Eritrea VCT - Challenge note

Date: July 14, 2001

To: VCT 100-Day Challenge Team Members

From: Team Mentors (elected from Leadership Group) - Drs. Warede and Andat cc: Managers of Team Members, Leadership Group, and other Stakeholders Subject: Ramping up the Use of our VCT Services in Downtown Asmara

The purpose of this note is to invite you to be part of a team that will lead the way on one of the most critical efforts in the history of our nation: stopping the HIV/AIDS epidemic in its tracks and preventing it from ravaging our country.

As you know, the HIV/AIDS infection rate has been growing steadily in our country over the past three years. We have reached the dreaded prevalence rate of 3%. Most other countries in sub-Saharan Africa have experienced this as an inflection point towards exponential growth in infection and prevalence.

We, leaders in Government and other stakeholders in civil society and the faith community are determined that Eritrea will defy this trend. With the help of our partners in UNAIDS, the World Bank, and other development agencies, we developed a five-year HIV/AIDS prevention strategy. But a strategy is not worth the paper it is written on unless it is put into action. And in our case, speed and agility is of the essence. So we decided to implement our strategy as a barrage of 100-Day Challenges, starting now, one round after another, until we flatten the curve of the epidemic!

The leadership team has decided to focus on six areas at once, and we’d like your team to tackle one of these: dramatically increasing the use of HIV/AIDS voluntary counseling and testing services in the Asmara region, in 100 days! The other five areas are listed in the Annex.

As you probably know, this has been proven to be a necessary pillar in any effort to fight the epidemic. When an individual knows that they are negative, they will be further incentivized to protect themselves from infection. And if they discover that they are positive and are provided with the proper care, counseling, and support, they will work to avoid infecting others. But there are several reasons why people avoid being tested, and we need to respect people’s choice on this. This has to be voluntary. Noone is to be coerced or shamed into getting tested.

It is not a simple task to crack this issue. And it is not for the faint of heart to commit to doing it in 100 days. But we have chosen your team carefully to represent a mix of all the groups that have the lived expertise to understand the issue, and the groups that can mobilize human and other resources to develop and implement solutions. We are confident that this team will both figure it out and make it happen, all in 100 days.

We’d like you to pay special attention to youth and young adults in particular, and also to commercial sex workers. Youth feel invincible. And this plays right into the hands of the epidemic. And commercial sex workers have a particularly high stake in this matter as it affects their livelihood, and at the same they can inadvertently become the source of rapid and widespread infections.

You might ask how will what we do in Asmara in 100 days on this issue help the country turn the corner on the spread of this heinous disease? Keep in mind that our intention is to move this work from the capital to the other 5 regions of the country, and to keep battling the disease with 100-Day Challenges in all 6 regions until we prevail. Our aim is to use each wave of 100-Day Challenges as a way to get smarter about the issue and to continually adjust our 5-year strategy as we go.

This will probably be different from any project you may have participated in. Here are some unique features of this way of working, other than the 100-day time frame:

• It will be up to your team to decide on the goal and to develop a plan to achieve it, including all experiments you may want to try along the way.
• Our only request is that the goal you develop is one involving the actual delivery of a concrete outcome – moving the needle in a significant way on the use of VCT services. Not a plan. Not a series of recommendations. Not just an awareness building campaign. But an actual result!
• You will elect your own team leader at the “Lift-off Workshop”, and you will decide how your team will function during the 100-days. You will be practicing self-governance and making all the decisions related to this project during the 100 days.
• We have asked ___ and ___ to act as mentors to the team. Their mission is to support you! It is your show.
• In addition to the mentors, ___ and ____ will be your guides and facilitators on your 100-Day journey. They have been trained on guiding teams on this unique way of navigating from intent to impact.

Learning Agenda

In keeping with the principle that each 100-Day Challenge is about achieving AND learning, here are some of the things that we in the leadership team would like gain insights on:

● What would it take to reduce the stigma associated with the disease, and to reassure people living with HIV/AIDS that they will not be ostracised or discriminated against?

● How do we protect the confidentiality of the results of the testing, and to increase public trust that we will continue to do so?

● How do we make getting tested the ‘cool’ thing to do for young people?

● How do we leverage testing and counselling services to advance other elements of our prevention strategy?

● What role, if any, can mobile clinics play in increasing uptake of the testing?

Next Steps

The 100-Day countdown will start on ____. Please free up ___ and ___ to participate in the Lift-off Workshop, when your team (and the other 100-Day Challenge teams) will decide on the specific goal to set, you will develop your plan, and you will decide how you will work together over the 100 days that follow.

The 100-Day Challenge facilitators will share an agenda in advance, and they will guide you through the workshop. We will join you at the start of the workshop to answer questions you may have, and again at the end to hear about the goal and plan and also about the support you may need from us.

In the meantime, please do not hesitate to reach out to us or to your facilitators if you have ideas or suggestions.

We are excited about accompanying you on this journey and supporting you on this critical effort. Sincerely,

Dr. Warede, Medical Director of the Central Region

Dr. Andat, Head of Strategy Unit at the Ministry of Health

Letterhead

Dear (Address to each selected team member)

Challenge note

The purpose of this note is to invite you to be part of a team that will help ____________make significant progress on (add Broad statement of the general focus area). This is particularly critical at this point because (State the why and why now).  You have been chosen because we believe you will bring passion, creativity and know-how to this topic.

What is this about?   (give guidance on focus, scope and learning agenda for the team)

We will tackle this critical issue using the principles and practices of the 100-Day Challenge approach. You will be part of a team that will come together for a workshop on DATE  to set your 100-Day goal and develop a 100-Day work plan to achieve it.

Here are some initial thoughts on how the team might sharpen its focus so it can make real progress in 100 days:

• Here you can mention any related initiatives.
• If there is one or two performance indicators (premium growth; etc.) mention these here

One more important consideration is to examine how we   If there are specific questions leaders would like to shed light on, or process to be tested, mention it here

The team will include representatives from the following departments: (List dept). This broad representation is essential, as we believe the key to success in this effort will be creating strong linkages and better coordination between all stakeholders that influence this issue.

At the Lift-off Workshop, your team will decide on the specific goal to set. I have asked NAME to put together a data package of baseline data that you and your teammates might be able to use as you discuss your goal.  (This would be helpful. But not essential. Maybe a data person can be seconded by the managers to chase this info)

I have also asked the Name of Ambassadors to provide facilitation support to the team. They are part of our Ambassador learning program. The practical part of the program is for them to support you and me in this effort. And of course, they are also doing their “day jobs.”

How is this different?

This is not for the faint of heart, but we are confident that this is the right team to tackle this issue. Here are some elements of the 100-Day Challenge work that makes this different from some of the “normal” projects you may have been a part of:

• We truly mean that it will be up to the team to finalise the goal and develop a plan to get there. It is your show. The facilitators and we are there to support you.
• You will get to elect your own team leader at the Lift-off Workshop, and you will decide how the team will function during the 100- days. Your facilitators will guide you through this. But you are the decision-makers when it comes to how the team will function and how it will govern itself.
• Your goal will involve actually delivering a concrete outcome – moving the needle on one or more key performance indicators. Not a plan, not just working on a system, but actually delivering a better result for ____________.
• The team’s work will start and finish in one hundred days – starting immediately after the Lift-off. So you will need to move into action quickly and decisively!
• Your team will be doing this concurrently with other 100-Day Challenge teams at two other operations, all focusing on defect elimination.  The teams and their mentors will be comparing notes and learning from each other along the way. So hopefully, this will also be an opportunity to build relationships with peers at other operations.

NEXT STEPS

First, you will receive an invitation to the Lift-off Workshop (one-day), please accept the invitation and free yourself up for this.

Second, the facilitators will send a brief package before the Workshop. Please review this and come prepared to dive into the discussions with your teammates. (Add if you are able to do this)

Third, please free yourself up as much as possible so you can focus on the work you and your teammates will do at the Workshop and in the 100 days that follow. You may need to dedicate 4-5 hours per week during the 100 days. Hopefully, this is aligned with your ‘day job’ anyway. Please let us know if you need help with this.

This is an important effort. We hope you are as excited to get started as we are. Together, we will make it happen!

Sincerely,