Methodological issues in evaluating HIV prevention community planning.

To be effective, HIV prevention programs should be planned in partnership with affected communities and should be built on a solid scientific foundation. In 1994, the Centers for Disease Control and Prevention (CDC) and its prevention partners implemented HIV prevention community planning to achieve primarily these two objectives. In order to manage the community planning process effectively, extensive evaluation activities were employed at both the grantee and national level. This paper describes the first year evaluation goals and methods in detail. Throughout, reasons for collecting specific types of information and for using particular methodologies are highlighted.

Community planning: a national strategy to improve HIV prevention programs.

Beginning in fiscal year (FY) 1994, the Centers for Disease Control and Prevention (CDC), in collaboration with health departments and other human immunodeficiency virus (HIV) prevention partners, set in motion a significant innovation in HIV prevention programs: HIV Prevention Community Planning. This process, implemented by all 65 health departments receiving HIV prevention funds from CDC, requires that the identification and prioritization of HIV prevention needs to be a shared responsibility between the health departments administering the funds and representatives of the affected communities for whom the services are intended. Guidance for this planning process strongly embraces the notion that high priority HIV prevention strategies and interventions must have a sound basis in behavioral and social science and that program planning must begin with an accurate assessment of the epidemiology of the current and projected future HIV epidemic. Rather than mandate a single standardized process for all of the 65 jurisdictions, CDC guidance provides flexibility for each jurisdiction to configure a planning process responsive to its own unique circumstances. However, all planning activities must be guided by 13 essential principles. This article will describe the principles and logistics of HIV Prevention Community Planning, identify the potential program benefits of this new undertaking, and describe implementation challenges.

State health agencies and the legislative policy process.

A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency's political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency's position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players. To take advantage of new opportunities for action, the public health (policy) leader must monitor the political environment continually.By working to anticipate and formulate legislation,health officials can form meaningful relationships with legislators and the community, which are the cornerstones of political strength.