experts, and in which recommendations were developed following shifts in evidence. Rather, changes were spurred by a country-level initiative, and a set of strategically framed arguments that resonated with funders and country-level actors. This bottom-up approach, supported by normative agencies, was transformative. For UNICEF, alignment between the organisation's country focus and the policy's underpinning values, enabled it to work with partners and accelerate widespread policy change.
[Prevalence of HIV infection and associated factors in the Central African Republic in 2010] Prévalence de l’infection VIH et facteurs associés en République Centrafricaine en 2010.
Calverton, Maryland, ICF International, 2012 Apr.  p.Nearly 68 percent of all HIV-positive individuals worldwide live in Sub-Saharan Africa. The region remains the most severely affected in the world, even though only 12 percent of the world's population lives there. Central Africa, which is less afflicted than Southern and Eastern Africa, nevertheless has a high enough level of infection for it to be characterized as a generalized epidemic. This is the case in the Central African Republic. The Central African Republic has long lacked reliable data on the epidemic, which has slowed the national response that otherwise would have occurred with more factual data. In response to the perceived need, the United Nations Population Fund (UNFPA), World Bank, World Health Organization (WHO), and Joint United Nations Program on HIV/AIDS (UNAIDS) have financed HIV testing in two multiple indicator cluster surveys--the 2006 MICS and 2010 MICS. This partnership has led to collection of reliable data to monitor trends in HIV prevalence and distribution among the population age 15 to 49. Also monitored are distribution of the epidemic by geographic region and population group. Because the decrease in HIV prevalence between 2006 and 2010 will be interpreted as an encouraging sign of progress, it is important to remain vigilant. The disaggregated results show that the epidemic continues to grow in scope and provokes disastrous consequences in certain groups. For the first time since 2006, the Central African Republic has reliable data to inform decision-making and intervention planning. These data have permitted the pandemic areas in the Central African Republic to emerge from the shadows. For the future, we wish to put in place systematic HIV testing similar to that of the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The UNFPA office in the Central African Republic is committed to improving knowledge about HIV and reinforcing the availability of information for planning, implementation, and follow-up of the country's National Strategic Plan for the Fight against AIDS.
Civil society involvement in rapid assessment, analysis and action planning (RAAAP) for orphans and vulnerable children. An independent review.
London, England, UK Consortium on AIDS and International Development, 2005 Jul. 63 p. (Orphans and Vulnerable Children)The Rapid Assessment, Analysis, and Action Planning (RAAAP) Initiative for orphans and other vulnerable children (OVC) was launched by UNICEF, USAID, UNAIDS, and WFP in November 2003. The first round of RAAAPs were carried out in 16 countries in Sub-Saharan Africa in 2004. The purpose of the RAAAP is to undertake an analysis of the situation of OVC and the response in each country, and then, based on this analysis, to produce a national plan of action to scale up and improve the quality of the response to OVC. This plan is then ratified by the government and provides a unifying framework that brings together the activities of all the different stakeholders under a set of common objectives and strategies. This includes all interventions for OVC, including activities of national and local government, donors and civil society organisations (CSOs). The first round of the RAAAP process consisted of a desk study, additional data collection and analysis in country, and a stakeholder workshop to validate the findings and draw up the OVC National Plan of Action. The process was led and coordinated by a national steering group which consisted of the government ministry with responsibility for OVC, other relevant government ministries and departments, development partners including UNICEF, USAID, UNAIDS and WFP and representatives of civil society organisations (CSO). The involvement of different stakeholders in the analysis and planning process is critical for ensuring their ownership of the resulting action plan. (excerpt)
Investing in people: national progress in implementing the ICPD Programme of Action, 1994-2004. International Conference on Population and Development.
New York, New York, UNFPA, 2004.  p.The 1994 International Conference on Population and Development (ICPD) articulated a bold new vision about the relationships between population, development and individual well-being. At the ICPD, 179 countries adopted a 20-year forward-looking Programme of Action (ICPD PoA), which built on the success of population, maternal health and family planning programmes of the previous decades while addressing, with a new perspective, the needs of the early years of the twenty-first century. As the ICPD is reaching its mid-point in 2004, it is fitting that countries take stock of progress that has been made so far in achieving the Cairo goals. UNFPA is mandated to assist countries in their review of operational experiences in implementing the ICPD PoA, and to that end, conducted a Global Survey in 2003 to appraise national experiences ten years after Cairo. An overall response rate of 92 per cent was achieved for developing and countries in transition. For donor countries, the response rate was 82 per cent. The objectives of this report are to: (a) describe, from an operational perspective, the progress that has been made, and the constraints that have been encountered, by countries in their efforts to implement specific actions of the ICPD PoA and the MDGs; (b) present measures taken with some regional highlights; and (c) summarize the major conclusions arising from the 2003 Global Survey and assess the way forward. The various chapters of the report present the findings and conclusions emanating from the analysis of the Survey. (excerpt)