Mbn hiv/aids evaluation final report Team of consultants

MBN HIV/AIDS evaluation

final report

Team of consultants:

Stan Bartholomeeussen (ACE Europe)

Geert Phlix (ACE Europe)

Carolien Aantjes (Independent consultant)

Ludo Welffens (Independent consultant)


February 2006

Preface

This report presents the findings of the programme evaluation on HIV/AIDS commissioned by the Dutch Co-Financing Agencies Cordaid, Hivos, Icco, Novib and Plan Netherlands. It is the fifth study in a series of programme evaluations organised during the period 2003-2006 by the MBN, the Network of Co-Financing Agencies (CFA’s) in the Netherlands. The evaluation was carried out by ETC, Crystal (first phase) and ACE-Europe (second phase) in 2005.

The HIV/AIDS epidemic continues to spread and erode development gains, not just in Africa, but in many parts of the world. In assessing the CFA’s response to HIV/AIDS there are certain challenges. First, HIV/AIDS is a new and unprecedented disease—one that spreads silently, invisibly and rapidly, and then kills 10 years later. Secondly, it kills the most productive people of society, young people and adults between 25-45 years old. The impact extends to society at large and seriously threatens social fabrics and economic development. The learning process about the exact impact of HIV/AIDS and how to mitigate this, is ongoing. A third challenge is that HIV/AIDS remains incredibly sensitive to discuss, and those infected are often stigmatised. This is both because HIV is spread sexually and through injecting drug use and because it is nearly always fatal in developing countries. A fourth important challenge is the feminisation of the HIV/AIDS pandemic. An increasing proportion of people infected by HIV/AIDS is female. Girls and women everywhere are highly vulnerable because of sex – and gender-based factors.

This evaluation reviews the CFA’s response to the HIV/AIDS pandemic from 2001 onwards and assesses the effectiveness, efficiency, relevance and sustainability of the CFA’s assistance. In the 1990’s early CFA action on HIV/AIDS involved support for AIDS focussed organisations from an emancipation point of view (HIVOS) or support for the health sector to integrate issues of HIV/AIDS (Cordaid). From 2001 onwards, besides supporting AIDS focussed organisations, the CFAs started to make a commitment to HIV/AIDS mainstreaming. The CFAs have since developed different strategies for addressing the problem in all regions and a variety of sectors. The priority given to HIV/AIDS has markedly increased. In the evaluation period (2001-2004), the CFA funding almost doubled: from Euro 12 million in 2001 to Euro 22 million in 2004.

Considerable progress has been made since 2001 by the CFA’s. HIV/AIDS related positions have been created, HIV/AIDS working groups or teams and focal points put in place, resource materials developed, new partnerships established, trainings organised, funding provided for HIV/AIDS programmes. Since 2003, the CFA’s have developed innovative approaches to internal mainstreaming and also started interesting experiments and research on external mainstreaming. The AIDS-focussed organisations visited are almost all involved in the delivery of comprehensive package of HIV/AIDS services. The strengths of their programmes lies in the holistic approach to HIV/AIDS, combining and linking HIV/AIDS awareness, voluntary testing and counselling (VCT), Home Based Care (HBC), orphans and vulnerable children (OVC) and income generating activities. The generalist organisations visited acknowledged the importance of integrating HIV/AIDS into their strategies and programmes. They responded to the HIV/AIDS epidemic adopting or modifying their programmes to the needs of the beneficiaries. They took the specific needs of PLWHA and affected households into account. The majority of the organisations ‘added’ additional HIV/AIDS-related activities to their current programme, only a few modified their core activities to respond to the changing context, exploring in depth the link between their programmes and HIV/AIDS. This resulted in an improved access of their constituencies to HIV/AIDS related services.
The CFA’s will give follow-up to this evaluation in several ways:

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  A public presentation and discussion will be organised to both share the findings and recommendations. The CFA’s expect to attract the interest of a broad public: CFA staff, including managers and directors, staff of other Dutch development organisations and academic institutions, and the Ministry of Foreign affairs;
  
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  Each CFA will carefully reflect on the lessons learned and the recommendations of this evaluation and design an internal follow-up process: an action plan with budget, planning activities for the CFA and for its partners;
  
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  Each CFA will take the recommendations into account, when developing their new strategic business plans for 2006-2010.
  
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  Where relevant and as much as possible the CFA’s will work together through SAN!. This collaboration can range from joint projects to lobby and advocacy;
  

The CFA’s learned from this evaluation to continue with some successes: being flexible donors, which is important in times of HIV/AIDS because the pandemic brings a lot of uncertainty to partner organisations and communities; emphasising HIV/AIDS workplace policies for local NGO’s; increased funding; organising linking and learning sessions and other capacity building processes; facilitating mainstreaming of HIV/AIDS.

The CFAs also learned that they need to improve on the following: more advocacy to include gender-based factors in HIV/AIDS policy-making and programming; challenging partners to include boys and young men in HIV/AIDS prevention activities in order to change heterosexual behaviour norms and values; challenging faith-based organisations to promote evidence based prevention methods, e.g. condoms; giving more and thorough follow-up to training and linking and learning activities; developing tools to translate policies into practices, pre-test them and make sure staff uses them; developing action plans, including budgets for boosting the important mainstreaming processes in existing partners and building HIV/AIDS competence of CFA staff.
The CFA’s would like to thank all those who have been involved in this evaluation for their co-operation, especially the partner organisations and the country and regional offices and departments. We would also like to acknowledge the work done in the first phase of the evaluation by Ms. Joanne Harnmeijer (ETC Crystal) for exploring the outline of this evaluation. We express our sincere appreciation to the way Mr. Stan Bartholomeeussen and Ms. Geert Phlix (ACE-Europe) designed and conducted this evaluation. The important technical advice from the MBN Reference Group, as well as the internal support of the CFA Co-ordination Group is gratefully acknowledged. Lastly, the views expressed in this report are those of the ACE-Europe evaluation team. We hope you enjoy reading the report.

28^th of February 2006


The MBN directors:

Sylvia Borren, Novib

Jack van Ham, ICCO

Manuela Monteiro, Hivos

Paul Lem, Plan Netherlands

René Grotenhuis, Cordaid.

“…the AIDS pandemic is exceptional as a global crisis and threat. This pandemic is exceptional because there is no plateau in sight, exceptional because of the severity and longevity of its impact, and exceptional because of the special challenges it poses to effective public action….an exceptional response is needed.” (Peter Piot, executive director UNAIDS, 2005)

The team succeeded in the effort to organise the visits to the different countries well and wants to thank everybody that made this possible, in particular, all the counterparts of the 5 CFAs that welcomed the team in their organisation (often at very short notice) and organised the visits to the beneficiaries. Without their very flexible way of dealing with our visit, the evaluation missions would not have gathered the important evidence material we can now use for responding to the different evaluation questions. The team also appreciated the time invested in this evaluation by all HIV/AIDS policy officers and their colleagues!

Team ACE Europe