**Town Hall Meeting Comments: Observations on Lessons Learned through
the Secure the Future Initiative of Bristol-Myers Squibb Company and the
Bristol-Myers Squibb Foundation.** *December 18, 2003*

Beginning in May 1999, Bristol-Myers Squibb Company and the
Bristol-Myers Squibb Foundation initiated a groundbreaking \$115
million, five-year program for the care and support of women and
children with HIV/AIDS in five countries in southern Africa and then,
four countries in West Africa. Since that time, more than 150 grants
totaling \$65 million have been distributed to local community groups
and medical institutions to fund both community outreach and education
projects as well as important applied medical treatment efforts. From
the outset, its goal was to support programs that could be replicated
within these countries and elsewhere while also building capacity so
that these local efforts could attract additional funders and ultimately
continue to grow independent of dedicated company or Foundation funds.

Now, with the creation of both The U.N.'s Global Fund to Fight AIDS,
Tuberculosis and Malaria as well as the U.S. Emergency Plan for AIDS
Relief, and with the recent declaration by the WHO of its intention to
have up to three million more patients under treatment over the next
several year, efforts to scale up treatment by focusing on community
mobilization efforts that build infrastructure and capacity have become
even more critical and relevant. The question of how to effectively
absorb the new funds being offered within a community-focused,
resource-limited setting must be addressed.

Over the past four years, Secure the Future has been seeking to do
precisely that -- creating partnerships in local communities, among
NGOs, community-based organizations, faith-based organizations,
governmental agencies and medical institutions, so that treatment can be
integrated into the community setting where it must be delivered
effectively and where problems that surround HIV/AIDS can be addressed
in a comprehensive and ongoing manner.

During the course of Secure the Future initiative, a number of important
models have been created across Africa, genuine capacity and
infrastructure has been built and a legacy program has been developed to
further expand the progress made and the successes achieved at the local
level over the past four years. Ultimately, the aim of the legacy
program is to ensure that community support and medical needs are
addressed in a coordinated and sustainable way at the local level. The
development of these models has led to a number of important lessons
learned that should prove of use in the fight against the HIV/AIDS
pandemic in resource-limited settings. Below is a brief discussion of
some of those lessons learned by Secure the Future and its participants:

-   Collaboration between research, treatment and community is essential
    to the optimal delivery of care. When Secure the Future was first
    initiated in 1999, it was believed that the program could operate on
    two separate and distinct tracks. The first would focus on
    community-based organizations that would receive education and
    outreach grants to care for orphans and others, to reduce the
    economic and social impact of HIV/AIDS in a variety of ways, to
    enhance prevention and education efforts and to build capacity. The
    second would develop medical research initiatives to prevent HIV
    transmission and expand access to treatment in resource-limited
    settings. As both these programs developed, it has become clear that
    the two tracks related and intersect and ultimately, must be
    integrated at every level in order to help ensure overall success.
    Therefore, Secure the Future is now developing a number of
    community-based treatment and support centers that will serve as
    models for integrating all aspects of care and support so that when
    greater treatment options are made available, they can be delivered
    appropriately while the many complex social and economic issues
    surrounding AIDS are addressed at the same time. Treatment goes hand
    in hand with community outreach, education, prevention and support.

-   The ability to build and enhance management, good governance and
    leadership capacity within community organizations working on
    HIV/AIDS is critical. The Bristol-Myers Squibb Foundation NGO
    Institute has been developed to serve as a legacy program that will
    continue to build and enhance management, good governance and
    leadership capacity among NGOs and CBOs working on HIV/AIDS through
    a unique five-country collaboration in the Secure the Future
    countries in southern Africa. Building management capacity in these
    organizations, professionalizing them, training them and sharing
    institutional learnings will help create an enduring and ongoing
    capability for the individual organizations supported by Secure the
    Future grants to continue to operate and grow well into the future.

-   Successful interventions require the consultation and engagement of
    all stakeholders. Diversity of opinion and experience and the goal
    of maintaining the credibility of the Secure the Future effort have
    translated into the development of several important models for such
    support initiatives. First, we learned a great deal from a broad
    range of perspectives from the technical advisory committees formed
    both for the medical research and the community outreach components
    of the program, each vetting grant proposals and indeed, actively
    soliciting groups for proposals around specific areas of concern
    when it became clear that certain programmatic efforts were not
    receiving the attention they required. These committees included
    broad representation from government, CBOs and NGOs, faith-based
    organizations and people living with HIV/AIDS as well as leading
    area and international academic, medical and research institutions.
    Second and just as important, health ministries in all the countries
    in which Secure the Future operates have been involved from its very
    beginnings, buying into the program as a whole and advising on its
    implementation, making certain that Secure the Future goals aligned
    and could even be integrated with national and locally-established
    HIV/AIDS policies and strategies. Finally, even as Secure the Future
    employs local staff in Africa, it does not simply tell communities
    what to do. Nor does it simply provide funds. It works with local
    organizations to empower them to develop solutions themselves.

-   Capacity building is a critical component within all programs.
    Secure the Future, like any similar initiative, one day will end as
    a distinct program. Yet, its legacy must endure if any lasting
    impact is to be expected. That is precisely why capacity building
    has become a preeminent component of every Secure the Future grant.
    A perfect example of how capacity building and infrastructure
    development can make a difference is the creation in 2003 of a
    Children's Clinical Center of Excellence, the first center in Africa
    focused exclusively on caring for children with pediatric HIV/AIDS.
    The center provides medical care for children with HIV/AIDS,
    conducts clinical research and trains health care professionals
    throughout the region about the disease. Bristol-Myers Squibb
    provided nearly \$6 million in funding to build this kind of
    infrastructure, equipping it and funding its ability to operate for
    its first five years, while serving as a model for the development
    of other such centers. The initiative was only possible through a
    unique partnership among Secure the Future, the government of
    Botswana, the Baylor College of Medicine's International Pediatric
    AIDS initiative and Princess Marina Hospital. Other children's
    centers are being planned, along with a number of similar
    infrastructure-enhancement, capacity-building efforts. This
    all-inclusive center has the ability to transform AIDS and AIDS
    treatment in the pediatric population.

-   Faith-based organizations are key role players in providing
    infrastructure within Able to expand from local the community and
    health care setting. BOCAIP (the Botswana Christian AIDS
    Intervention Program) began as a local program, providing HIV/AIDS
    counseling and support. Secure the Future helped increase its
    capabilities, capacity, scope so that this faith-based initiative
    has developed into a network of grass roots, community AIDS efforts
    involving churches and para-church organizations throughout
    Botswana. It has provided holistic counseling including home visits,
    on site counseling, community outreach, support groups and material
    assistance to those infected and affected by HIV/AIDS. And the
    success of the program has led to increased support of BOCAIP by
    other donors. Another example that began as a specifically local
    faith-based initiative and that has grown is a parish nurse program
    in South Africa that recruits retired nurses through parishes,
    providing home-based care to fellow church members on a local basis
    with support from Secure the Future. Supervised by home health
    workers, this effort began in Catholic Church parishes in South
    Africa. Again, Secure the Future funding and capacity building has
    allowed the program to grow so that it now has nurses working
    through Methodist and Baptist churches as well.

-   The need for vigorous monitoring and evaluation. With funds being
    committed across the continent to a greater degree than ever before,
    it is more important than ever before that transparency,
    accountability and controls on how monies are spent are implemented
    and results of local efforts are measured and assessed. Secure the
    Future has built model programs both in monitoring and evaluation.
    On the monitoring front, it has developed a formalize program in
    monitoring in partnership with professionals from the auditing firm
    of PricewaterhouseCoopers to ensure that even before a grant is
    made, controls and processes are in place in the local organization
    to properly administer the funds and allow for evaluations of work
    done. By so doing, the program has been able to build capacity and
    sustainability in these organizations, guiding grantees in
    developing those controls and administrative structures not only to
    utilize funds most effectively, but also to build their
    organizations in ways that would allow them to attract additional
    funders. Secure the Future also sought the independent monitoring
    and evaluation skills and expertise of Yale's Center for
    Interdisciplinary Research on AIDS to train community-based
    organizations in capacity building, overseeing site visits for
    evaluations and preparing periodic reports of the program's
    progress. All grants under the Secure the Future program are
    evaluated periodically.