The PATA Network Strategy 2024-2030

THE PATA NETWORK

STRATEGY 2024-2030 Frontline Healthcare Providers: Champions for Children, Adolescents & Young People

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GROWING THE NETWORK

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MAKING THE FACE OF CARE VISIBLE

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TRANSFORMING SERVICE DELIVERY IN PARTNERSHIP WITH COMMUNITIES

CONTACT US: Building 5a, Waverley Business Park, Wyecroft Road, Mowbray, Cape Town, 8000 Tel: 27 214479566 | Email: info@teampata.org | Website: https://teampata.org Linking and Learning Hub: https://patahub.org Twitter: @teampata Instagram: @Teampata Facebook: @PaediatricAdolescentTreatmentAfrica LinkedIn: @Paediatric-Adolescent Treatment Africa YouTube: https://www.youtube.com/@teampata7083

© 2023, PATA PATA is registered in South Africa as Paediatric AIDS Treatment for Africa (PATA) and operates as Paediatric – Adolescent -Treatment Africa. The organisation is registered as a Non-Profit Company (NPC: 2007/012017/08), a Non-Profit Organisation (NPO: 090 092) and as a Public Benefit Organisation (PBO: 9300034219).

ABOUT THIS DOCUMENT This strategy document aims to position PATA for the next phase of its work and development. It does this by articulating our why (our rationale), describing the foundations upon which we will build, and outlining the direction of our work in the years to come.

We will use it as a guide to steer towards, to reflect upon regularly, and to gauge our progress.

This strategy was developed in consultation with PATA staff and board members. Network members, PATA advisory panels, youth representatives, partner organisations and donors were also consulted.

ABOUT PATA

PATA is an action network of frontline healthcare providers (FHPs)1 who work in partnership with communities to Provide access to prevention services, optimal treatment, and comprehensive people-centred care that is rights-based, friendly and stigma free with a focus on Improving quality HIV services and related health2 and support services3 for children, adolescents and youth in Africa through Facilitating a powerful platform and processes for regional collaboration, capacity building, peer-to-peer exchange and learning, and advocacy for practice, programme and policy improvements

CHILD-ADOL RESPONSIVE SERVICES

PITC, EID, DSD and AHD MANAGEMENT

PSYCHOSOCIAL SUPPORT

CLINIC-COMMUNITY COLLABORATION

LINKAGE, TRACE and RETAIN

VL MONITORING TEST & TREAT

BETTER ART for KIDS!

SRHR-HIV INTEGRATION

CLINIC-COMMUNITY COLLABORATION

TASK SHIFTING

GBV and MENTAL HEALTH SCREENING

MOTHERBABY PAIR VISITS

1 Frontline Healthcare Providers (FHPs) are at the heart of our strategy. They include doctors, nurses, pharmacists, social workers, counsellors, community health workers, peer supporters and other healthcare providers working in or with primary care facilities or situated at the interface of formal health and community service delivery.

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Related health services include those addressing TB, malaria, maternal, new-born and child health, non-communicable diseases, sexual and reproductive health and rights, and mental health.

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Support services include psycho-social support, addressing gender based violence and violence against children (with a focus on social protection), early childhood development, and nurturing care interventions.

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CONTENTS OUR WHY

FOUNDATIONS

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THE ROAD SO FAR, WHERE WE ARE NOW

BACKGROUND & CONTEXT

Why children, adolescents and youth?

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Why Africa?

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Why frontline healthcare providers (FHPs)?

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The PATA Network

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Programming and quality improvement

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Linking & Learning

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Advocacy and influence

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About This Document

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About Pata

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Appendix: Unpacking the Theory of Change

OUR NEXT DEVELOPMENT STEP

TAKING THE NEXT STEP

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Strategy 2024-2030

Expansion targets Vision

Mission Theory of Change

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FOUR CRITICAL TRAJECTORIES

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Operationalising the theory of change: SIX STRATEGIES

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Implementation architecture

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Taking the next step

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OUR WHY BACKGROUND & CONTEXT

OUR WHY | BACKGROUND & CONTEXT

WHY CHILDREN, ADOLESCENTS AND YOUTH? The Global AIDS Strategy states that one of the most glaring disparities in the HIV response is the failure to meet the needs of children living with, or at risk of, HIV. Progress in preventing vertical transmission has flatlined and challenges in delivering quality care persist, with poor uptake of testing, gaps in ART initiation, low retention rates and poor adherence to HIV treatment.

Children, adolescents and youth continue to be left behind in the HIV response.

Inequities in HIV diagnosis and treatment between children and adults: » 57% of children living with HIV receive antiretroviral treatment, compared to 77% of adults » 46 % of children experience viral load suppression, versus 71% in all populations » 13% of all AIDS-related deaths are among children, who represent only 4% of people living with HIV

Advanced HIV disease in children with co-infections (e.g., pneumonia, TB, malaria, diarrheal diseases and severe malnutrition) contribute to poorer health outcomes, increased morbidity, and early mortality.

Adolescent girls and young women in the Eastern and Southern Africa Region face serious challenges to fulfilling their sexual and reproductive health and rights including vulnerability to HIV, sexually transmitted infections and unintended and unsafe pregnancy. The adolescent birth rate in this region is twice the global birth rate. In sub-Saharan Africa new HIV infections are three times higher among adolescent girls and young women (aged 15-24 years) compared to adults and account for 63% of all new infections amongst women and girls. Only 55% of adolescents in the region are receiving lifesaving treatment, with AIDS remaining the leading cause of adolescent mortality across 12 East and Southern African countries.

Prevalence of modifiable non-communicable diseases (NCDs) among adolescents and young people is on the rise. Conditions such as obesity and diabetes are increasingly common and mental health challenges are most prevalent.

Children and adolescents who experience poverty and exclusion are more likely to be left behind. This includes adolescent parents affected by HIV, their children, and the children of inadequately served populations and groups affected by discrimination. Socio-economic, gender and other inequalities, as well as mental health challenges, violence, stigma, discrimination, and harmful laws and practices, remain barriers to accessing sexual and reproductive health and rights and undermine prevention efforts, access to treatment and retention in care.

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There is an urgent need to overcome barriers to quality, non-discriminatory healthcare and to address the underlying factors that drive inequalities and poorer health outcomes for children, adolescents and youth.

Multiple, intersecting global crises are undermining political commitment and financing for the HIV response and for sexual and reproductive health and rights. A targeted approach with appropriate investments and leadership at all levels is essential. Ending AIDS in children, adolescents and young people will require the scaleup of proven interventions, accelerated innovation, and models of care that work for children and their families.

A new Global Alliance to end AIDS in children by 2030 was launched in 2022 to ensure that no child living with HIV is denied treatment and to prevent new HIV infections. The Global Alliance will measure progress towards the Sustainable Development Goals with a focus on key priority actions for children and adolescents at national and regional levels.

WHY AFRICA? With only 15% of the world’s population, Africa bears a disproportionate burden of morbidity and mortality and is at the epicentre of the HIV pandemic. 90% of children and adolescents living with HIV live here.

Africa also has a growing youth population. This ‘youth bulge’ results in a sharp increase in the absolute number of young people at risk of contracting HIV and related diseases.

Further, political, economic and social factors mean that African health systems are often fragile and under resourced. A growing number of healthcare providers are leaving the continent for wealthier countries, seeking better life opportunities. There is a clear need for well capacitated and supported frontline healthcare providers (FHPs) and community partners to ensure access to quality stigma-free health services for children and adolescents if we are to achieve the goal of ending AIDS by 2030.

For these reasons our direct programmatic work and our network is Africa-centred and African-led.

To maximise our reach and make a wider impact, all our tools and resources are available and we actively engage with organisations and leaders who seek to do similar work in other regions.

Through partnership with global stakeholders we influence and shape programmes and policies that serve the global good.

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OUR WHY | BACKGROUND & CONTEXT

WHY FRONTLINE HEALTHCARE PROVIDERS (FHPS)?

The critical gaps that remain in the HIV response are centred around access to quality services. FHPs, along with the facilities they work in, play a vital role in delivering and integrating HIV services. Increased investment and health system strengthening on the frontline of service delivery is urgently needed if we are to reach global targets and end AIDS in children, adolescents and young people.

We acknowledge that significant progress has been made in the HIV response through: »

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scaling interventions which inject additional resources and targeted programmes into national health systems, and community-led interventions with a strong focus on community engagement and monitoring – though this sometimes shifts responsibility for quality care from formal to informal systems

But we notice a glaring blind spot – the roles and voices of healthcare providers are often excluded, neglected or rendered invisible.

When healthcare providers are visible, they are often characterised as part of the problem: they are unfriendly; they have negative attitudes; they discriminate against key populations; they stigmatise young people seeking sexual and reproductive health rights and services.

These perceptions, while sometimes valid, fail to recognise the reality that FHPs: »

play a critical role in the HIV response in the delivery of services

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often work in tough, under resourced circumstances, and are subject to many of the same constraints that face their clients

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are seldom acknowledged or engaged as critical partners with agency and a positive role to play

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work in environments where voicing their concerns or challenges is difficult and may threaten their job security

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generally want to do their jobs well, and to make a meaningful contribution

In short, we believe that FHPs are a neglected but critical part of the solution: they are, and can increasingly become, champions and change agents for the rights and health of children, adolescents and young people. They work close to the ground and are themselves members of the communities they serve, making them best placed to develop context-specific and sustainable solutions.

Working with FHPs and facilities offers a costeffective and sustainable approach to enhancing comprehensive service delivery and making lasting change. Our preference is to leverage existing resources rather than introducing solutions that might not seamlessly integrate or endure over time.

This is crucial considering declining trends in HIV investment.

Health systems must be responsive to local contexts. We need healthcare providers with the capacity to deliver holistic and integrated services that are friendly, stigma free, rights-based and people-centred.

PATA believes that building more effective health systems will require transformation from the ground up. Therefore, we position frontline healthcare providers who work closely with communities at the heart of our strategy.

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FOUNDATIONS THE ROAD SO FAR, WHERE WE ARE NOW

FOUNDATIONS | THE ROAD SO FAR & WHERE WE ARE NOW

THE PATA NETWORK

This strategy builds upon a solid track record. PATA is already positioned as a skilled, resourceful, and reliable strategic and technical partner in the global HIV response. Over the years, we have built the foundations of a strong and effective network. Our new strategy does not depart from these foundations but seeks to build and expand upon them – to position PATA and its network as frontline leaders in the HIV response.

The PATA network offers a platform for frontline healthcare providers to share their experiences, challenges, and perspectives on child and adolescent HIV service delivery. The network helps bridge the gap between global commitments and local realities by implementing and documenting service delivery models that are locally-led, effective, scalable and cost-efficient.

The PATA network provides a safe space for frontline healthcare providers to connect, motivate, and inspire each other to deliver comprehensive childand adolescent-friendly services and care that is rights-based, stigma-free and people-centred.

Before outlining our new strategy, we offer a brief summary of PATA’s foundations and accomplishments.

THE NETWORK INCLUDES

Mali Burkina Faso

4 571 FHPs in 904 health facilities

Ghana Côte d'Ivoire

Nigeria

Togo

2 997 Ministry of Health

Ethiopia Cameroon Uganda

DRC Gabon

Kenya

Rwanda

representatives, managers and policy makers

Burundi Tanzania

528 peer supporters (community health workers)

Angola

741 members of community-based organisations or non-governmental organisations

Mozambique Zambia

Malawi Zimbabwe

Namibia Botswana

4850 members on the PATA Linking and Learning Hub

Eswatini Lesotho

This network of FHPs collectively contributes to supporting

South Africa

307 057 children and adolescents receiving ART, with many more receiving quality prevention services, care and support from frontline healthcare facilities.

Of the above, PATA provided direct technical, linking and learning support to 451 health facilities who collectively supported 178 186 children and adolescents on ART between 2020-2023.

PATA network countries with active programmes PATA network countries

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PROGRAMMING AND QUALITY IMPROVEMENT PATA drives implementation of best practice strategies and service delivery improvements for children and adolescents affected by HIV through its engagement as a technical provider in several regional programmes, and by implementing incubation projects which strengthen local health systems and produce learning and innovation.

In 2023, PATA had active projects in Angola, Cameroon, Eswatini, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

PATA quality improvement methodologies, trainings, mentorship, and its suite of tools are applied across a comprehensive care model and service delivery framework.

TARGETING PATA aims to reach facilities and frontline healthcare providers who may not be reached by large-scale interventions.

Wherever possible, we reach out to under resourced facilities in areas outside of obvious urban centres. We aim to strengthen health systems where the need is most pressing, and where there are good opportunities to develop tailored interventions that are responsive to the local context.

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FOUNDATIONS | THE ROAD SO FAR & WHERE WE ARE NOW

CLINIC-COMMUNITY COLLABORATION (C3) Collaborative partnerships between clinics and community based organisations can be transformative in the HIV and health response. PATA championed and popularised a systems-oriented methodology known as C3: ClinicCommunity Collaboration.

The methodology includes: »

Tools, community dialogues, mapping and community-led monitoring

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Task-shifting, training and integration of peer support/mentor mother/ community health worker models

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Clinic-Community local forums (including the sharing of data and strengthening referral pathways and undertaking joint initiatives)

This approach has enhanced the work of many civil society programmes beyond our own, and influenced the thinking and policy frameworks of global agencies.

The ABCD approach is central to C3:

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Ask: engage key stakeholders to assess existing services and service delivery gaps Boost: strengthen service delivery with training, technical support and resources Connect: facilitate linkages between clinics and communitybased organisations to improve referrals and service linkage Discuss: promote ongoing engagement though regular case reviews, community-led monitoring and advocacy

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VALUING RELATIONSHIPS, WORKING IN PARTNERSHIPS Wherever possible, PATA works in partnerships at local, national, regional and global levels. We are recognised as a highly skilled and valued partner that brings a unique approach to collaboration. Partnerships create opportunities for enhanced sustainability, deepened influence and wider impact. They also improve efficiency by expanding our reach without the need for an extensive and expensive staff complement.

LINKING & LEARNING Linking & learning is at the centre of PATA’s work – it weaves together all levels of our in-person and online offerings, helps connect our network, supports strengthened practice on the ground, drives innovation, and informs our advocacy agenda.

The PATA Linking & Learning Hub is a digital platform for regional collaboration, capacity strengthening, and peerto-peer learning for the PATA network and beyond. It is a virtual community of healthcare providers (and others) committed to improving paediatric and adolescent HIV services in Africa. In 2023, the hub had 4 850 active members.

The PATA website provides access to information on PATA programming, online resources and a link to the PATA Linking and Learning Hub. Through the Hub, healthcare providers can access all PATA’s online training resources and tools, as well as valuable linking and learning events, such as PATA REALs4 and TeleECHOs5.

PATA also convenes national forums and regional Summits. PATA Summits (held annually) offer an opportunity for healthcare providers to share their experiences and engage in peer-to-peer learning to improve paediatric and adolescent HIV treatment and service delivery in Africa. Summits aim to strengthen service delivery leadership and build the capacity of health and service provider teams on the frontline.

Across various linking and learning activities, PATA offers an important reality check against global and national commitments, where progress and everyday challenges, setbacks, lessons and real-world practical solutions from our region are shared and discussed. Understanding the perspectives and experiences of FHPs strongly informs PATA’s advocacy work.

4 REAL stands for “Review cases, Engage peers, Access experts and Learn lessons”. PATA REAL is a quarterly webinar series for health providers in the PATA network. It showcases real cases encountered during routine clinical care, with the aim of providing practical learning to improve paediatric and adolescent HIV service delivery.

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TeleECHOs are webinars hosted by the World Health Organisation (WHO) and partners (including PATA), focused on paediatric and adolescent HIV treatment and care.

FOUNDATIONS | THE ROAD SO FAR & WHERE WE ARE NOW

ADVOCACY AND INFLUENCE PATA is recognised as an important regional advocate. We work alongside healthcare providers to amplify their voices and facilitate their participation in policy and decision-making processes. Their invaluable, first-hand experiences from the ground offer critical insights and solutions for addressing the gap between policy and practice.

To enhance our understanding of service delivery needs and challenges, and to gather evidence for informed advocacy efforts, we actively engage frontline health providers through various methods including:

PATA provides evidence and voice from the frontline through its participation in key global coalitions, working groups and learning forums focused on paediatric and adolescent HIV in Africa.

These include: »

Global Alliance to End AIDS (global/regional/ national)

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Coalition for Children affected by AIDS (CCABA)

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Child Survival Working Group (CSWG)

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Rapid assessments

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WHO adolescent working group

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Focus group discussions

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WHO paediatric TeleECHO collaboration

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Reality check surveys and polls

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Healthcare provider campaigns

Global Accelerator for Paediatric Formulations Network (GAP-f)

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Documenting stories and evidence from the frontline

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Children HIV Exposed and Uninfected (HEU) Working Group

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Co-development of technical and policy briefs, journals and tools

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Paediatric-Adolescent HIV Learning Collaborative Africa (PAHLCA)

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National Technical Working Groups (TWGs)

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Regional Inter Task Team – East Southern Africa (RIATT-ESA)

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End Paediatric AIDS in Children (EPIC)

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Frontline AIDS Global Partnership

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OUR NEXT DEVELOPMENT STEP Strategy 2024-2030

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OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

This strategy coincides with a critical moment in the HIV trajectory. This is an opportune moment to consider what it will take to enable effective service delivery. We aim to contribute both to the ‘last mile’ of the HIV response, and to lay foundations for the ongoing pursuit of universal healthcare beyond 2030.

Financing for the global HIV response is at a turning point: there is a need for cost-effective, integrated, comprehensive, locally-led and sustainable solutions – which is what PATA offers. The time has therefore come to expand and deepen PATA’s work.

This new strategy centres: 1. Growing the PATA network as a collective voice for FHPs in Africa 2. Building local champions with the capacity to lead and drive service delivery innovations 3. Amplifying FHPs’ collective voice as agents of change and champions for children and adolescents 4. Expanding and deepening the scope of PATA’s technical support

Our growth and expansion plans resonate with feedback from partners, network members and other stakeholders who strongly affirmed the value of PATA’s past and present contributions. The prevailing sentiment, to which this strategy aims to respond, was a resounding “We want more of everything!

However, expansion must happen without eroding gains already made, and without compromising our commitment to offer technical support that is low-cost, locally driven and informed by the experiences and perspectives of FHPs and their clients.

EXPANSION TARGETS »

Double total network membership from 4 571 to 9 142

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Expand our programming footprint in West and Central Africa from two to four countries

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Grow overall network from 24 to 30 countries

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Expand active programming into 50% of overall network countries

Strengthen programming to include prevention, broader health6 and psycho-social support as part of a comprehensive package of care

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Double total network health facility coverage from 904 to 1 808 with 50% active in PATA programming, linking and learning across a three-year period

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Expand, consolidate and refine our comprehensive technical assistance package

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Identify, build capacity and support FHP champions and leaders who can increasingly represent the network

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Improve online systems and strategies that will enable us to mobilise, service and grow engagement with this expanded network

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Increase children and adolescents receiving ART across the total PATA network by 30% from 307 057 to 399 174

Achieving this will require an expansion in PATA’s staffing and budget, which can be accomplished with relatively modest new investments. Details of the organisational adaptations required to realise these goals are outlined on page 24.

6 In some countries broader health with include TB, malaria, maternal, new-born and child health, non-communicable diseases, sexual and reproductive health and rights, and mental health. Psychosocial support will include addressing gender based violence, violence against children (with a focus on social protection), early childhood development, and nurturing care interventions.

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VISION All African children, adolescents and youth affected by HIV access prevention, optimal treatment and comprehensive person-centred care, enabling them to live long, healthy lives.

THEORY OF CHANGE INPUTS

STRATEGIES Learn

» Staff, board & advisory groups

4. Project Implementation

» Partners » Technical expertise » Methodologies » Reputation

Strengthe

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» Network

3. Capacity Strengthening PATA NETWORK

2. Linking & Learning 1. Network Development Con

The subsections which follow unpack the trajectories and strategies which drive our theory of change, and the implementation architecture that helps us to realise it.

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n ect

OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

MISSION To connect, motivate and empower a network of champions for health, rights and service quality for children, adolescents and youth affected by HIV in Africa.

OUTCOMES

» Frontline healthcare providers at facilities deliver quality prevention, optimal treatment & personcentred care to children, adolescents and youth affected

by HIV

5. Advocacy & Influence

Change & Influence

» The HIV programming and policy environment is more enabling for frontline healthcare providers and the children, adolescents and youth they serve

IMPACT

All African children, adolescents and youth affected

by HIV receive quality healthcare and live longer, healthier lives.

» Frontline healthcare providers participate meaningfully in decision-making; their voices and insights are heard and valued

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FOUR CRITICAL TRAJECTORIES We work to CONNECT with FHPs and to link them to each other, within and across countries. Together, we constitute the PATA Network. This network is the relational space that contains and enables most of our work – it is central to PATA’s strategy and success.

health systems. They also influence each other across and through the network (e.g., role modelling child and adolescent friendly attitudes and practices), and participate in advocacy efforts as champions for children at higher levels to influence district, national, regional and global policy and programming.

The PATA Network is our entry point for STRENGTHENING FHPs and facilities. This work increases connection and engagement – helping to develop the network – while directly developing skills and knowledge and motivating FHPs’ to enhance service quality.

PATA makes use of data, evidence and the collective voice from its network to advocate for changes that can create a more enabling policy and programme environment for effective service delivery. This, in turn, enables new connections, new possibilities for strengthening healthcare provision, and new learning and innovation.

FHPs engage in local advocacy and other change efforts to work towards effective, comprehensive service delivery for children, adolescents and young people in their own facilities and their local

& Infl uence

Network of FHPs: champions for the health and rights of children, adolescents and youth

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These three trajectories (CONNECT, STRENGTHEN, LEARN) amplify each other and build the capacity for effective INFLUENCE leading to CHANGE at local, national, regional and global levels.

c on n e c t

Learn

See the Appendix for a more detailed breakdown of these trajectories, how they are set in motion and sustained, and an overview of their outcomes and impact.

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Strengthen

Doing all of this, while implementing incubation projects which test out innovative approaches and solutions in the field for potential scaleup, contributes to LEARNING. We document evidence and insights from project innovations and from network members and package these for sharing across the network (resourcing our STRENGTHENING trajectory) and with others in the field.

All four trajectories work to position FHPs as champions of children’s health and rights, from the most local level to the global stage.

ge han

In countries with active projects, FHPs can access training, mentoring or direct support from a PATA Country Representative or technical assistance provider. We also facilitate quality improvement processes at facility-level, and convene in person and online forums, learning exchange events and communities of practice. A wide variety of online learning materials are also available on the Hub, enabling self-study or collaborative upskilling for groups of FHPs.

OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

OPERATIONALISING THE THEORY OF CHANGE: SIX STRATEGIES In practice, our Theory of Change will be operationalised by six interlinked strategies which support the four trajectories outlined above. These strategies are a means of organising the change trajectories for more efficient management, coordination and implementation. Together, they will drive PATA towards its goals in the coming years.

1. Network development

4. Projects for innovation, learning & health system strengthening

2. Linking & learning

5. Advocacy and influence

3. Locally-led in-country capacity strengthening

6. Organisation development

Each strategy contributes to all trajectories – i.e., CONNECT, STRENGHTEN, LEARN & INFLUENCE – albeit in different ways. Below we describe each strategy and our broad objectives in this strategic period (2024-2030).

1. NETWORK DEVELOPMENT Expand and strengthen an Africa-wide network of frontline healthcare providers & facilities working in partnership with communities.

This is a core strategy as it is foundational to, and fed by, all other strategies. The network is critical to PATA’s credibility and legitimacy, and a key pathway to impact and sustainability. It enables us to expand our influence within the continental community of FHPs in cost-effective ways. It embodies and amplifies the voices and experiences of FHPs in the interests of improving service quality and finding solutions to problems in the field. It provides a strategic platform for growing solidarity and for championing the health and rights of children, adolescents and young people affected by HIV in Africa.

By 2030 we will: »

Double the size of the network

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Increase the number of PATA-affiliated FHPs, expand total network coverage to at least 30 countries, while reaching more facilities with active programming in 50% of countries

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Increase FHP participation and engagement in PATA’s offerings

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Increase the number of FHP champions who • lead and facilitate cascading of innovations and lessons to underserved facilities • represent PATA in influential spaces at national, regional and global levels

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2. LINKING & LEARNING Facilitate processes and platforms for healthcare providers across the network to exchange frontline experiences, share knowledge and learning, and access support and development opportunities.

Learning together is one key way in which the network comes to life; it both sustains it and deepens active engagement. Learning is also at the heart of how we understand processes of change, quality improvement and, ultimately, impact. Linking & Learning is the lifeblood of PATA, feeding into and enabling all other strategies.

other forums for conversation about the work and experiences of FHPs. As such, it is also a valuable source for gathering and compiling data about our network and the wider FHP community.

By 2030 we will: Linking & Learning is a process, supported by the PATA website and the Linking & Learning Hub which provide access to a wide range of resources and learning opportunities, but also through events at country and regional level (e.g., national trainings and forums; project forums; the PATA Summit, which brings people together from across the entire PATA network).

Training, webinars and other resources are free to network members. The Hub also hosts community conversations, specific communities of practice, and

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Build a strong culture of self-directed learning across the network

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Double the uptake of learning opportunities (online growth and engagement) by network members

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Expand access to global, regional, national guidance by implementing a highly effective communications strategy

OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

3. CAPACITY STRENGTHENING IN-COUNTRY Provide locally-led, responsive and cost-efficient technical assistance to targeted FHPs and facilities.

This strategy is accomplished mainly by Country Representatives (and sometimes wider teams) based in countries with active projects. These in-country PATA staff – usually local people who know the context and local networks well – offer direct, in-person technical support, and onsite mentorship to selected FHPs in selected facilities/communities. They also facilitate access to learning resources and expertise. Their role is to facilitate the adoption and implementation of change on the frontline.

This work aims to develop clinical skills and knowledge and to identify and support service improvement areas. It will also address FHPs’ well-being and strengthen their leadership, management and advocacy capacity.

By 2030 we will:

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Expand into new countries – the network will be present in 30 countries by 2030, prioritising those where HIV prevalence and gaps in reaching targets for children, adolescents and youth are highest (e.g., West and Central Africa)

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Increase targeted FHPs’, facilities’ and community organisations’ competence in relevant clinical, HIV and support services, enabling the delivery of comprehensive treatment and support to children, adolescents and youth

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Strengthen local systems for health around targeted sites (clinic-community-collaboration; improved local programming and linkages)

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Improve user experience, service scores and health outcomes at targeted sites

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Broaden service delivery frameworks with increased tools that support the integration of HIV, TB, malaria, MNCH, SRHR and psychosocial support services with increased attention given to mental health, GBV and ECD7 8

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Increase targeted FHPs’ and community leaders’ capacity to advocate for change with local duty-bearers

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Increase targeted FHPs’ and community leaders’ capacity to engage in self-care, and effective team leadership and management

Related health services include those addressing TB, malaria, maternal, new-born and child health, non-communicable diseases, sexual and reproductive health and rights, and mental health.

Support services include psycho-social support, addressing gender based violence and violence against children (with a focus on social protection), early childhood development, and nurturing care interventions.

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4. PROJECTS FOR INNOVATION, LEARNING & HEALTH SYSTEM STRENGTHENING Design and implement targeted projects to enhance service delivery and clinic-community collaboration, and to drive innovation.

Projects provide a mechanism for innovating and testing interventions for potential scale up.

Additionally, donor-funded projects are a key means of financing our work in all six strategies.

Two principal kinds of projects are undertaken: »

By 2030 we will: »

Expand our data utilisation, knowledge and evidence base to inform service delivery improvements

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Document and disseminate models/best practices/approaches that make an impact

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Collate evidence of transfer and onward impact of innovations and lessons learned

Defined technical assistance projects. These projects may include elements of innovation, but may also involve roll-out of existing methodologies, practices or models with technical support provided by PATA.

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Strengthen M&E systems (knowledge management hub) aligned with local health information systems, enabling real-time data collection and reporting on project interventions

The latter expand our reach and enable us to finance work in-country. They are undertaken only if they support our overall mission –projects involving opportunities for learning and innovation are prioritised.

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Expand and deepen project partnerships (i.e., work in consortia) as a vehicle for expanding learning and influence

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Incubation projects. These single- or multicountry projects are usually undertaken in partnership with other civil society organisations (global and/or local) and in collaboration with Ministries of Health. They are aimed at incubating and testing new solutions/approaches to improve service delivery for children, adolescents and/or young people. Such projects offer opportunities to learn, to develop innovations and disseminate them, and to learn from and mutually influence project partners. These projects also offer the opportunity to expand our network by reaching new sites and FHPs.

Learning from projects – translating raw experience and data into knowledge that can be disseminated and used as a basis for advocacy and influence – will be supported by a strong monitoring and evaluation (M&E) function. A knowledge management hub will be established to enable full and meaningful utilisation of data to feedback into improving programming and for advocacy.

OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

5. ADVOCACY AND INFLUENCE Advocate and influence at local, national and global levels, to bridge the policy-practice gap.

The content of this work flows from strategies 1 through 4. We support local FHPs to undertake advocacy and we aim to position them as champions for children, adolescents and youth in the HIV response. We support FHPs’ voices and experience to be heard and amplified at local level and in strategic platforms to which they might not otherwise have access.

By 2030 we will: »

»

»

Support FHPs to successfully implement local advocacy plans, driving systems change and service improvements at facility level and at the interface between clinics, communities and other systems (e.g., local authorities, local health departments) Support FHPs as they participate in national Technical Working Groups enabling their effective participation, leading (where possible) to improvements in practice, programming and policies Support the effective participation of FHPs in national, regional and global platforms, meetings and conferences

»

Participate and influence regional and global decision-making platforms (e.g. the Global Alliance; Technical Working Group; etc.) with FHP champions

»

Monitor the degree to which FHP experiences and voices are invited, listened to and taken seriously – i.e., impact on decision making, programming and policy

»

Monitor the degree to which: • Gaps in service delivery are addressed • The needs of FHPs are addressed (increased investment, more engagement)

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6. ORGANISATION DEVELOPMENT Align systems to strategy: develop the PATA team, systems and resource base.

To implement these strategies and catalyse our theory of change, PATA’s core team and systems need to be aligned. This will require additional resources, additional staff, and a degree of reframing and restructuring of some aspects of our work. At the same time, PATA seeks to remain lean and cost-effective – in the longer term, investing in network growth should enable significant expansion of impact for relatively modest additional investment in our core systems and capacity.

In the coming years we will mobilise additional resources to enable us to invest more heavily in network development, in standardising and strengthening our technical assistance resources and our shared practice of mentoring, in influencing and accompanying change, and in tracking impact (M&E).

By 2030 we will: »

Find efficiencies and increase income to enable these changes; where possible seek financing for broad trajectories or strategies rather than limited projects – this is especially necessary in relation to network development, practice development and knowledge management

»

Restructure aspects of the organisation to align with the new strategy and invest in building or hiring capacity in the following areas:

»

•

Leading network development (strategy, technical systems, relationship management, communications to drive and mobilise network growth and engagement)

•

Leading practice development in relation to technical assistance (articulating our practice more clearly; quality improvement)

•

Country-level teams (Country Representatives with expanded in-country teams in more countries)

Invest in strengthening systems for: •

Monitoring impact and tracking learning

•

Hosting the network online (Hub expansion and development)

•

Managing and cohering a distributed team (e.g., human resources and communications systems)

»

Refining our technical assistance and knowledge resources (courses, publications, other documents and media) so they are user-friendly and easy to access

»

Sustain and develop our governance and accountability structure; this includes an active and highly skilled Board of Directors with connections to the global HIV response, a Technical Advisory Panel, a Youth Advisory Panel, and a Healthcare Provider Advisory Panel •

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Strengthening the Healthcare Provider Advisory Panel (in particular) is a priority in the coming period as a core group of FHP champions for children, adolescents and youth

OUR NEXT DEVELOPMENT STEP | Strategy 2024-2030

IMPLEMENTATION ARCHITECTURE The PATA Core Team is based in Cape Town, South Africa and distributed across countries in which PATA runs active incubation projects and partnerships. Most PATA staff – especially those involved in strengthening and strategic work – have a background as frontline healthcare providers themselves.

The Cape Town Office holds the whole system together by centralising organisational functions (e.g., financial management and human resources) and programming functions (e.g., project management and M&E). It develops and maintains the online platform (the PATA Hub), coordinates across the network, and provides overall strategic direction, with the support of the Board and Advisory Panels. The Cape Town team also focuses on sustaining, expanding and deepening the network in African countries where PATA does not have active projects but a need for our work exists.

PATA’s regional and global influencing agenda is led by senior staff in the Cape Town office. This is done, wherever possible, in collaboration with members of the wider network.

We seek to foreground the voices and experiences of FHPs themselves and bring them to global spaces – directly, or through research and evidence from implementation. The insights and intelligence generated in the process of connecting, strengthening and learning with our network offer unique perspectives and practical solutions to many of the blockages and challenges facing the wider HIV response and offer an important opportunity to integrate HIV services and advance our commitment to Universal Health Care for all.

PATA Network​

Distributed team members are based in countries where they have intimate local knowledge and established relationships. They focus on network development, capacity strengthening and influence in their countries, as well as in participating in the wider work of the PATA network. Essentially, their work is to activate our theory of change, while supporting the implementation of specific projects.

Country Representatives may be supported in country by small teams – e.g., field workers, technical assistance providers – depending on the scale of project activities.

Country Representatives and/or their teams engage with selected health facilities, FHPs and communities.

PATA usually works with smaller, lower volume sites that do not have existing support – health facilities and communities with less resourcing, where largescale, high-profile programmes may not reach. Our aim is to ensure quality improvement across the health system, not just in big city sites or centres of excellence. This direct accompaniment is financed through projects, which in turn generate materials, resources and learning which feed back into the larger PATA network to strengthen practice and inform our advocacy agenda.

Frontline providers & community partners

Programme Implementation and Technical Support ​ PATA has local country representatives, and technical support providers in each of the countries where it is implementing projects​ ​ Coordination & Management​ Central Office – Cape Town​ •

Senior Management Team (including a Executive Director, Head of Finance and Operations, and Head of Programmes and Knowledge)

•

Advocacy, ​Communications & ​ Networking team

•

Monitoring Evaluation ​and Learning team

•

Finance &​Operations team

Governance ​& Accountability​ Board of Directors​

By linking to each other, and to the larger PATA team and network, Country Representatives contribute to cross-country, cross-project learning and capacity strengthening.

TAP – Technical Advisory Panel​ YAP – Youth Advisory Panel​ HAP – Health Provider Advisory Panel​

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TAKING THE NEXT STEP

TAKING THE NEXT STEP

PATA VALUES Do it Right: We strive for quality, friendly, stigma free, safe and rights based services for all. We aim to turn our passion into action, and commitment into results that improve the health and wellbeing of our team, and those we serve.

rt nk you fo aking the time t o eng Tha age with these ideas!

CHILD-ADOLESCENT FRIENDLY SERVICES

Do it Together: We can only end AIDS together in ways that foster inclusivity, clinic-community collaboration, and respect for diversity, with equitable access to Universal Health Care that is locally led, and context specific.

Our partnerships are prefaced on respect, trust and transparency where healthcare providers are supported to be change-makers and champions of service delivery on the frontline.

CLINICCOMMUNITY LINKAGE

All In!

BETTER ART for KIDS!

Do it Right, Do it Together, Do it Now!

Do it Now: We believe there is urgency and that now is the time to galvanize solidarity, strengthen alliances, and act together with strategic partners, communities and frontline healthcare providers to ensure holistic wellbeing and end AIDS once and for all.

As we prepare to step into this next phase of our development we invite network members, partners, colleagues and other stakeholders to engage with this document and with us. We would welcome your questions, feedback or offers of support.

Thank you for taking the time to engage with these ideas!

The PATA team | November 2023 | info@teampata.org

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APPENDIX: UNPACKING THE THEORY OF CHANGE The table below is an expanded description of how we will activate our theory of change. It describes what PATA will do to generate movement in each trajectory, unpacks their intended outcomes at different levels, and links these to the overall impact we seek.

Key aspects of our six strategies are disaggregated in the central column. This framework will also inform our strategic monitoring efforts in the coming years – indicators of change against critical outcomes will be built into our monitoring system.

CHANGE TRAJECTORIES / what we do CONNECT / NETWORK Build and grow a vibrant, engaged, southern-led network of frontline healthcare providers (FHPs).

MEANS / how we do it

OUTCOMES & IMPACT / why we do it

•

Communication, marketing & mobilisation Increasing:

•

Online platforms (the PATA Linking and Learning Hub, and its Communities of Practice, country-level WhatsApp groups, newsletters and other modes of engagement)

» »

Network scale and engagement (breadth/coverage & depth) Connection and access to support and knowledge resources Solidarity Voice and visibility Role modelling Leadership and representation

•

Networking (by Country Representatives, through programmes, technical support and local linkages)

» » » »

•

Linking & Learning at local, national and regional levels (e.g., national forums, the PATA Summit, community dialogues)

FHPs feel more supported, less alone, more able to make a positive contribution, more able to grow and develop their skills, practice, attitudes and voice.

•

Taking action together (using our voices and skills to make change locally, nationally, globally)

STRENGTHEN / CAPACITATE Strengthen and improve the knowledge, attitudes and practices of FHPs and facilities so they are better equipped to respond to the needs of children, adolescents and young people affected by HIV/ AIDS (and, in the process, lay foundations for higher quality and more universal healthcare).

•

Localised technical assistance, mentoring Growing FHPs’ and facilities’: in-country (including quality improvement » Clinical and service delivery capacity (technical and at facility level and facilitation of greater soft skills) clinic-community collaboration) » Capacity for self-care, self-mastery, team National forums/summits management and leadership » Capacity for advocacy and influence (making change Global summits where it is needed) Face-to-face and online trainings

LEARN / INNOVATE & BUILD AN EVIDENCE BASE Build knowledge and evidence by implementing and learning from innovative projects, from working with partners in the field, and by engaging the network itself.

⬇ ⬆

• • •

Other stakeholders at local, national, regional and global levels recognise the value and importance of the network and its critical role in the HIV response.

Online/in-person peer learning via PATA REAL case reviews and Communities of Practice

AND

•

Research, monitoring and evaluation

•

Develop and document evidence-based interventions, models and guidance (e.g., C3)

The PATA Network and its partners have access to and share high quality, evidence-based resources to strengthen their own practice and programming, and to improve health system functioning from the bottom up.

•

Build a comprehensive library of proven training, technical assistance and quality improvement resources that are opensource and shared online

•

Regularly gather and document experiences and perspectives of the network and learn from FHPs’ experiences and innovations

•

»

Strengthening facilities’ approach to collaborating with communities and engaging the wider health system for comprehensive service delivery

⬇ ⬆

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APPENDIX: UNPACKING THE THEORY OF CHANGE

CHANGE TRAJECTORIES / what we do

⬇

CHANGE / INFLUENCE Improve practices, influence colleagues, and strengthen and enhance the functioning of local, national and global health systems.

MEANS / how we do it

•

OUTCOMES & IMPACT / why we do it

»

Use lessons learned, innovations and insights, and leverage on our growing web of strategic partnerships and influential relationships at global and policy level to communicate and advocate effectively for change at local, national, regional and global levels

» » »

Inform service delivery improvements at local level and collectively influence policy at local, national and global level.

» » » »

FHPs champion change and service improvements in health facilities FHP champions lead and facilitate cascading of innovations and lessons from implementation to underserved facilities FHPs engage and work collaboratively with community partners FHPs’ input is invited and valued in technical working groups and other policy forums Increased investment in FHPs well-being and development Changes in guidance, protocols, systems, policies and plans Improved health system performance Better health outcomes for children, adolescents and young people affected by HIV and served by PATA network members

⬇ ALL OF THIS CONTRIBUTES TO THREE OVERARCHING FIELDS OF IMPACT: »

Healthcare providers at frontline facilities deliver quality prevention, optimal treatment and comprehensive person-centred care to children, adolescents and youth affected by HIV Indicators:

• •

»

The HIV programming and policy environment is more enabling for healthcare providers and their clients Indicators:

•

Improved health outcomes across the cascade Service users report improved satisfaction

•

FHPs’ perspectives reflect improved service delivery environment and improved job satisfaction Changes in policy and programming at national, regional and global levels

⬇ OUR ULTIMATE GOAL »

All African children, adolescents and youth affected by HIV receive quality healthcare and live longer, healthier lives.

Indicators:

•

Demographic and health-outcomes data and evidence from UNAIDS, WHO, and other credible sources

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