The Journey of the HIV/AIDS Scorecard for Moldova kicks-off …

By Veronica Cretu

Back in the fall of 2019, during one of my missions to Chisinau, I spent half a day with a group of great professionals who have been working for years in the field of HIV/AIDS in Moldova.

While I am not a health sector policy maker nor a medical doctor, I still had few great opportunities to transfer some of my knowledge and skills from education sector to health sector; i.e. back in 2005-2008 I facilitated several training programs on HIV/AIDS policies at the work place with Elena Jidobin at International Labour Organisation. Elena, who was as passionate and committed to her work, was keen to bring some innovative approaches into her program in order to reach out to as many employers and employees and raise awareness about HIV/AIDS prevention. Another great experience goes back to the period of 2008-2012 during which I coordinated a national scale project on Decisions for a Healthy Life Style, in which HIV/AIDS contents have been embedded into a curricular we, as Open Government Institute, managed to institutionalise in the Moldovan Colleges and Vocational Schools. I am proud that today the course is a mandatory one and no longer optional. With this, there is hope that young Moldovan students will be able to make better informed decisions about their health and life style.

With this background in mind, and with my humble knowledge about the HIV/AIDS, I found myself back in Chisinau sharing about what a Scorecard on HIV/AIDS would bring into the sector and why it would be a valuable tool.

I find Scorecards promising. If these are well-designed and well-thought through tools, they can help improve the status quo of any sector, initiative, or even of a smaller scale project. During 2016-2018, I coordinated a Governance Reforms Scorecard project for the World Bank in Moldova, and the ambition with that project was to design a framework that helps monitor the results achieved on the selected reforms that the Moldovan Government had committed to. The results were expressed through numbers (numerical values of indicators). These were then used to calculate a score of overall progress on the reforms. However, with so many transitions in the Moldovan Government during the last years, that Scorecard is a ‘sleeping beauty’ still.

Let us have a look into what a Scorecard is and why is it such an important tool. Balanced scorecard has been of the most significant management tools of the past 75 years.

Managers across organisations do indeed recognise the impact that measures have on performance. However, often times, unfortunately, measurement is not yet fully considered as an essential part of organisational strategy. In a rapidly evolving environment, organisations fail not only to introduce new measures to monitor new objectives or processes but also fail to really question whether or not their old approaches are still relevant to the new initiatives, or to their new strategy.

Accordingly, effective measurement, must be an integral part of the management process.

“The balanced scorecard, first proposed in the January-February 1992 issue of HBR (“The Balanced Scorecard—Measures that Drive Performance”), provides executives with a comprehensive framework that translates a company’s strategic objectives into a coherent set of performance measures. Much more than a measurement exercise, the balanced scorecard is a management system that can motivate breakthrough improvements in such critical areas as product, process, customer, and market development.” (source: https://hbr.org/1992/01/the-balanced-scorecard-measures-that-drive-performance-2)

Many companies have a wide spectrum of operational measures for their activities, but the problem with these is that they are bottom-up and derived from ad hoc processes.

What is unique about the scorecard’s measures is that it departs from the organisation’s strategic objectives, vision, or longer-term mission and the targets around those. Due to the fact that managers are selecting only a limited number of critical indicators, the scorecards help focus on achieving the strategic vision.

While the Balanced Scorecard has been initially designed for private sector, the framework has found wide-spread use in the public and not-for-profit sector as well. This is how organizations such as World Bank, and others, are integrating it as an approach through their country strategies and interventions. Many governments have also started to implement performance management frameworks such as Scorecards, and Singapore, UK, India, Canada, USA are just few examples with many more governments following the trend.

Now, back to the 2019 mission in Chisinau and HIV/AIDS.

During the past 15 years, there has been a tremendous progress in the AIDS response which has inspired new commitments and targets. In 2016 United Nations Member States committed to reducing new HIV infections to fewer than 500 000 annually by 2020—a 75% reduction compared with 2010—and ending AIDS as a public health threat by 2030.

The United Nations General Assembly agreed in June 2016 that ending AIDS as a public health threat by 2030 requires a Fast-Track response, with three milestones to be reached by 2020: Reduce new HIV infections to fewer than 500 000 globally. Reduce AIDS-related deaths to fewer than 500 000 globally. Eliminate HIV-related stigma and discrimination. Point 10 of the HIV Prevention 2020 Road Map, stipulates that: “Countries will develop or adjust a shared accountability framework across sectors, civil society and implementers and provide for regular reporting of progress against results at the subnational, national and international level. The HIV prevention scorecard being developed by UNAIDS, in which scores are based on a combination of coverage, output and outcome indicators for key programme components in the Global AIDS Monitoring system, can serve as a useful tool for a regular review of performance at all levels.”

In order to join efforts in “Accelerating HIV prevention to reduce new infections by 75%”, a team of experts, under the auspices of the National HIV/AIDS prevention and Control Program in Moldova, with the support of UNAIDS, in partnership with Public Association “Positive Initiative” and other public institutions, came together to put this idea into practice. Svetlana Plamadeala, UNAIDS Country Manager, who is a very passionate advocate of the health sector, ensures that we have everyone we need on the team in terms of expertise and experience; and we are able to smoothly develop the prototype of the Scorecard. I have happily accepted to take the lead on this exercise.

The elaboration of the HIV Scorecard in Moldova is also supported within the “Sustainability of Services for Key Populations in the EECA Region” project (#SoS_project), implemented in Moldova by the Public Association “Positive Initiative” in cooperation with the Alliance for Public Health, Ukraine, and funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

We have started the process of working on both long lists of indicators to be tracked with the Scorecard and gradually get to our shorter lists, with all indicators having a protocol in place. During the month of March 2020 we aim to co-design a Scorecard which would help:

• Monitor progress around a certain set of epidemiological, programmatic, financial, management related and human rights indicators;

• Represent progress on all selected indicators in a user-friendly, visual manner, on an open source platform, with a comparative analysis of the real results as opposed to the baseline and set targets.

We also plan to pre-validate our approach in an open, transparent and participatory manner with all relevant national stakeholders and think about ways to institutionalise a response mechanism based on the results of the indicators monitored through Scorecard in the field of HIV/AIDS. With this Scorecard, we want to generate a culture for evidence based decision making that could be embedded across the health sector and beyond!

Members of the core team of this exercise are:

Daniela Lupan, who brings more than 18 years of experience in donor funded projects, 13 years being dedicated to public health related projects. Daniela will work with programmatic related indicators and will also look into the epidemiological ones. Andrei Lungu is a lawyer and within our team he will work on Human Rights related indicators. Sorina Vesiolii, is a procurement consultant, and she will focus on procurement related indicators which is going to be an interesting and valuable part of the Scorecard. While “Initiativa Pozitiva” represented by Ruslan Poverga and Constantin Cearanovski bring in a lot of valuable practical experience in working on rehabilitation and resocialization of vulnerable groups of population. Thus, making the Scorecard a truly authentic tool for the sector.

This work on the Scorecard has just kicked off and much more is to come … Stay tuned!