Mbn hiv/aids evaluation final report Team of consultants

4.3.2.2. Efficiency

In general, the 17 counterparts involved in HIV/AIDS services delivered their services in an efficient way and achieve quit good results with limited funds. However, this degree of efficiency varies between the counterparts visited as they have been confronted with factors that enhance efficiency and factors that threaten efficiency. Not all organisations could deal with these factors in the most optimal way.

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  Factors that contribute to efficiency: collaboration with other public or private services (to avoid duplication of services), local government structures (ex. free use of government infrastructure), good referral systems (referring clients to VCT and ARV sites) and participation in district and national AIDS committees. Another important factor is knowing one’s own limits and focusing on certain target groups and/or activities. Taking care of staff and volunteers also contributes to efficiency (offering counselling services to one’s own staff and volunteers). The holistic approach, combining different HIV/AIDS services, also contributes to efficiency.
  

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  Factors that have a negative impact on efficiency have also been identified: the wide spread of poverty, hunger and dysfunctional local and national government hamper the implementation of high quality services (e.g. situation in Zimbabwe). Many organisations have problems with recurrent costs and staff absenteeism (due to HIV/AIDS or due to flight to better paid jobs). All counterparts are confronted with an increasing demand. Trying to respond all needs can threaten the efficiency of the organisation.
  

The NGOs and CBOs visited are involved in the same type of HIV/AIDS services, but experiences are not shared enough, organisations are not sufficiently linked. NGOs that support CBOs did contribute to the strengthening of organisational capacities but did not invest enough in documenting good practices, setting up experiments, learning from experiments and stimulating sharing and learning. An example: AFSA (South Africa) supports more than 50 CBOs. The evaluators could visit two of them that are involved in similar activities (combination of HBC, support groups, income generating activities, referral to clinics, food parcels for families and OVCs, etc.) but the quality of the services and the approach differed between them. One could learn a lot from the other (both operating in the same area) but this exchange was not organised (although many other sharing and learning initiatives have been organised by AFSA).

The efficiency of advocacy and lobby differed between the counterparts visited. Some counterparts perform excellently, having a well-considered lobby strategy, excellent capacity, well elaborated cases and position papers, an access to media and a network of policy influencers. Only three counterparts have this capacity. However all 17 HIV/AIDS focussed counterparts visited do experience cases of violation of human rights and/or know very well what the needs of PLWHA (men and in particular women) are. Most of them do not succeed in documenting these experiences or giving the voiceless a voice. The evaluators are of the opinion that lobby expertise is so specific and demanding that it would not be efficient to increase lobby capacity within every organisation (not many results have been reported by them). One must either invest thoroughly in lobby capacity (long-term capacity building process) or enhance networking with organisations/networks that are active in advocacy and lobby.