The USAID Program for Strengthening the Central American Response to HIV (PASCA) is a five-year regional contract. The purpose of the Task Order (TO) is to provide technical assistance and support for achieving USAID's objectives for expanding and strengthening the response to HIV in Central America. USAID/PASCA implements specific activities in Panama, Guatemala, El Salvador, Costa Rica, Nicaragua, and Belize. Nicaragua is a new addition to the program with FY09 additional (PF) funds. Regional activities also include Honduras.

PASCA will provide technical assistance and training on the effective implementation of HIV policies. Specifically, the project will contribute to the achievement of the following results:

a) National and regional strategic HIV/AIDS and TB plans budgeted, implemented, monitored and supported;

b) National and regional advocacy plans effectively implemented;

c) Policies and activities designed to mitigate HIV/TB co-infection implemented; and

d) The Private Sector Social Responsibility initiatives promoted to increase efforts and achieve major private sector commitment to institute HIV workplace policies.

Cross-cutting issues that will be addressed include human rights, stigma and discrimination and the impact of gender roles on the epidemic.

The activities implemented through PASCA are organized around three primary programmatic areas, for which technical assistance and training is provided:

a) Strategic planning;

b) Monitoring and evaluation; and

c) The development and implementation of projects funded by the Global Fund.

PASCA will focus its support on monitoring the national and regional responses to the epidemic. This will primarily be accomplished through the promotion of implementation of appropriate operational information systems, which will standardize data collection and reporting from different actors, ensure that adequate structures are in place to produce reports, and ensure that competent personnel are in position to analyze and use information produced for public decision-making.

PASCA will promote coordination activities with other donors such as bilateral and multilateral cooperating-agencies in Central America. Issues of common interest will be identified, and technical opportunities for cooperation to leverage financial resources and areas will be sought.

Other activities to be developed by PASCA include:

a) Provide Technical Assistance and support activities in Nicaragua in policy areas such as strategic planning, monitoring and evaluation, private sector business practices, and strategic information. To date, activities under PASCA have been focused specifically in five countries (Belize, Costa Rica, El Salvador, Guatemala, and Panama), and at the request of USAID/Nicaragua, the project will now be expanded to include limited-scope activities in Nicaragua. Technical assistance will be focused on: strategic planning, application of mechanisms and tools that provide information for planning and advocacy activities, such as the National AIDS Spending Assessment (NASA), and the AIDS Policy Effort Index (API), etc.

b) Share methods, tools, and other useful information through Web pages and other tools; improve M&E skills and knowledge; and share best practices and lessons learned. The purpose of this activity is to promote the use of technology tools such as videoconferences in order to carry out planning activities, monitoring, and inquiries; sharing lessons learned and best practices; and facilitating the communication between different working groups such as Regional Monitoring and Evaluation Committee, Regional Coordinating Mechanism (RCM), etc. This will allow not only more frequent and systematic communications, but will also avoid additional expenses such as the mobilization of the different counterparts throughout the region.

c) Support legal assistance to advise MARPs groups as well as train MARPs/community-based organizations in different aspects of organizational capacity and development. MARPs, besides suffering from discrimination and stigma, have little support from other organizations/persons and limited organizational capacities. These factors prevent their participation in an appropriate manner in prevention, planning, and monitoring activities. The most vulnerable groups will be supported to strengthen their advocacy capacities at different levels (government, donors, and other groups) to ensure their participation in the different decision-making spheres and support their inclusion in prevention and service delivery projects for this population allowing them to work with improved capacities and skills as part of the positive response to the epidemic.

d) Support USG in logistic and mobilization actions to facilitate the design, validation, and implementation of the Partnership Framework (PF) and its Implementation Plan (PFIP) as well as support the Steering Committee led by Regional Coordination Mechanism of the Central America Council of Ministries of Health (COMISCA/RCM) to monitor the PFIP. The implementation of the PF requires consultation and mobilization throughout the Central America region, as well as validation meetings and commitment ratification. The USG does not have a technical agency presence in all countries, and has decided to use the working platform that the PASCA Task Order provides in all countries to facilitate the mobilization, communication, consultation, and meeting organization to ensure that there is a mechanism by which the USG can ensure the appropriate monitoring and communication takes place under the PF with stakeholders. Additionally, it is expected that during the period of the PF, the PASCA will cover logistic, communications and mobilization assistance to the Steering Committee formed by the RCM as well as to the official and political counterpart for the PF, the Central American Council of Ministries of Health (COMISCA).

e) Expand M&E activities in the countries to harmonize the HIV strategic information subsystems in each country. In the past several years, countries in the Central American region have initiated efforts to improve monitoring of activities to contain the AIDS epidemic. It is expected that PASCA will support this effort by systematizing processes and promoting the harmonization of information sub-systems in each of the countries in order to achieve a national system for strategic information that will allow access to systematic, timely and evident-based information. This system should be built around current platforms, but will ensure that it meets the requirements of decision-makers and technical staff so that they can fulfill national and international commitments in the areas of information, indicators, and goals.

f) Promote the use of strategic information. It is necessary to increase activities to provide information to the different decision-maker levels for appropriate evidence-based decision-making. The information shall be available to high level authorities, technical staff, civil society organizations, NGOs, donors, and USG agencies. For this purpose, it is expected that the project will intensify the use of available information through different methodologies, tools, technological and printed media, to ensure that the information reaches all interested parties.

PASCA will develop training activities addressed to MARP groups as well as train MARPs/community-based organizations in different prevention technical aspects such counseling and testing as part of their promotion, prevention and capacity building. The lack of technical capacity is a barrier to their effective participation in an appropriate manner in prevention, planning, and monitoring activities.

PASCA will support each country to develop further and implement its National M&E Plan and will strengthen national and regional capabilities to use strategic information to continue or correct the course of HIV/AIDS activities and strategies. PASCA will build the capacities and skills of members of the National and Regional M&E Committees, government officials in charge of M&E, directors of the National AIDS Programs, and key civil society actors. PASCA will develop and deliver training programs to address areas such as choosing appropriate indicators; using methodologies for measuring effects, results, and impacts; applying analysis techniques; and responding to demands for reporting. To share methods, tools, and other useful information, PASCA staff will maintain regular contact with national authorities, ministries of health (MOHs), and national and regional committees through monthly electronic communications.

PASCA will also conduct workshops to build skills in information analysis. These workshops will help to highlight the importance of having a strong HIV M&E Unit within government structures and the need to allocate sufficient resources for the unit's operation. These M&E units are responsible for collecting information for the indicators defined in the national M&E plans and ensuring their analysis and dissemination to national and local decision-makers. PASCA will provide ongoing technical assistance to the national M&E units to enhance their capacities in appropriate data collection procedures, demonstrate how to engage the participation of data providers and how to identify and resolve bottlenecks to data acquisition and information dissemination.

To link the findings of M&E with the national response, PASCA consultants will provide TA to national M&E committees to develop reports and fact sheets that make strategic information available to key stakeholders who make decisions on resource allocation and effective intervention strategies.

Throughout, the project will be critically involved in fostering M&E plans that are implemented annually in all PASCA countries and that inform the regional response to the epidemic. PASCA will provide TA for civil society actors and other partners in the national response, to develop their capabilities to monitor and evaluate progress (or bottlenecks) in implementing the strategic plan. Additionally, PASCA's expert consultants will work with program implementers on ways to make information available and useful to civil society actors. In addition to official mechanisms to convey information about budget issues and HIV programmatic advances and challenges, PASCA will provide each country with a special site (within the PASCA website) to highlight related news, activities, and reports.

As part of the effort to foster external observation, PASCA will provide TA and training to appropriate counterpartsfor example, staff from the legislative branch, civil society, professional associations, and universities in techniques such as secondary analysis, policy and implementation mapping, decision-making criteria development, rapid assessment methodologies, and others.

PASCA will apply the Health Policy Initiative's (HPI) Policy Implementation Assessment Tool to determine the status of implementation of national HIV/AIDS policies in at least three Central American Countries. Based on the findings, PASCA will prepare country reports and organize multisectoral public forums and discussion groups with decision-makers and implementers to address challenges and improve policy implementation. PASCA will also introduce ways to assess operational barriers to program implementation. In coordination with government, civil society (including PLWHA), and cooperating agencies. PASCA will also apply their operational barrier assessment tool to look at obstacles to universal prevention, care, and mitigation interventions. National authorities and other implementers will use the results of the assessments to introduce corrective actions and strengthen interventions.

PASCA will organize and facilitate virtual meetings of the Regional M&E Committee to exchange knowledge and experiences and facilitate replication of best practices in countries. Every two years, PASCA, in coordination with other partners (such as UNAIDS, CDC and PAHO), will support a face-to-face meeting of the Regional M&E Committee to review implementation of National M&E Plans. PASCA will analyze information from country M&E reports and prepare a comparative regional report.

To gauge the policy environment, PASCA will conduct AIDS Policy Effort Index (API) assessments in two countries, including indicators of HIV-related stigma and discrimination. PASCA will do this as it has in the past, by engaging an expert consultant in each country to help identify potential respondents and contact them, administer and collect the questionnaires, collate the results, and write a report. The PASCA project will collaborate with USG partners and other collaborating organizations, including research institutions, to further develop analytical models, projections, and socioeconomic impact studies. As appropriate, PASCA will provide TA and organize training workshops for country nationals in the use of the AIDS Impact Model, the GOALS Model, and the Resource Needs Model, in part to support the development of the national strategic plans. In coordination with UNAIDS, PASCA will continue to support National AIDS Spending Assessment (NASA) studies and analyses by helping to plan the assessments and write and review the reports. As part of the process, PASCA will help to identify lessons to improve NASA methodology and ensure timely reporting. PASCA will encourage the incorporation of a gender perspective in all aspects of research, analysis, and information dissemination.

PASCA will provide technical assistance and training to improve strategic plans and translate them into operational plans and guidelines in order to strengthen the technical and management skills of GFATM grant recipients and projects under the context of a country and regional approach.

In regards to national strategic planning, PASCA will support countries with either their midterm review and/or planning updates based on country advances and needs. PASCA staff and regional consultants will provide TA to multi-sectoral strategic planning committees as they develop the evaluation and/or review processes and tools. Once the reviews are underway, PASCA will facilitate meetings and workshops to share findings and package them for use in formally updating the plans. This will be a critical part of the strategic planning process designed to ensure a multisectoral and participatory approach. PASCA will work with national HIV/AIDS authorities and other key stakeholders to clearly define roles and responsibilities, share strategic information, establish and review the work of country theme groups, and strengthen mechanisms for the mobilization and allocation of country resources. In the end, all countries in the region will have an evaluation of their current plans and either a new or an updated national strategic plan.

PASCA staff and regional consultants will coordinate directly with Ministries of Health and national HIV and STI programs to help draft, review, and disseminate the assessments and develop the next generation of strategic plans. The approach will emphasize multisectoral participation by the Ministry of Health (MOH), the National HIV/AIDS/STI Program, the National TB Program, civil society networks and organizations (including PLWHA), FBOs, and bilateral and multilateral cooperating agencies. As one of the cross-cutting themes of PASCA will be the use of strategic information for decision-making, PASCA will develop fact sheets and electronic documents as ways to share updated data and analyses, including epidemiological data, costing and expenditure information, and relevant data on gender norms and stigma-related barriers. In countries where PASCA assists with model updates (e.g., of GOALS, AIM, Resource Needs), those results will provide critical inputs for strategic planning.

PASCA will approach the operational policy environment in two different ways. First, to translate strategic plans into action, countries need to develop and budget annual or biennial operating plans. As PASCA moves the policy agenda towards implementation, PASCA will hire expert consultants to provide technical assistance on operational plans by facilitating their drafting and review, monitoring approval processes, and supporting printing and dissemination. PASCA will strengthen the capacity and leadership of national authorities and other key actors through TA and the organization and facilitation of training workshops and meetings to promote information analysis and other needed skills.

In coordination with government, civil society, and cooperating agencies, PASCA will use the Health Policy Initiative developed operational barrier assessment tools to look at obstacles to effective implementation. The results of the assessments will be used to strengthen interventions. Realistic priority-setting based on costs and effectiveness is missing from many national strategic plans. PASCA will coordinate with World Bank, AIDS Strategy and Action Planning program, and UNAIDS to train country counterparts to apply the Resource Needs Model and the GOALS Model to estimate the overall costs of their plans, prioritize interventions, and identify budget gaps. PASCA staff and consultants will provide direct technical assistance to country nationals to apply the models. They also will develop and facilitate training workshops to strengthen the capabilities of MOH-led country teams to calculate the costs of implementing their strategic and operational plans. With new information and the skills to use the models, countries will develop more realistic and viable annual or biennial operating plans. PASCA staff and consultants will also review budgets and make recommendations for implementing existing operating plans. The outcome of these exercises will be national strategic plans that have realistic goals and identified priorities; country operational plans (annual or biennial) with estimated costs; and, finally, national assessments that identify funding gaps. The information generated under these exercises will also be used as strategic information for advocacy initiatives.

PASCA will provide technical assistance to Regional and Country Coordinating Mechanisms (RCM and CCMs), Principal Recipients, and Sub-recipients of Global Fund grants. PASCA will provide funding for key participants to attend regional Global Fund meetings in order to keep CCM members updated on the technical, financial, and eligibility changes of each round. In addition, PASCA staff and national and international consultants will support country staff to prepare new Global Fund proposals, modify pending proposals, and manage and implement approved grants. PASCA will provide grant writing advice and critical external review to CCMs in at least two countries to prepare grant proposals for the next Round, and they will also provide similar support to other countries (Guatemala and Panama, for example) to improve and resubmit proposals rejected in Round 8. For new proposals, PASCA staff and consultants will facilitate meetings and provide expert consultation to help members reach consensus, review eligibility criteria, develop proposal schedules, organize into committees to review national strategic plans to determine proposal priorities, and draft the proposal. PASCA will facilitate the participation of civil society and PLWHA in grant proposal preparation. For rejected proposals, PASCA will work with CCMs to facilitate meetings to analyze and review Global Fund recommendations to ensure that Global Fund suggestions are taken into account in preparing new proposals for Round 9 and beyond. Together with the RCM, CCMs, and Principal Recipients, PASCA will identify bottlenecks for financial and programmatic implementation of ongoing projects. Since available resources are not sufficient for full-scale evaluations of all Global Fund grants in all countries, PASCA's staff and consultants will analyze the quarterly or semi-annual reports of the Principal Recipients to identify problem areas. PASCA will then work with implementing partners and donors to prepare work plans so that actions can be taken to surmount obstacles and proceed with the timely implementation of planned activities. PASCA staff and consultants will also provide TA to implementing organizations to organize and facilitate training sessions for CCMs, Principal Recipients, and Sub-recipients to help them build institutional capabilities for designing and automating information management systems; organize effective systems for management and decision-making; and strengthen reporting capabilities and communications. PASCA technical assistance will also ensure that the most vulnerable groups will be supported to strengthen their advocacy capacities at different levels (government, donors, and other groups) in order to guarantee their participation in the different decision-making spheres and support their inclusion in prevention and service delivery projects for this population allowing them to work with improved capacities and skills as part of the positive response to the epidemic.

To foster regional efforts, PASCA will work with the RCM, in close collaboration with the World Bank, UNAIDS, the CDC, and other donors, to develop a regional strategic plan that focuses on government commitments to universal access, highlighting issues such as stigma and discrimination reduction, gender equity, mobile and vulnerable populations, and pricing of antiretroviral drugs. PASCA will participate in consultative meetings and help to draft and review the regional strategic plan. In support of this regional agenda and within the RCM structure, PASCA will also provide TA to conceptualize, write, and review new GFATM proposals, modify pending proposals, and build RCM and recipient capacity in all management areas to ensure effective project implementation.

PASCA will develop training activities to address MARP groups as well as train MARPs/community-based organizations in different prevention technical aspects as part of their capacity building. The lack of technical capacity is a barrier to their effective participation in an appropriate manner in prevention, planning, and monitoring activities.