Demonstration projects have an important role in health systems strengthening. Using best practices, the EQUIP team is able to use methods, approaches, and tools that have been demonstrated to be effective, useful, and
applicable.

A demonstration project is a geographically defined entity where substantial, and most probably complex, health system strengthening reforms are undertaken. Demonstrations are undertaken with the purpose of testing the feasibility of the demonstration reforms and evaluating their early impacts, in order to inform policy and implementation decisions. Frequently, pilot projects are seen as mechanisms to test reform on a small scale, with the ultimate goal of “scaling up” or “rolling out” the reform. This chapter suggests that, in practice, objectives for undertaking health system pilots vary substantially and, even if the piloted reform is not in the end rolled out, pilots may lead to other equally important outcomes.

Assessing Alignment

When EQUIP visits a PEPFAR country with the intention of supporting the Ministry of Health to achieve its UNAIDS 90-90-90 targets, it is crucial that their program portfolio aligns with the local USAID Mission and Ministry of Health key priorities.

The EQUIP program considers five criteria before commencing with a Demonstration Projec:

  1. Fit with Host Country Priorities: EQUIP will assess, confirm and align with the resources, policies, priorities and needs of the country‘s plan for HIV/AIDS.
  2. Evidence-Based Programming: All projects must be framed as part of a development hypothesis where interventions directly support what is required to reach the stated/desired result. The logical connections and the assumptions should reflect recent rigorous and compelling evidence of what works to improve reading outcomes at scale.
  3. Scalability: Scalability is demonstrated by the ability to replicate the key elements of a project that were deemed critical to its effectiveness at scale (regional, national) as well as the Demonstration Project’s affordability over the mid and long-term, given a country‘s total projected resource envelope.
  4. Activities and Budgets Linked to Goals and Targets: The causal linkages between activities to the top-line goal(s) and the magnitude of funding levels allocated to these activities demonstrate alignment. A fully aligned portfolio will show how each activity or component is related to the achievement of Goal 1, 2, or 3 targets, with all funding allotted to these activities or components.
  5. Performance Monitoring and Performance and Impact Evaluation: Every project must integrate a monitoring and evaluation plan. All large or pilot projects mustalso design a performance or impact evaluation plan during the project design phase.5