4.3.2.1. Effectiveness
The AIDS-focussed organisations (n=17) offer a comprehensive package of HIV/AIDS services to their beneficiaries either directly or through linkages with other providers (referral to VCT and ARV sites). The strength of their programmes lies in the holistic approach to HIV/AIDS and the continuum of prevention, care, treatment and impact mitigation they are able to offer. Through the focus groups discussions, the evaluators got an idea of the outcomes at the level of the beneficiaries:
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The evaluators noticed, by all counterparts visited, an increased understanding by the beneficiaries of HIV/AIDS and how to protect themselves (see judgment criteria forms in country reports which are available on request). However the evaluators didn’t observe any evidence of behavioural change.
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Beneficiaries could access information (although sometimes poor and not available in local languages), condoms (but not at the faith-based organisations in the sample) and counselling services of varied quality. When infrastructure was available, beneficiaries were referred to VCT sites (some of the counterparts offered VCT services themselves) and/or were put on treatment (men as well as women).
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Treatment programmes appear to be effective only when there is a thorough follow up and support of the people taking up ARVs (through peer support groups, counsellors, family members). All counterparts offering a holistic package of services, were aware of this pre-condition and hence supported peer groups, offered counselling services and organised treatment literacy activities. Some of the counterparts actively tried to guarantee no interruption of the treatment programmes, paying transport costs (to reach ARV sites) or accompanying people to clinics.
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Beneficiaries were very appreciative of the HBC-services, some of them stating that if the HBC giver had not come to their house and insisted on helping, they would have died.
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A considerable number of orphans and vulnerable children were accessing food, received counselling services, attended support groups and were able to go to school or receive a vocational training.
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Coping mechanisms (apart from the psychological counselling) of the whole family were strengthened through the provision of food parcels (although not sustainable but necessary in view of the impact of the HIV/AIDS epidemic), or the development of small income generating activities (but with limited profits). AIDS-focussed organisations contributed to a limited extent to the enhancement of the coping mechanisms of families. They did not or not actively search or succeed in building partnerships with development organisations experienced in livelihood programmes, income generating schemes, etc.
The support of CFAs to these counterparts resulted in an increased capacity of service providers and facilities and an increased number of people being served. These outputs and outcomes could have gone to scale if others replicated the good practices. Now the impact remains limited due to the small scale of interventions, the similar approaches and the varying quality of services offered. However these counterparts all face similar challenges related to their service delivery that need a critical reflection and an appropriate response:
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To intensify and optimize prevention activities, including: (1) reflections on the ABC strategy and (2) reflections on how to challenge factors that increase HIV/AIDS vulnerability such as gender inequality.
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To improve the quality of the HBC services: by harmonizing and standardizing HBC services, looking for a genuine collaboration between civil society and government, challenging the gender divide and the increased burden on female voluntary caregivers
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To improve the quality and results of income generating activities: reflections on a collaboration with other organisations that have experiences with the set up of income generating activities
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To look for appropriate responses for the growing phenomenon of OVCs
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To enhance free treatment roll out programmes and reflect on the role of civil society in this.
All CFAs have tackled some of these issues during their dialogues and capacity building initiatives but this process needs to be intensified. More collaboration and exchange of good experiences is needed.
A HIV/AIDS competent society has been build but at limited extent:
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New social fabrics have been established that take up their responsibility to address the impact of the HIV/AIDS epidemic in their communities but sustainability of these groups is at stake.
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Members of community based groups/organisations acquired certain competences and skills and some of them served as resource person in their neighbourhood. They could break down barriers of stigma and taboo and even could serve as watch dogs for problems related with OVCs (e.g. child abuse or problems with foster care). However, the evaluators still could witness denial attitude and stigma. Only a few cases of violation of human rights have been cited.
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CBOs have been formed and capacitated, reaching out to constituencies that would not be reached by the government services of NGOs but the GIPA principle is not often applied.
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Most of these organisations and peer groups are focussed on their daily work and are rarely involved in advocacy activities or linked to bigger networks (such as networks of PLWHA).
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Some advocacy and lobby counterparts who have been funded can be seen as leaders in their country (especially in South Africa).
Further we present some challenges counterparts are confronted with in order to have a greater impact on building up HIV/AIDS competence within the communities they are working in (some of them have also been documented in the first phase of the evaluation):
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Prevention and awareness activities need to be intensified and a new paradigm needs to be developed for preventive measures which is also acceptable for faith based organisations. However most counterparts are not reflecting deep enough on this approach. Some actors, like ICCO’s global partner the Eucumenical Advocacy Alliances, are involved in this debate, but these discussions were not yet shared with the counterparts visited.
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CBOs and all kinds of support groups play an important role in reaching out to constituencies in more remote and poor areas. However they seem to be instrumentalised as executors. They are rarely linked to national networks, experiences are neither documented nor shared; they are not sufficiently capacitated to advocate cases of violation, etc.
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The 17 AIDS-focussed organisations did reach men as well as women, but –except a few cases- did not cope with the gender divide in their work. Most of them (except for a few) did not challenge the factors that affect women’s and girls’ vulnerability to HIV/AIDS: men who decide about sex, domestic and sexual violence, the irresponsible behaviour of men, a lack of economical resources, the economic discrimination of single, widowed and divorced women, etc. These organisations should be questioned by the programme officers of the CFA about the effectiveness of their services.
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There is no explicit link between AIDS-focussed organisations and other development organisations. Counterparts are generally not involved in partnerships that go beyond their sector (no multi sector approach). The evaluators did not see links between gender, economic development and HIV/AIDS interventions or links of HIV/AIDS interventions with sustainable livelihood programmes.
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People living with HIV/AIDS are treated as beneficiaries. The staff of NGOs do take over the work from them and do not involve PLWHA in strategic thinking and advocacy activities. Some exceptions can be noticed (WASN, FACT, Samuha/Samraksha)
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The HIV/AIDS specific counterparts tend to react to the emerging needs without first conducting situational analyses, and responding in a classic way (few exceptions of innovative responses). Organisations rarely seek new and better ways to implement their programme or look for responses to an ever-increasing need. This might be due to the huge impact of the AIDS epidemic: people and organisations are surviving and coping. The impact of AIDS on psychological health of people can’t be wiped out.
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