During the annual COP stakeholder process, PEPFAR country teams engage partners to survey the landscape of HIV services, programs, resources and constituencies, see changing conditions and needs, and determine optimal strategic responses. These strategic priorities are the starting point for COP planning and budgeting.

The lenses and exercise that follow were developed from Training Resource Group’s (TRG’s) strategic decision making materials, and draw on a body of tested materials used by TeamSTAR with PEPFAR teams across the globe. They provide a framework for considering and explaining what criteria you value in a particular deliberation, and how you prioritize those criteria.

While you probably already use some of these lenses automatically in your work now, understanding how and why you use the lenses will help you become more aware of your own individual decision-making priorities. When that consciousness is shared by your entire team, your group can use a common language to discuss choices and decisions, craft and refine strategy, and ultimately maximize impact.

Prioritizing Options: The Six Strategic Lenses

1. The Urgency Lens helps you sort for the most immediate priorities.

What will happen if you ignore the issue at hand? How important is it that a decision is instituted immediately? Teams that look at potential programs and decisions through the lens of urgency are guided by the significance of the intervention, and the need for it to be implemented swiftly and without delay.

In one PEPFAR country, blood safety programming was an example of an urgent need, especially in the provinces. Seventy percent of the available blood supply was channeled to children with severe anemia caused by malaria infections. Without improvements in blood safety equipment and supplies, this country’s PEPFAR team was concerned that infection rates would increase. A priority intervention in this country was therefore to ensure that blood remains safe for distribution, beginning at the national level and then moving quickly to support to the provinces. In this case, time sensitivity clearly must be a motivating factor in activity prioritization.

2. The Sequential Building Block Lens helps you recognize actions and activities that are prerequisites before other interventions can be initiated, before other priorities can be addressed.

Managers who engage the a sequential building block lens base decisions on what actions and activities must occur before other interventions can be initiated. As an example, a primary PEPFAR goal in one country could be improving the quality of district health workers through in-service training – a difficult task when health workers fail to show up to work. In such a scenario, the team might determine that a code of conduct for provincial health workers should be distributed and implemented before absenteeism can be adequately addressed. While the code of conduct in this case would not in itself qualify as a priority objective for the team, it could be a necessary prerequisite for success in another important area. As such, progress towards the end goal is made one building block at a time.

3. The Relationship Building Lens helps you identify interventions that – though not at the top of your list – are priorities for government partners and other stakeholders, and if taken will build goodwill to tap later for support with tougher challenges.

Regardless of the internal priorities of a given PEPFAR country team, it may be beneficial in some instances to identify interventions that are be top priorities of the team’s implementing partners or partner governments and stakeholders. By viewing decisions through a relationship building lens, USG teams not only foster ownership and sustainability, they build alliances and goodwill with stakeholders that may be called upon to support future challenges.

In one PEPFAR country, for example, a new minister of health articulated “systems strengthening” as a top government concern. Despite the team’s initial inclination that other priorities should demand greater attention, this PEPFAR team made a deliberate decision to focus their COP on efforts that would contribute to the new minister’s goals, such as HR management systems. While the decision required that funds be pulled from other efforts, team managers used the opportunity to build relationships with government officials and sustain stakeholder efforts.

4. The Feasibility Lens helps you single out activities that are doable with the resources available and considerate of MOH, PEPFAR and NAC priorities. There is a high probability that the current environment enables the team to implement these activities and achieve agreed upon results.

Is a proposed activity achievable given available resources? Will the current environment allow the team and its partners to implement the activities and achieve its agreed-upon goals? The feasibility lens considers how probable success is when making decisions.

One PEPFAR program, for instance, assisted the local ministry of health in strengthening its national laboratory network. The team chose to focus on this intervention because they knew that it would receive outstanding government support for the project. Coupled with exceptionally strong USG capacity in country, the team realized that the activity could be effectively addressed while the resources and government willpower were present. As the team looked through the feasibility lens, they realized they the strengthening of laboratory networks was “low hanging” fruit that should be implemented.

5. The Team Commitment Lens helps you identify an idea or intervention for which there is enough strong commitment and enthusiasm within the PEPFAR country team to see it though to implementation and action.

The team commitment lens takes advantage of existing levels of interest within the PEPFAR team for tackling projects, and prioritizes those activities above others. During the COP preparation for a PEPFAR program in its second year, for example, national staff in one PEPFAR country felt passionately about working with the government to establish technical working groups. Despite pressing workloads in other areas and the understandable pushback from other team members, team managers realized that the existing levels of energy and enthusiasm for the initiative would render the activity successful. In this case, the internal dynamics of the PEPFAR team were put first, and three new technical working groups are now being launched as a result.

6. The Potential Impact Lens helps you zero in on interventions that if initiated could potentially achieve significant impact in the fight against HIV in the country.

Seeing potential projects and activities through the lens of potential impact helps teams to target interventions that could potentially have the greatest affect on the team’s mission. For example, one PEPFAR team observed that HIV prevalence rates were increasing in a border province of their traditionally low-prevalence country after that border was opened to a neighboring country. In its COP deliberations, the team decided that two levels of interventions would have a greater payoff in the fight against HIV in their country than any others: increasing intensity of services and programs in the border province, and engaging joint activities in the border region with the neighboring country’s PEPFAR team. By focusing its programming on targeted impacts within a concentrated geographic region, the team hoped to have a greater affect on limiting the spread of HIV in their country than by simply spreading the program throughout an increasing number of provinces.

Conclusion

The complexity of PEPFAR interagency structures and shared resources means that PEPFAR staff members and teams are constantly making decisions together. Competing priorities can’t be resolved to everyone’s satisfaction all the time, but by using strategic lenses for decision making, teams can understand and be intentional about how and why they prioritize one issue over another. The lenses allow groups to see where individual team members may have differences in their own decision making criteria and to examine those differences building toward a decision, consensus, or compromise on issues later. As a result, strategic thinkers who can explain the overall logic of certain decisions and bring groups to resolution in a fair and participatory manner can add important value to their team’s processes.

Depending on the situation, certain strategic thinking lenses may need to be prioritized over others. By engaging deliberately and consciously in the decision-making process, PEPFAR teams can use the lenses to help ensure adherence to team goals and priorities, and ultimately to increase mission impact. In fact, PEPFAR country teams that examine and reach consensus – or agree to disagree — on objective decision-making criteria can ensure increased fairness, and maximize team efficiency, engagement and buy-in… ultimately leading to increased success.

Introducing the Strategic Thinking Lenses: A Step-By-Step Guide to Practical Application

How can you introduce the concept of strategic lenses to your team’s potential decisions? The below outlines an exercise that country teams can use in situations such as technical working group retreats or Partnership Framework (PF) Management Team workshops. These steps will help groups and individuals generate discussion, explain their rationale and criteria for potential decisions, and come to consensus on strategy.

1. Introduce the six strategic thinking lenses

• Gather or generate a list of all the possible interventions the team is considering, and post the list visibly in the room you are using. Consider using flipcharts for maximum effect. You may wish to brainstorm, by technical area or topic group, options.
• Explain that your task, as a group, is to sort through these possibilities strategically.
• Introduce the six strategic thinking lenses, and ask participants to think of each lens as bringing clarity from one angle. Use one lens at a time to discuss dimensions, distinctions and patterns that might not otherwise be visible.

2. Divide into topic groups

Depending on the programs, you may divide the larger group into topic groups such as prevention, health systems strengthening, and strategic information. With larger groups of participants, and to keep small group populations to 6 or 7 people, you can sub-divide these main topics any number of ways: for example, the health systems strengthening topic could be sub-divided into strategic clusters such as national-level human resources management and systems; human resources for health (HRH) pre-service education; laboratories and networks; and province and municipal-level HSS.

3. Assign one lens to each of the members of the topic group

This would mean that members of the prevention group would all be assigned to a different lens. In the next step, they will be able to represent the topic group’s thinking when divided into the groups that will be using the different lens to evaluate the interventions.

4. Group participants into lens-specificgroups

• Depending on the size of your participant group, two or more participants may now be assigned to each lens.
• Explain that each lens is assigned a different color:
  • Lens #1: Red
  • Lens #2: Blue
  • Lens #3: Green
  • Lens #4: Orange
  • Lens #5: Yellow
  • Lens #6: Black
• Provide each lens group with the appropriate colored marker or dots to indicate that they feel the intervention is important when viewed through their lens. [Note: If agencies are not evenly represented, you may decide to ask a number of people from the over-represented agencies to observe, but not participate, in the lens-specific review.]

5. Invite the lens-specific groups to review the lists of interventions posted along the wall

• Explain to each group that they must agree whether to place a dot next to a particular intervention indicating that it is important when viewed through their lens.
• Each group may use an unlimited number of dots, but they should think of each dot as special, that will be applied wisely. Only one dot should be placed, at maximum, per intervention.
• By placing the dot next to an intervention, the group is collectively saying the there is a need for the intervention according to their assigned strategic lens.

6. Facilitate a discussion in the plenary group about what the different colored dots and cluster of dots reveal

You may wish to start this discussion by asking each lens-specific group to give some highlights regarding what they learned by only looking through their assigned lens. Highlights should be brief, and you don’t need to dwell on the placement of specific dots.

7. Discuss, as a team, what the placement, patterns and cluster of dots reveal regarding strategic priorities

This is the heart of the conversation and decision-making exercise. Ask people to put aside their specific lens, and facilitate a discussion within the plenary.
You may wish to use the questions below as a guide.

• What are we seeing with the placement of dots in each topic area?
• Across the topic areas, where are the greatest concentration of dots for any given possibility?
• What surprises are there for you, if any?

Responses to these questions will help surface preliminary conclusions about how the team is seeing priorities. The intent of these questions is to quickly reveal any conflicting perspectives about program area priorities. These conflicting perspectives should be acknowledged, and not debated.

The next set of questions will help bring greater understanding about specific priorities, and could change perspectives or at least mute some potential debate points.

• What is your reaction to where the red dots (urgency) are placed?
• What clusters of dots have both a red and a blue dot (building block)?
• What is the message about these clusters?

Using these questions will help the participants to illuminate perceptions of urgency across the program by asking what they think will need to be addressed first.

If an intervention has both red and blue color dots, ask if this may be a top priority. If so, place a large check mark next to that activity.

• What clusters have a red (time sensitivity), blue (building block) and black (potential impact) dot?
• What is the message about these clusters?

The black dots add perceptions of significant impact to the check-marked first priorities. Circle in red the needs and interventions with all three dots – red, blue and black. Ask participants to share perspectives about what the cluster of these three dots says to them. If the cluster also includes a green, orange or yellow dot, ask what these additional dots say. Any of these three – the advocacy lens, the feasibility lens or the commitment lens magnifies the power of the merged lens focused on an important strategic priority.

There will also be important strategic priorities that will not have a red or blue dot. They may not be seen as urgent or as a building block to other goals.

• What is your reaction to where other black dots are placed?
• If they are with a cluster of green, orange or yellow, what messages to these additional dots convey?

This discussion will help to pinpoint these additional important strategic priorities. If these needs and interventions also include a green, orange or yellow dot, ask what these additional dots reveal. If the group agrees the need or intervention is also an important strategic priority, circle it in red also.
Finally, ask:

• What is the overall picture we see emerging?

This question will help you cement the conclusions about strategic priorities emerging from the strategic lenses exercise.

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Further Reading

Leadership for Change: Enduring Skills for Change Masters, Rosabeth Moss Kanter. (Available from www.hbsp.harvard.edu)