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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.
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)
Africa Recovery. 1999 Dec; 13(4): p..Within a generation, the world could -- and should -- become a place where every infant is properly nurtured and cared for, where every child receives a quality basic education, and where every adolescent is given the support and guidance he or she needs in the difficult transition to adulthood, says the State of the World's Children 2000, published in December by the UN Children's Fund (UNICEF). Acknowledging the progress made in protecting children over the course of this century and in the decade since the 1989 adoption of the Convention on the Rights of the Child, UNICEF says much more remains to be done. It draws particular attention to three tragedies of which children and women are currently the main victims, largely in the developing world: armed conflict, HIV/AIDS and poverty. And the report adds that women are victims of these ills in disproportionate numbers due to gender discrimination. (excerpt)
New York, New York, UNICEF, 2003 Sep.  p.Armed conflict fuels the spread of HIV in many ways: by the disintegration of communities, displacement from the home, separation of children from their families, and the destruction of schools and health services. Another contributing factor is rape and other human rights abuses that proliferate during wartime. Moreover, the impoverishment that results from conflict situations often leaves women and girls destitute. For many, trading sex for survival becomes the only option. Crowded and unsafe camps for internally displaced persons and refugees expose women and children to the risk of sexual violence. That, combined with inadequate health services and opportunities for learning and recreation, creates a situation that is conducive to the spread of HIV. (excerpt)