Ryan White HIV/AIDS Program Part A Manual

The following EMA/TGA experiences provide insight on how the CEO can ensure effective planning and implementation when Part A responsibilities are delegated. The CEO is ultimately responsible for ensuring that all Part A programs in a service area meet legislative requirements and HAB/DSS expectations.

When responsibility of administering the Part A program is delegated to the health department or some other government agency or office, the CEO can help prevent or resolve problems by taking the following steps:

• Choose someone with related knowledge and skills. Someone with a strong public health background, knowledge/experience with the Ryan White HIV/AIDS Program, and direct access to you and your office is best.

• Make sure administrative staff are competent, knowledgeable, and diverse. Ensure staff has strong HIV/AIDS experience and pertinent technical skills.

• Ensure clear lines of communication among all partners. Consider establishing a team of people to conduct ongoing, regular activities to keep you informed.

• Require linkages among Ryan White programs, and between Ryan White and other HIV/AIDS programs and activities. Consider a working group or task force comprised of Part A partners, Part B, HIV prevention providers, Medicaid, CHIP offices, providers of homeless services, representatives of the incarcerated, State and/or local AIDS entities, AIDS policy groups, etc.

• Be sure that Intergovernmental Agreements (IGAs) are monitored and followed.

• Require the administrative agency to build and maintain relationships with infected and affected communities. Use methods such as community forums and hotlines to obtain consumer and community input.

Staff Roles

The experiences of EMAs/TGAs suggest that staff involvement is important whenever administrative responsibility for Part A has been designated to another department. CEO staff can help with the following:

• Attend meetings, make community contacts, and make themselves available to key stakeholders, including PLWHA communities.

• Build relationships with other CEOs in an EMA/TGA, including those with whom the CEO has IGAs in place. These relationships can help encourage cooperation in ensuring delivery of HIV services, protect the CEO when signing assurances on behalf of the EMA/TGA, ensure maintenance of effort in a positive way, and minimize the potential for grievances.

• Require attendance at planning body meetings to keep the CEO informed of the process and any related issues, and to provide CEO input to planning.

• Maintain close relationship with an external administrative agency or fiscal agent to ensure that CEO expectations are communicated and that the CEO is apprised of any problems with the disbursement of funds.

• Communicate information from the CEO to other AIDS policy or program offices within city, county, and State governments.

• Promote collaboration among Ryan White partners and between Parts A and B and other HIV/AIDS-related entities in needs assessment and planning activities, prevent duplication of efforts, and prevent adversarial relationships among agencies.

• Require the administrative agency to serve as a direct mediator between Ryan White partners or between Ryan White programs and other public agencies that report to the CEO. They can help resolve problems quickly so that care and services to PLWHA are not compromised or interrupted.

The CEO can help resolve some common problems with Ryan White programs. Following are some examples.

The Problem: The planning council is not representative

The planning council is not reflective of the epidemic in the EMA/TGA. PLWHA are not adequately represented and the membership from a particular community is far short of what it should be. These issues can result in the CEO becoming the target of angry consumers, who feel their voice is not being heard in decision making. Further, the level of Part A funding may be jeopardized, and HAB/DSS may require changes in membership as a Condition of Grant Award.

What the CEO Can Do:

• Arrange for an assessment of the problem. Establish a task force of representatives from the CEO office, the administrative agency, and the affected community to discover what is causing recruitment problems.

• Have the planning council or CEO (or designee) seek technical assistance from HAB/DSS.

The Problem: Fund disbursement is delayed

Disbursements to service providers are taking twice as long as they should. In some organizations, this is causing services to clients to be interrupted. The CEO is getting calls from angry providers who are saying they will have to lay staff off and stop certain services, and from consumers who now have to go further from home to receive services from unfamiliar organizations and providers. The planning council is preparing to file a formal grievance with the CEO.

What the CEO Can Do:

• Arrange for an assessment of the problem by the appropriate unit within your local government, a representative of your office, or an independent consultant. Be sure to have the planning body representatives and the affected community provide their input. Take corrective action based on the results of the assessment. 

• Assign one of your staff to be a liaison with the administrative agency to monitor its activities, including its interaction with the planning body.

• Seek technical assistance from HAB/DSS.

The Problem: Planning council discord and public perceptions of CEO disinterest

There is a perception in the community that HIV is not a priority for the CEO and that he/she is uninterested in the needs of PLWHA. A growing conflict between two provider groups erupted at a recent planning council meeting. The local paper reported that HIV providers are putting the needs of PLWHA second to their own individual agendas.

What the CEO Can Do:

• Keep abreast of the Part A process and be knowledgeable about the personalities and issues that influence the process.

• Ensure that problems are resolved or addressed before they become highly visible and/or explosive.

• Ensure that your staff and liaisons maintain active lines of communication among all key stakeholders and represent you as a leader who is accessible and knowledgeable. 

The Problem: Contracting not reflective of planning council priorities

The administrative agency is making contracts to provider agencies that are not in line with the service priorities that have been established by the planning council. Due to a number of vacancies on the planning council and a number of new members who are still learning their roles, the planning council has been unable to effectively monitor and oversee the allocations process. PLWHA groups are calling your office to complain and demand that the situation be corrected.

What the CEO Can Do:

• Ensure that planning council vacancies are filled in a timely manner to avoid a lack of balance between the planning council and the administrative agent.

• Ensure that you and your staff are monitoring the activities of the administrative mechanism. Make sure it is responding to the direction of the planning council.

• Ensure that planning council members are diverse, talented, and appropriately trained to fulfill their responsibilities, and that they have the capacity to evaluate the administrative agent.