Mbn hiv/aids evaluation final report Team of consultants

Executive summary
Five Co Financing Agencies (CFAs: HIVOS, ICCO, Novib, Cordaid and Plan) participated in the MBN HIV/AIDS evaluation. The evaluation assessed the relevance, effectiveness, efficiency and sustainability of the CFA’s funding strategies, policies and practices in the fight against HIV/AIDS in the Southern African and South Asian regions. The CFAs wanted to know the extent to which their support in the period 2001-2004 has contributed to the fight against HIV/AIDS. The intervention strategy of the five CFAs comprises (1) poverty reduction, (2) civil society building and (3) advocacy and lobby. In the context of HIV/AIDS, “poverty reduction” can be seen as the delivery of HIV/AIDS services, such as prevention, access to treatment, care and support initiatives. Civil society building is about the support to, and capacity building of emerging community-based organisations (CBO’s), peer support groups and NGOs involved in the provision of HIV/AIDS related activities. Advocacy and lobby concerns the support to CBOs and NGOs who are involved in advocacy and lobby activities on HIV/AIDS issues, or the participation in networks and campaigns at a regional and international level to advocate and lobby HIV/AIDS-related issues, mostly on the rights of PLWHA, access to treatment and increased funding for HIV/AIDS programmes.
The overall evaluation question was divided into four sub-evaluation questions:

(1) To what extent did the CFAs respond to the HIV/AIDS epidemic and build up competence to cope with HIV/AIDS

(2) To what extent and how successfully did each CFA perform in enabling the different counterparts to contribute to the fight against HIV/AIDS and to cope with the HIV/AIDS epidemic ?

(3) What has been the contribution of the HIV/AIDS focussed counterparts to the fight against HIV/AIDS ?

(4) To what extent did the generalist counterparts cope with HIV/AIDS ?
The evaluation included visits to 34 counterparts in four countries: South Africa, Malawi and Zimbabwe, which are considered as high HIV/AIDS prevalence countries, and India, which is considered a low prevalence country, but is experiencing a generalised epidemic in some states. Of each CFA, seven counterparts were visited, at least one counterpart per CFA per country. In each country, the sample contained a balance between AIDS focussed and generalist organisations. The evaluators held interviews with the management and staff of the counterparts, following the different judgement criteria. At each counterpart, the evaluation team spent at least one day in the field, interviewing and holding focus group discussions with beneficiaries.

The evaluators identified the following differences among the CFA’s:

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  Hivos focuses on HIV/AIDS specific organisations and its strong involvement in lobby and advocacy programmes.
  
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  Hivos and Novib prioritise support to prevention and awareness programmes, with Novib focussing on gender based violence and women’s rights and Hivos on sexual rights issues and specific target groups such as men having sex with men, migrants, refugees, sex workers, etc.
  
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  Cordaid and ICCO work among others with faith based organisations involved in the whole prevention to care continuum. Cordaid in particular has invested in treatment programmes and has supported some experiments. Cordaid and ICCO also challenge the position of the church regarding their prevention approach focussing solely on abstinence and faithfulness as well as their position regarding the rights of people living with HIV/AIDS.
  
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  Plan, as a child rights organisation, focuses on the support of orphans and vulnerable children, their families and communities. Plan supports programmes that cover the whole prevention to care continuum, including impact mitigation.
  

Considerable progress has been made since 2001 by the CFA’s. HIV/AIDS related positions have been put in place. Hivos created a specialised team of HIV/AIDS programme officers (vertical structure), Novib, Cordaid, ICCO and Plan created focal points and HIV/AIDS project groups or working groups (horizontal structure). Resource materials have been 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.

All CFAs have approved policies regarding HIV/AIDS (except Plan which is in a drafting process). The creation of HIV/AIDS working groups and teams and the appointment of HIV/AIDS policy officers have accelerated the development and implementation of such a policy. However, concrete annual action plans are often lacking and so is the systematic follow-up. The HIV/AIDS officer and the focal points do not have sufficient time available to always be on hand for the necessary support to build up adequate competence within the CFAs to cope sufficiently with the epidemic which is constantly changing. Knowledge management on HIV/AIDS is limited and that in combination with a sometimes frequent rotation of personnel, leads to a lack of HIV/AIDS competence by programme or country officers who often have a ‘generalist’ profile. Therefore, dialogue with counterparts on HIV/AIDS issues becomes difficult or remains superficial in the event of a monitoring visit. Apart from a few examples (related to Hivos and Cordaid), the evaluators did not notice an in-depth exchange on HIV/AIDS between the CFA programme officer and the counterpart.

The CFAs are rarely (individually) involved in HIV/AIDS related advocacy and lobbying at the international level and at the level of the Netherlands. The CFAs fund SAN! and Sharenet in the Netherlands as well as international networks or organisations for lobbying the European Commission, UN agencies or others. The evaluators consider this as an appropriate choice, taking into account that lobby expertise on HIV/AIDS-related issues lies within these networks and international organisations more than within the CFAs.

All counterparts in Southern Africa are aware of the importance of internal mainstreaming and are in the process of drafting a HIV/AIDS workplace policy. In India, the understanding of internal mainstreaming is generally poor, given the present stage of the epidemic. To support these processes the CFAs have challenged their counterparts through partner consultations and the organisation of workshops, mainly on internal mainstreaming (workplace policy development). The counterparts appreciate these efforts but are expecting a more challenging dialogue with their respective programme officers, in particular on the implementation of good practices.
The CFAs have demonstrated a certain degree of flexibility with regard to budget spending, for example through opting for budget support schemes. This enabled counterparts to adjust programmes and budgets according to the needs of their beneficiaries, which is essential in a rapidly changing HIV/AIDS context. Most of the counterparts visited appreciated the additional support (ad hoc budgets for internal mainstreaming processes) for the development of HIV/AIDS workplace policy, but feared that limited funding will affect implementation .The approved guidelines by the CFA’s within SAN! in December 2005 on ‘Support to Partners to Manage HIV/AIDS in the Workplace’ with financial commitments is an effective answer to these concerns. These guidelines are adopted for the two pilot countries of Uganda and India (except Novib who adopted them for all countries and counterparts).
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, VCT, HBC, OVC, income generating activities. A number of AIDS-focussed

Organisations are working on the enhancement of coping mechanisms of families, but in this they rarely looked for partnerships with experienced develop or generalist organisations with for example livelihood programmes. The support of CFAs towards the counterparts has resulted in an increased capacity of service providers and an increased number of beneficiaries. However, outputs and outcomes remain somehow limited due to the small scale of interventions, the similar approaches and the varying quality of services offered. The evaluators noticed in the interviews and focus groups discussions with beneficiaries, a good understanding of HIV/AIDS and how to protect themselves. However, many of the organisations do not seem to reach men to discuss responsible attitudes and male sexual behaviour. Concerning advocacy and lobbying, some counterparts are acknowledged as leaders at a national level in advocating for the rights of PLWHA and access to treatment. But the role of most counterparts remained at local level. This is due to the limited human resource and lobby capacities and missed opportunities to link their experiences and practices to national and international lobby networks.

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 all aim to take into account the specific needs of PLWHA and affected households. 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 strategies of the generalist organisations are in general not based on a systematic needs assessment, but on their daily practice (except the JOPM programme did a HIV/AIDS community analysis). Generally, these external mainstreaming processes were initiated by the counterparts themselves, unlike internal mainstreaming, which were mainly donor-driven. External mainstreaming is felt by counterparts as a difficult task that needs careful knowledge management and increased support and funding.
Most of the counterparts are gender sensitive in their HIV/AIDS programmes, responding well but in a classical way to the needs of women by improving their access to a variety of HIV/AIDS services. However most of them do not contribute effectively to the empowerment of women, including the necessity to change the (power) relationship between men and women in a HIV/AIDS context. Addressing absolute poverty and all forms of societal violence that women and their children face are prerequisites to win the fight against HIV/AIDS. All HIV/AIDS policies approved by the CFAs subscribe the gender – HIV/AIDS relationship as being fundamental in their fight against HIV/AIDS. The evaluation team, however, did not find well drawn up strategy or action plans for the implementation of those policies (some exception related to programmes on gender based violence). The first initiative in that direction is the new SAN project “Gender, women and HIV/AIDS”.
The contribution of the CFAs to the fight against HIV/AIDS can be valued as meaningful. However, the worldwide HIV/AIDS scenario remains bleak, particularly in terms of behaviours change among men in the visited countries. Further, denial and stigmatisation remain important problems in the daily fight against the epidemic. An intensified response and an increased investment in best practices and innovative approaches are required. The evaluators are of the opinion that the CFAs can take up a leading role and have formulated six recommendations to guide them:

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  To continue to enhance HIV/AIDS competence within each CFA
  
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  To strengthen the capacities and expertise of counterparts, establishing a more in-depth dialogue
  
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  To enhance collaboration: between CFAs, between counterparts, between local level, regional and international level.
  
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  To continue the implementation of the donor guidelines and adopt local solutions regarding financing insurance costs
  
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  To strengthen the comparative advantages of the CFA’s being “generalist “organisations and thus investing in HIV/AIDS mainstreaming. At the same time support AIDS focussed interventions and establishing links between the two type of organisations (AIDS focussed and generalist organisations) in order to reach scale.
  
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  To strenghten the focus on gender