united nations development programme...

HIV/AIDSEVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIA

United Nations Development Programme

Evaluation Office, May 2006United Nations Development Programme

HIV/AIDSEVALUATION OF UNDP’S ROLE AND

CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIA

Copyright © UNDP 2006, all rights reserved. Manufactured in the United States of America

The analysis and recommendations of this report do not necessarily reflect the views of the United Nations Development Programme, its Executive Board or the United Nations Member States.This is an independent publication by UNDP and reflects the views of its authors.

Design: Suazion Inc., Bloomingburg, NY Production: A.K. Office Supplies

Team Leader Dr. Sulley Gariba

International Ikwo Arit EkpoConsultants A. E. Elmendorf

Anthony Kinghorn

National Yema Ferreira (Angola)Consultants Simon Muchiru (Botswana)

Yayehirad Kitaw (Ethiopia)Keiso Matashane-Marite (Lesotho)Steven Chizimbi (Malawi)Scholastika Ndatinda Ipinge (Namibia)Shaun Samuel (South Africa)Dumisile Shabangu (Swaziland)Mukosha Bona Chitah (Zambia)Anna Cletter Mupawaenda (Zimbabwe)

EO Task Manager Ruth Abraham

Research Assistants Anselme SadikiAfiya McLaughlin-Whyte

External Reviewers Dr. Sigrun Mogedal, HIV/AIDS Ambassador,Government of Norway

Professor Lincoln Chen, Harvard University

EVALUATION TEAM

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIA

CONTENTS

Foreword iii

Executive Summary vii

1. The Evaluation Challenge 1

1.1 HIV/AIDS in Sub-Saharan Africa 21.2 Case-study countries and the variations among them 21.3 Evaluation goals and methodology 41.4 Limitations of the evaluation

and lessons for future evaluations 6

2. UNDP’s Role and Activities in the HIV/AIDS Response 9

2.1 Context: Rapid change in the environment 92.2 UNDP’s HIV/AIDS response:

Corporate and regional strategies and programmes 142.3 Overview of UNDP’s role and activities

in the HIV/AIDS response 152.4 Conclusion 18

3. Key Contributions and Outcomes of UNDP in the HIV/AIDS Response at the Country Level 21

3.1 Governance 213.2 Leadership 273.3 Mainstreaming of HIV/AIDS 293.4 Capacity development 343.5 Partnership coordination for country results 423.6 Conclusions on country-level contributions and outcomes 46

4. Summary of Findings and Recommendations 49

4.1 Summary of Findings 494.2 UNDP comparative advantages in addressing HIV/AIDS 514.3 Recommendations 52 i


ii

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIACONTENTS

Annexes

1. Terms of Reference (Summary) 552. Basic data on case-study countries 573. UNDP Country Cooperation Frameworks (CCFs) and HIV/AIDS in case-study countries 584. UNDP HIV/AIDS Programmes in case-study countries 625. HIV/AIDS financial data on case-study countries 666. Country case-study summaries 727. Synthesis of Global Policy Interviews 1018. References 1059. List of people met 11010. Acronyms 114

Boxes

Box E.1 Promising practices at the country level xiii

Box 1.1 Five outcome themes 5

Box 1.2 Methodology lessons for future UNDP evaluations 8

Box 2.1 The UN General Assembly Declaration of Commitment on HIV/AIDS—Global Crisis-Global Action 10

Box 3.1 Key contributions and outcomes of UNDP in HIV/AIDS governance 22

Box 3.2 Zimbabwe: Maintaining supportive HIV/AIDS governance under challenging conditions 23

Box 3.3 Botswana: Strengthening HIV/AIDS governance at national and decentralized levels 24

Box 3.4 Key contributions and outcomes of UNDP in HIV/AIDS leadership 26

Box 3.5 Namibia: Leadership in advocacy for private sector and gender empowerment 28

Box 3.6 Malawi: From individual to organizational leadership 29

Box 3.7 Key contributions and outcomes of UNDP in HIV/AIDS mainstreaming 30

Box 3.8 Angola: Mainstreaming HIV/AIDS in the education system 31

Box 3.9 Swaziland: Mainstreaming HIV/AIDS in the police force 32

Box 3.10 Key contributions and outcomes of UNDP in capacity development 35

Box 3.11 Zambia: UNDP roles in NAC Institutional development 36

Box 3.12 South Africa: Strengthening capacity for local and community-drivenresponses for empowering the poor and vulnerable 38

Box 3.13 Ethiopia: Improving community capacity to respond to HIV/AIDS through Community Conversations 39

Box 3.14 Key contributions and outcomes in partnership coordination for country results 42

Box 3.15 Lesotho: A UNDP Resident Representative creates new partnerships, with results 44

Figures

Figure 1.1 The AIDS epidemic in Sub-Saharan Africa, 1985-2003 2

Figure 1.2 HIV prevalence rates among pregnant women attending antenatal clinics in case study countries, 2004 3

Figure 2.1 External AIDS funding’s impact on public expenditure on health 13

Figure 2.2 Changes in external HIV/AIDS funding for case-study countries 13

Tables

Table 1.1 Variations among case-study countries in HIV prevalence, income and population 4

Table 2.1 Engagement of principal external HIV/AIDS financiers varies greatly among case-study countries 12

Table 2.2 UNDP support and activities in case-study countries 16

Table 2.3 UNDP spending on HIV/AIDS in case-study countries, 2002-2004 17

Table 2.4 Urgency accorded to HIV/AIDS by UNDP COs, 1999-2004 18

FOREWORD

Data from UNAIDS show that sub-Saharan Africa is disproportionatelyaffected by HIV/AIDS. Sub-Saharan Africa has just over 10 percent ofthe world’s population, but is home to more than 60 percent of all peopleliving with HIV—25.8 million. Southern Africa remains the epicentre ofthe global AIDS epidemic. The Evaluation Office undertook thisstrategic evaluation in ten countries—nine of which are in SouthernAfrica—Angola, Botswana, Lesotho, Malawi, Namibia, South Africa,Swaziland, Zambia and Zimbabwe—and Ethiopia in the Horn of Africa.

UNDP has been advocating for action against HIV/AIDS for more thantwo decades. Since 2000, HIV/AIDS has become one of UNDP’s toporganizational priorities, and it has worked towards integrating it intobroader efforts to support effective democratic governance and povertyreduction. During the second multi-year funding framework period(2004-2007) Responding to HIV/AIDS became one of UNDP’s five coregoals. This is expected to contribute directly to Millennium DevelopmentGoal 6 on combating HIV/AIDS.

The purpose of the evaluation was to assist UNDP in positioning theselected UNDP country offices for a more effective role in response to thecrisis. Its findings are expected to contribute to the formulation of futureUNDP strategies at the country level in combating HIV and AIDS. Theevaluation shows that UNDP has played multiple roles in the HIV/AIDSresponse at the country level, and UNDP country offices were engaged atvarious levels in stimulating HIV/AIDS policy development, planningand action at the country level. Important contributions and outcomeswere identified by the evaluation, including capacity development andpolicy support to national HIV/AIDS commissions and councils, supportto decentralized HIV/AIDS responses at all levels of government anddown to the local level, support for elaboration of HIV/AIDS-relatedpolicies, actions related to gender and stigma, support for civil societyorganizations and their HIV/AIDS responses, leadership developmentprogrammes for HIV/AIDS, and Community Conversations to engageand stimulate HIV/AIDS-related initiatives.

The evaluation emphasizes the need for country offices in the case-studycountries to demonstrate a much higher level of urgency in their work onHIV/AIDS. Findings reveal that there is a disconnect between the UNDP iii


corporate strategy for HIV/AIDS and implementationby country offices and little evidence of integration ofcorporate, regional and country level strategies andactivities. There is also a disconnect between CountryCooperation Frameworks and actual activities. Widevariations exist in the technical and organizationalcapacity of the country offices to support nationalHIV/AIDS responses.

The Evaluation Office invited observations on thefinal draft report from two distinguished experts in thefield, Dr. Sigrun Mogedal, HIV/AIDS Ambassador,Government of Norway and Professor Lincoln Chenof Harvard University. Both commentators wereoverall positive, but found the terms of reference forthe evaluation ambitious, as did the evaluation team.Both expressed concern—a concern shared by theevaluation team and the Evaluation Office—aboutthe adequacy of the data underlying the evaluation.Prof. Chen noted in particular the weaknesses in dataon UNDP resources devoted to HIV/AIDS.

Both reviewers regretted the lack of comparativeunderstanding and full analysis of the roles of otheractors beyond UNDP. Prof. Chen found himselfconfused on the relative roles of UNAIDS, WHO,UNDP, and other UN bodies working on AIDS inthe case study countries. Dr. Mogedal found the largestweakness of the report to be its focus on UNDPwithout dealing much with the rest of the ‘inner circle’of actors, even within the UN family itself. Prof.Chen considered the finding “reasonably credible”that UNDP has an “important role to play, exercisedthis role in a responsible manner, and seemed togenerate some impact, however imperfectly measured.”To him the “recommendation for stronger UNDPleadership especially at the country level seemsappropriate.” For Dr. Mogedal, the main findingsand observations are “of great importance” and “verymuch in line with my own findings and experience.”For her, they call to mind the challenge of UN reformfor “a UN presence that is dynamic, able to analyze,adapt and give substantive advice.”

The evaluation is the result of the dedication,commitment and contributions of a number ofpeople. We are deeply indebted to all the people whoworked tirelessly to complete this evaluation, especiallythe evaluation team members led by Dr. Sulley Gariba.

Team members were Ms. Ikwo Arit Ekpo, Mr. A.Edward Elmendorf and Dr. Anthony Kinghorn. Dr.Gariba coordinated preparation of the initial draft ofthe report, and Mr. Elmendorf served as coordinatingauthor of the report.

I wish to acknowledge with great appreciation thesupport of the United States Agency for InternationalDevelopment's Regional Center for Southern Africafor contributing the valuable services of Ms. IkwoArit Ekpo, Sr. Regional HIV/AIDS Adviser.

The evaluation draws heavily on the work of tennational consultants who elaborated country assess-ments of UNDP HIV/AIDS activities in each of thecase study countries: Ms. Yema Ferreira (Angola),Mr. Simon Muchiru (Botswana), Dr. Yayehirad Kitaw(Ethiopia), Ms. Keiso Matashane-Marite (Lesotho),Mr. Steven Chizimbi (Malawi), Ms. ScholastikaNdatinda Ipinge (Namibia), Mr. Shaun Samuel(South Africa), Ms. Dumisile Shabangu (Swaziland),Mr. Mukosha Bona Chitah (Zambia), and Ms. AnnaCletter Mupawaenda (Zimbabwe). The countryassessments are being published as a separate volume.The international team members led an orientationworkshop of the national consultants in Johannesburg,South Africa at the start of the evaluation. Thecontributions of Mandisa Mashologu, Senior PolicyAdvisor/NPO, UNDP Lesotho, are acknowledgedfor her insights at both the orientation workshop fornational consultants and the writers’ workshop, aswell as for work on the annexes.

I am very grateful to all UNDP colleagues atheadquarters, the Regional Centre and country officeswho supported the work of this evaluation. Myspecial thanks go to all the Resident Representativesand the staff of the case study countries, the Directorof the Bureau for Policy Development (BDP) andthe HIV/AIDS Group, senior representatives of theRegional Bureau of Africa and staff, and othercolleagues from Development Group Office andBureau for Crisis Prevention and Recovery whoprovided vital feedback to the team and theEvaluation Office. We owe a great deal of gratitudeto the numerous government officials, partnerorganizations, donors, and members of civil societyorganizations, whose insights were invaluable to theevaluation team.iv

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAFOREWORD

v

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAFOREWORD

The team’s two researchers Mr. Anselme Sadiki andMs. Afiya McLaughlin-Whyte, who were guided by Ruth Abraham of the Evaluation Office and byMr. Elmendorf, produced useful background work. Ialso extend appreciation to those in the EvaluationOffice who provided technical, administrative andlogistical assistance. In particular I would like tomention Evaluation Office colleagues MahahouaToure, Immaculee Ilibagiza, Hajera Abdullahi andAnish Pradhan for their untiring support. I alsothank Margo Alderton, editor of this report.

Finally I would like to thank my Evaluation Officecolleague Ruth Abraham, task manager for thereport, who ably managed the evaluation.

Saraswathi MenonDirectorEvaluation Office

EXECUTIVESUMMARY

INTRODUCTION

RATIONALE

Southern Africa is the subregion where the HIV/AIDS pandemic is themost devastating in the world and where the danger to sustainingdevelopment achievements is the greatest. The subregion is also sufferingfrom the effects of poverty, drought and famine, and the severe erosion ofhuman capacities. A number of factors, including social circumstances,economic conditions and population mobility, have increased the severityof the epidemic. Further, gender differences are at the root of a numberof social, economic and political factors that drive the HIV/AIDSepidemic and result in a disproportionate number of affected women andadolescent girls. Without an understanding of the complex relationshipbetween gender and HIV/AIDS, strategies to tackle the epidemic are notlikely to succeed.

The Evaluation Office undertook a strategic evaluation of the role ofUnited Nations Development Programme (UNDP) and its support inaddressing HIV/AIDS in 9 countries in Southern Africa: Angola,Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambiaand Zimbabwe. Ethiopia, in the Horn of Africa, was also included in theevaluation since it is estimated to have the second highest number ofHIV/AIDS-infected people in Africa.

OBJECTIVES

The purpose of the evaluation was to assess the role and contributions ofUNDP in the achievement of key outcomes at the country level. Thisincluded a review of the UNDP role and contributions in the policy andplanning choices made by countries in relation to HIV/AIDS. The termsof reference called upon the evaluation to assess whether UNDP wastargeting the right areas and taking the correct approach, and to assess theoutcomes of its strategy, programmes and projects in addressing HIV/AIDSat the country level. The terms of reference also called for the evaluationto be strategic and forward-looking. It was expected to assist the UNDPcountry offices (COs) concerned in taking an increasingly effective role inHIV/AIDS, with appropriate contributions from corporate units and theRegional Centre for Southern Africa. The findings were also expected tocontribute to future UNDP strategies and programmes on HIV/AIDS. vii


CONCEPTS AND METHODOLOGY

The evaluation covered the period 1999 through2004, but the report takes into account many criticaldevelopments in the HIV/AIDS response in 2005.The evaluation included an overview of the StrategicResults Framework (SRF) in 1999 and included anoverview of budgeted activities that were eitherongoing or had not yet begun. It reviewed outcomeevaluations conducted by UNDP at the country,regional and subregional levels. It also reviewed thecontributions of UNDP towards the Multi-YearFunding Framework (MYFF) 2004-2007, in whichresponding to HIV/AIDS was a separate corporate-level goal. The focus of the evaluation was at thecountry level.

The evaluation used a variety of approaches and datasources, which allowed the team to triangulate itsresearch and arrive at robust findings. These included:n

A preliminary review of internal UNDPdocuments.

n

Country assessments by national consultants inten countries and six country visits by interna-tional consultants. The assessments involvedinterviews and focus groups, and included viewsof UNDP and other United Nations (UN) staff,donors, government officials, people in communitybased organizations, women’s organizations,and academics.

n

Policy interviews in New York and several otherlocations with key personnel from UNDP, otherUN bodies, and partner organizations.

The evaluation focused largely on UNDP contribu-tions and outcomes and the environment in whichUNDP HIV/AIDS activity at the country level hastaken place.

The contributions and outcomes analyzed in theevaluation identified notable changes in responses toHIV/AIDS. However, at the time of the evaluation,many interventions had not been implemented for an extended period, so findings on outcomes wereoften limited. There were limitations on ability totriangulate and validate views. Validation was mademore difficult by a scarcity of quantitative evidence.Since HIV/AIDS activities of other donor partnerswere not assessed, the team was unable to gain asmuch understanding of partner activities as wouldhave been desirable for a thorough assessment ofUNDP comparative advantages with respect to HIV/AIDS. Weaknesses in monitoring and evaluation at

the CO level also impeded the evaluation task.Additional limitations were encountered because UNDPwas often only one of several players associated withan outcome. Nonetheless, the review of contributionsand outcomes is sufficiently robust to present anumber of conclusions and raise key strategic issuesthat have implications for strengthening the roleplayed by UNDP in the HIV/AIDS response.

CONTEXT

THE GLOBAL CONTEXT

Heads of State from around the world adopted theMillennium Declaration in September 2000. Includedin it are eight development goals, comprising anambitious agenda for reducing and ultimatelyeliminating poverty. Of these, Goal 6 calls for haltingand beginning to reverse the spread of HIV/AIDS,malaria and other major diseases by 2015.

In June 2001, at the special session of the GeneralAssembly on HIV/AIDS, heads of state and govern-ment adopted by acclamation the Declaration ofCommitment on HIV/AIDS, “Global Crisis —Global Action” (resolution S-26/2) to express theircommitment to addressing the HIV/AIDS crisis.The Declaration articulated measurable goals toreverse the epidemic, including targets in several keyareas. It also called for a fundamental shift in theglobal response to HIV/AIDS as not only a publichealth dilemma, but also a global economic, socialand development issue of the highest priority, andthe single greatest threat to the well-being of futuregenerations. A commitment was also made at thespecial session to create the Global Fund to FightAIDS, Tuberculosis and Malaria (GFATM), in therecognition that if brought to scale, efforts to preventand treat HIV/AIDS, tuberculosis and malaria couldchange the course of these diseases.

THE UNDP INSTITUTIONAL AND POLICY ENVIRONMENT

UNDP has been advocating for action againstHIV/AIDS since the late 1980s. In 2000, it madeHIV/AIDS one of its top organizational priorities,integrating it into broader efforts to support effectivedemocratic governance and poverty reduction. SinceJune 2001, several Executive Board sessions havebeen devoted to reviewing UNDP contributions towardsviii

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAEXECUTIVE SUMMARY

ix


reversing the HIV/AIDS pandemic within the contextof the UN System Strategic Plan for HIV/AIDS for2001-2005. This culminated in the decision to makeHIV/AIDS a vital consideration for UNDP duringthe second MYFF period (2004-2007), and one offive core goals for the organization — Goal 5:Responding to HIV/AIDS. This will contributedirectly to Millennium Development Goal (MDG) 6on combating HIV/AIDS. The HIV/AIDS servicelines were consolidated from five to three areas underthe second MYFF: leadership and capacity develop-ment to address HIV/AIDS; development planning,implementation and HIV/AIDS response; andadvocacy and communication to address HIV/AIDS.

GROWTH IN EXTERNAL FINANCIALRESOURCES TO FIGHT HIV/AIDS

Considerable growth in external financial support forthe fight against HIV/AIDS was seen at the countrylevel during the review period. This has led todramatic increases in total public expenditure onhealth in some case-study countries (potentially ashigh as 700 percent in Zambia, for example). Theconsequences include new challenges for developingcountries in managing public finances and ensuringthat donors respect country priorities. This implies,also, changes in the needs of UNDP’s nationalpartners, which now require more support for themobilization and the effective use of new externalfinancial resources for HIV/AIDS.

Headquarters data suggest that between 1999 and2004 total UNDP planned spending from its ownresources for HIV/AIDS projects and activities was atleast $3 million per year in the 10 case-study countries.Cost-sharing resources brought the total to nearly$6.5 million per year, or a minimum of $21 million inthe case-study countries during the period of theevaluation. In contrast, GFATM commitments tothe case-study countries amounted to $312 millionfor signed grants as of April 2005. Thus, UNDP isbecoming a smaller player on the HIV/AIDS scenethan it was in the 1990s. However, the evaluation foundthat UNDP has had important accomplishments inrelation to the size of its funding.

UNDP, THE UN SYSTEM, AND THE INTERNATIONAL COMMUNITY

The central position of UNDP Resident Representativesand UN Resident Coordinators in the international

system of development support is almost universallyrecognized. In the case-study countries, the UNDPcoordination role sometimes extended beyond UNorganizations to include additional partners,especially where new financial resources wereprogrammed by non-UN organizations.

UNDP comparative advantages in the fight against HIV/AIDSThe comparative advantages of UNDP in the HIV/AIDS response vary from country to country.Nonetheless, there was one key comparativeadvantage that is institutional in character: Theposition of UNDP as coordinator and voice for theUN system and UN country teams. The evaluationperceived a UNDP comparative advantage in facilitating the effective involvement of other smallerUN organizations and donors, especially in smallercountries and where major donors are relatively lessactive. However, as financial resources from non-UN institutions assume greater prominence, UNDPrisks losing relevance at the country level unless itgives greater attention to coordination beyond theUN system.

The generally strong relationships between UNDPand governments represent another key comparativeadvantage, but it has been under-used in the case-study countries. The ability to promote and facilitatemainstreaming and integration of HIV/AIDS issuesinto development and poverty reduction strategiesshould be a comparative advantage of UNDP in allcountries, as was the case in Angola and Swaziland.

UNDP was also thought to have a comparativeadvantage in addressing certain aspects of AIDS-related governance issues, including decentralizedsupport to the HIV/AIDS response, the humanrights dimensions, and gender.

Finally, the evaluation found that UNDP should havea comparative advantage in capacity development, asin its work for decentralized HIV/AIDS responses inBotswana and Zambia. Developing and using all ofits potential comparative advantages at the countrylevel poses continuing challenges.

It was not clear whether the comparative advantageof UNDP was viewed as actual or only potential. Toooften, UNDP leadership was seen as bureaucratic anddiplomatic rather than substantial and development-oriented. UNDP might achieve development results

as much by trust and facilitation as by the provisionof financial resources. The Secretary-General hascalled for the creation of joint UN HIV/AIDS teamsat the country level. UNDP must be at the heart ofthe implementation of this new arrangement.

FINDINGS

The relevance, effectiveness and sustainability ofUNDP HIV/AIDS responses represent core issuesfor the evaluation. They are discussed in thefollowing three sections: key contributions andoutcomes of UNDP engagement in HIV/AIDS;UNDP HIV/AIDS strategy and management of theUNDP HIV/AIDS response; and monitoring,evaluation, and sustainability of the UNDP HIV/AIDS response.

KEY CONTRIBUTIONS AND OUTCOMES OF UNDP ENGAGEMENT IN HIV/AIDS

UNDP has played multiple roles in the HIV/AIDSresponse at the country level. In general, the roles andcontributions of UNDP were relevant to thesituations of its partner countries, but they risk losingrelevance as the environment for UNDP engagementchanges. It was too soon to assess the effectiveness ofthe UNDP response in achieving developmentimpact in a number of areas, but certain importantcontributions and outcomes were identified, alongwith some missed opportunities and marked inter-country variations in programmes and results.UNDP effectiveness and sustainability of UNDPinterventions were limited by lack of attention tomonitoring, evaluation and exit strategies.

Overall, the evaluation found that UNDP is support-ing those programmes and activities that it said itwould support. Activities--frequently at the pilotlevel--included leadership development programmesfor HIV/AIDS; Community Conversations toengage and stimulate HIV/AIDS-related initiativesat the community level; capacity development andpolicy support to national HIV/AIDS commissionsand councils; support to decentralized HIV/AIDSresponses at provincial, district and local governmentlevels; support for the elaboration of HIV/AIDS-related policies, including action related to genderand stigma; support for civil society organizations(CSOs) in their HIV/AIDS responses; generation ofknowledge through activities such as national human

development reports related to HIV/AIDS;mainstreaming or facilitating integration of HIV/AIDSissues into activities beyond the traditionalHIV/AIDS ‘sector;’ support for workplace HIV/AIDS responses in the UN family of institutions; andpartnership actions for country results.

Beyond the activities that UNDP financed, UNDPCO managers and staff were engaged at variouslevels in stimulating HIV/AIDS policy development,planning, and action at the country level.

The signal accomplishment of UNDP lies in movingHIV/AIDS paradigms from biomedical towardsdevelopment perspectives in almost all the case-studycountries. The shift was part of a global change, butUNDP was widely considered to have been instru-mental in successfully advocating for it withincountries and for helping to institutionalize this shiftin development planning and management. Supportat the country level in systematically promoting the shift has been significant. However, UNDP has achieved only limited change in translatingawareness and policy acceptance into actions,especially beyond the HIV/AIDS sector. In addition,the recent growth in external financial resources andresulting prominence of treatment creates the dangerthat developmental approaches to combating theepidemic may lose attention.

Relevance and effectiveness of UNDP role and contributionsFive themes were used as the organizing frameworkfor the evaluation—governance in relation to HIV/AIDS, HIV/AIDS leadership, mainstreamingHIV/AIDS into other development activities,capacity development for HIV/AIDS response,and partnerships for country results.

Governance, including gender and CSO engagementUNDP contributed substantially to the paradigm shiftfrom biomedical to developmental perspectives onHIV/AIDS and greater commitment of governmentsand their partners towards policies, strategies, structuresand processes that shape national responses. Threesignificant outcomes stand out: changing nationalpolicies and strategic frameworks for managing HIV/AIDS; strengthening decentralized HIV/AIDSinstitutions; and increasing the presence and voice of CSOs and vulnerable groups in advocacy andx


xi


participation. The quality, effectiveness and sustain-ability of changes in these three areas were mixed.

There are ongoing challenges to enhancing the roles ofnational HIV/AIDS commissions and decentralizedstructures, and the participation of key stakeholders,including vulnerable groups. The quality of countrystrategies to address these issues in the case-studycountries could be improved, and plans to translate thesestrategies into action were often not well developed.

The reputation of UNDP for strong links withgovernment created unexploited opportunities forinfluence on HIV/AIDS governance. Many otherdevelopment partners have become involved instrengthening national HIV/AIDS structures andgovernance, often with larger financial and humanresources than UNDP has available.

Gender and HIV/AIDS are inextricably linked.Gender inequality is a key factor in the HIV/AIDSepidemic among women, and young girls in particu-lar, are disproportionately affected by the pandemic.Several UNDP initiatives, particularly at thecommunity level, have positively and markedlyinfluenced gender dynamics. However, it wasdifficult to establish that UNDP programmeschanged gender-related issues concerning HIV/AIDSon a significant scale. In a number of countries,UNDP has promoted increased recognition of therights and roles of women, people living with HIV/AIDS and CSOs in governance and in multisectoralresponses. UNDP spearheaded initiatives to establishand strengthen umbrella or coordinating CSOs, butdid not provide enough support to achieve measurableimpact, especially at the peripheral levels wherepopulations most need support from CSOs.

LeadershipUNDP has helped strengthen HIV/AIDS-relatedleadership through programmes that develop leadershipamong politicians and government officials,community and civil society bodies, and someprivate-sector entities. In addition, the UNDP COsthemselves, through the interventions of ResidentRepresentatives, Resident Coordinators and COstaff, have contributed to HIV/AIDS leadership.However, there is still a great need to enhance HIV/AIDS-related leadership in the case-study countries.

The evaluation found inspiring examples of leadership‘breakthroughs,’ particularly in the UNDP Community

Conversations and leadership development programmes.However, at the time of the evaluation, it wasuncertain whether UNDP interventions, includingits Leadership Development Programme, hadachieved sufficient scale and depth to respond fully toleadership needs.

It was difficult to verify that effective interventionsreceived adequate support, and that interventionsthat were supported represented true areas ofcomparative advantage for UNDP in relation to its other HIV/AIDS work and the work of itsdevelopment partners. The UNDP concentration onindividual leadership development needed to becomplemented by emphasis on group leadership.

MainstreamingUNDP has contributed to acceptance of themultisectoral nature of the epidemic and the need formainstreaming--inclusion of HIV/AIDS issues inpolicies, plans and action in government responsesbeyond the health and HIV/AIDS sectors; enhance-ment of the roles of non-governmental partners andsuccesses in facilitating mainstreaming in policystatements, implementation of mainstreaming inmultisectoral responses; and emergence of workplaceprogrammes in UNDP COs and in public andprivate sector entities. However, despite the initia-tives of UNDP and its partners, and successes infacilitating mainstreaming in policy statements,implementation of mainstreaming was still at anearly stage in most case-study countries, especially inkey areas such as poverty reduction strategies.

HIV/AIDS deepens poverty and increases inequalitiesat every level. It is critical to integrate HIV/AIDSpriorities into poverty reduction strategies to helpcreate an enabling policy and resource environment.UNDP was influential in integrating HIV/AIDSinto poverty reduction strategy documents in severalcountries, working closely with governments andnational partners. However more needs to be done inthis area.

UNDP mainstreaming contributions seemed unlikelyto have substantial impact. Very little attention waspaid to gender and HIV/AIDS mainstreaming, evenat the government policy level. Where this was done,as in Botswana, follow-through was limited. Whilethe problem of making the leap from policy languageto follow-up implementation is not unique toUNDP, there is a long way to go to achieve full

integration of HIV/AIDS into poverty reductionstrategies, papers, processes and outcomes.

Though UNDP leadership has triggered someimportant changes through the UN ‘We Care’workplace programme in some countries, in others,UNDP was seen more as a participant than a leader.There were missed opportunities for UNDP COs andother UN partners to learn from each other in thisregard. COs did not integrate this activity systemati-cally into their own activities and programmes.

The limited mainstreaming of HIV/AIDS into otherUNDP programmes and activities is of particularconcern. This suggests limited ownership of theHIV/AIDS agenda among UNDP CO staff beyondthose immediately responsible for HIV/AIDS response.

Capacity developmentCapacity development is a top priority for UNDP insupporting programme countries. While resultsdiffered among countries, both institutional andindividual capacity at all levels, from national anddecentralized to the community level, has beenstrengthened by UNDP. In particular, UNDP hasenhanced capacity to respond to HIV/AIDS in thefollowing areas: individual and institutional capacityin national HIV/AIDS commissions and ministerialdepartments; capacity for decentralized planning,management and implementation; capacity ofHIV/AIDS-related CSOs and community levelcapacity; empowerment of people living withHIV/AIDS and others vulnerable to effects of theepidemic; and knowledge relating to HIV/AIDS toguide responses. In some countries, UNDP appearsto have missed opportunities to deal with larger-scalecapacity problems in public sector management,particularly related to human resource planning,development and management.

UNDP has had notable achievements at thecommunity level and at decentralized levels ofgovernment, where limited ability to promote activityis often a major gap in national response. However,results related to gender and HIV/AIDS and thedevelopment of the capacity and involvement of womenhave not featured prominently in many countries.

Serious constraints so far on outcomes of capacitybuilding with CSOs and other players are:inadequate consideration of sustainability plans,inexistent exit strategies, and achieving the requiredscale of impact.

An increasingly prominent area of capacity develop-ment is building country capacity to mobilize andmanage external HIV/AIDS resources. UNDP hasbegun to grapple with this issue, particularly throughits GFATM principal recipient (PR) role. In the past,insufficient emphasis had been given to movingresources (such as GFATM) beyond the nationallevel to decentralized and community levels. UNDPassumed a major capacity development role throughits PR responsibility for GFATM resources in two ofthe case-study countries, where it is likely thatwithout UNDP support no access to GFATM wouldhave been possible. However, while the importanceof UNDP’s capacity development contributions asGFATM PR was underscored, UNDP’s assumptionof this role raised concerns among some stakeholdersas to whether it created a conflict of interest withother UNDP activities, particularly with its role ofneutral advisor to the public authorities.

Approaches to UNDP HIV/AIDS capacity develop-ment innovations were sometimes weak in strategicfocus, leading to limited sustainability and impact.Issues of scale and sustainability were raised withrespect to Community Conversations in severalcountries. The role of UN Volunteers, which hadbeen successful in achieving urgent outcomes, needs tobe more strategic. UNDP training in several countrieslacked coherent planning and follow-up. These issueswere thought appropriate for action by the UNDPSouthern African Capacity Initiative (SACI).

The scale and range of HIV/AIDS capacity challengesin the case-study countries remains huge. UNDPrisked spreading itself too thin as a result of limitedprioritization, limited consolidation of capacitydevelopment agendas, and limited reinforcement and exchange of experience among countries.Stakeholders found a possible role for the UNDPRegional Centre for Southern Africa in cross-country experience sharing.

HIV/AIDS partnership coordination In nearly all the case-study countries, UNDP hasplayed an important role in partnership coordinationfor the achievement of country results. This was mostevident in financial resource mobilization from theGFATM in Angola and Zimbabwe. UNDP assistedsome countries in obtaining increasing governmentfinancial allocations to HIV/AIDS, but the amountswere dwarfed by the larger funding from externalpartners such as GFATM and the US President’sEmergency Plan for AIDS Relief (PEPFAR).xii


xiii


UNDP made important contributions in some of thecase-study countries in strengthening interagencysynergy among UN organizations and officialdevelopment partners, as exemplified by the effectivefunctioning of HIV/AIDS Theme Groups. Obstaclesto effective partnerships included: inadequatecommunication, inadequate agency role definitionand resulting tensions, limited UNDP assertiveness,and excessively project-focused approaches. Differences

among UNDP headquarters staff in their personalcommitment to the corporate HIV/AIDS agendawere also cited as a reason for inter-country differences in the UNDP HIV/AIDS response.

UNDP’s HIV/AIDS practice is a part of a largerjoint UN programme—UNAIDS—of which UNDPis one of 10 co-sponsors. At the country level, theyform the UN Theme Group on HIV/AIDS. For

As an indication of the importanceand value of monitoring, evaluating,and disseminating promising prac-tices, this box summarizes oneexample from each of the case-studycountries documented in the mainreport, in the country summariescontained in Annex 6, and in thenational consultant assessments.

ANGOLA: Mainstreaming HIV/AIDS into the education system—UNDP trained social actors (teachers,community leaders, armed forces,civil society and the media) onhuman rights, peace, gender andHIV/AIDS. This contributed toestablishment and strengtheningof community social networks fordialogue and provision of servicesto adolescent mothers, orphansand people living with HIV/AIDS.

BOTSWANA: Advocating andsupporting the establishment ofNAC and civil society coordinatingorganizations—Consistent supportby UNDP for the national AIDS coor-dinating organization started withthe AIDS/STI Unit within the Ministryof Health, and was eventuallyinstrumental in the establishmentof the National AIDS Council,chairedby the President, and NACA, with its Director elevated to the status ofPermanent Secretary to provide highprofile and commitment to AIDS.Similar support and advocacy alsoled to the establishment of key civilsociety coordinating bodies forPLWHA, ethics and AIDS serviceorganizations.

ETHIOPIA: Strengthening capacityfor community driven solutionsthrough Community Conversations(CC)—in Alaba and Yabello districts,communities certainly not used todiscussing such matters, the partic-

ipatory process of CC enhancedknowledge on AIDS and helped tobreak the silence, reduced stigmaand led to greater support forPLWHA and increased VoluntaryCounselling and Testing uptake. Atthe time of the evaluation the COwas generating lessons on how CCcan be sustained and rolled out ona larger scale.

LESOTHO: Creating partnershipsfor leadership engagement andsocial mobilization—a new UNDPResident Coordinator used herposition as co-chair of an ExpandedHIV/AIDS Theme Group to forgepartnerships with developmentpartners, engage donor supportand mobilize national leadershipcommitment on AIDS. She usedthe platform to mobilize resourcesfor crafting and publishing a widelyused review ‘Turning a Crisis into anOpportunity’. Working collabora-tively with other partners, theResident Coordinator launched thebook and used it as a tool for mobi-lizing national action against AIDS.

MALAWI: Supporting the designof the AIDS SWAp—UNDP supportfor the AIDS Round Table facilitatedearly engagement of developmentpartners and led to the creation of adonor funding basket or AIDS SWAp,with about $400 million in pledges.

NAMIBIA: Engaging the privatesector to mobilize the businesscommunity on AIDS—grant supportto the National Business Coalitionon HIV/AIDS (NABCOA) led toincreased awareness about AIDS.Training of employees and devel-opment of a toolkit resulted in theexpansion of programmes and themobilization of businesses at thenational and municipal levels,

through AMICALL (Alliance of MayorsInitiative for Community Action onAIDS at the Local Level).

SOUTH AFRICA: Reducing stigmain the workplace through GIPA—focusing on decentralization themesas a result of its collaborativearrangements with the govern-ment, UNDP provided support toboth the private and public sectorthrough workplace programmesfor PLWHA. It was successful inreducing stigma and empoweringPLWHA to live productive lives.

SWAZILAND: Using leadershiptraining to facilitate scaling upAIDS awareness for the PoliceForce—as a result of UNDP train-ing, the Assistant Commissioner of Police scaled up training andestablished a Committee on AIDS.He expanded AIDS activities to allfour regions of the country, thusincreasing awareness.

ZAMBIA: Using underutilizednational human resources as UNVolunteers (UNVs), to meet thedemand for AIDS Programming—through careful assessment and in response to national requests,national UNVs were deployed to actas catalysts for facilitating districtAIDS action plans, and therebyfacilitated access to resources available through the World Bank.

ZIMBABWE: Staying the course in challenging circumstances—consistent support to the NAC andthe country during trying times hasresulted in successful mobilizationof funds through the GFATM. UNDPstarted developing increasingcapacity of the NAC to assumeresponsibility for managing funds.

BOX E.1 PROMISING PRACTICES AT THE COUNTRY LEVEL

UNDP, the most significant institutional changeduring the period of this evaluation was the strikinggrowth of the UNAIDS Secretariat and theexpansion of its presence in the field. In manycountries, the UNAIDS Secretariat has recruitedCountry Coordinators, while UNDP has only parttime HIV/AIDS focal points. Tensions underminedsynergies between the two in some countries.

Many stakeholders would like UNDP to providemore leadership in partnership coordination forcountry results in the HIV/AIDS response.Strategies to strengthen partnership developmentroles require the consideration of several factorsincluding: specific circumstances and opportunitiesin each country; capacity of COs and the skills andattitudes of specific Resident Representatives,Resident Coordinators and staff; clarification of rolesbetween UNAIDS and UNDP at the country level;and improved design and communication of theUNDP CO HIV/AIDS strategy.

The positive partnership coordination outcomesdocumented in the evaluation were widely thought tohave been accomplished with less-than-adequate COand Regional Centre staff and coordination—a viewshared among CO staff and many developmentpartners. The newly established Regional Centre wasseen by many as an important complement to the CO,but its role was not well understood. CO capacitymight be strengthened by ‘projectizing’ support andthereby removing it from the constraints of the UNDPCO administrative budget. Data from the last year ofthe evaluation indicate that the share of UNDPHIV/AIDS spending increased in only four of theten case-study countries, and actually declined in six.

STRATEGY AND MANAGEMENT OF THE UNDP HIV/AIDS RESPONSE

UNDP has made significant efforts to mobilizeresources for its interventions in the fight againstHIV/AIDS. It operates at three levels—corporate,regional and national. Resources are mobilizedthrough different funding sources: the GlobalThematic Trust Fund set up in 2002 to supportGlobal Cooperation Framework resources; projectsat the regional level; and core and non-core resourcesat the country level.

Strategic focusThere was a disconnect between the UNDP corporatestrategy for HIV/AIDS and implementation by COs,

and little evidence of integration of corporate,regional and country-level strategies and activities. Afurther disconnect existed between the countrycooperation framework (CCF) and actual activities.Broad frameworks were not consistent nor did theyadequately capture what UNDP actually planned andexecuted at the country level.

Such disconnects between CCFs and programmestatements, compared to actual activities, mightindicate adaptation, evolution and flexibility in theUNDP response. Alternatively, they might indicatedisjunctions among the paradigms and strategies of UNDP COs, headquarters and the regionalcentre. Headquarters initiatives did not seem to bereliably consistent with country-level circumstancesand capacity.

Funding by UNDPThe role of UNDP in HIV/AIDS substantially increasedamong the countries reviewed in this evaluationperiod, with many new activities being funded.Nonetheless, in some countries, HIV/AIDS still wasnot a central element in country programmes. Areview of CCFs showed that discussions ofHIV/AIDS were vague and somewhat limited.

UNDP spending on HIV/AIDS has substantiallyincreased. Although financial information was notavailable to assess patterns and trends with a highdegree of confidence, the evaluation found significantdifferences among the case-study countries in theamounts and shares of HIV/AIDS spending in totalcountry programme spending. The low levels andsmall shares of HIV/AIDS in UNDP countryprogramme spending in some countries as late as2004 (6 percent to 9 percent in three countries) didnot reflect the UNDP corporate priority and strategyon HIV/AIDS at the country level. The very highshare in other countries (as high as 62 percent in onecountry) suggests that determined leadership by theUNDP Resident Representative or the UN ResidentCoordinator can make a significant difference.

CO HIV/AIDS capacityWide variations exist in the technical and organiza-tional capacity of the COs to support nationalHIV/AIDS responses, as well as the determinationof CO managers and staff to take action. Thedifficulty in obtaining financial and other data onUNDP HIV/AIDS projects and programmes fromheadquarters databases and from the COs themselvesxiv


xv


raises questions about the capacity of UNDP to beaccountable and manage resources in an effective andtimely manner.

Statements and performanceDespite UNDP’s achievements in makingHIV/AIDS a development issue, there were seriousgaps between statements made by UNDP and its performance. The soaring rhetoric of seniormanagement statements and UNDP publications onHIV/AIDS was inadequately matched by compara-ble CO performance in the design and execution ofUNDP activities. Overall, there were large deliverygaps in translating policies into actions.

Implementation was given inadequate attention attwo levels: UNDP projects and programmes requiregreater support from COs to reduce delays in execution;and, as increasing external financial resources werebeing promised by donors for the HIV/AIDS response,UNDP was not yet providing the new types ofsupport needed for the execution of country HIV/AIDSprogrammes in the public and private sectors, includingthe non-governmental organization community.

MONITORING, EVALUATION,AND SUSTAINABILITY OF THE UNDP HIV/AIDS RESPONSE

The limited quantity of monitoring and evaluationdata imposed serious constraints on the evaluationand raised questions regarding the sustainability ofthe UNDP HIV/AIDS response. Weaknesses wereobserved in the lack of outcome-oriented evaluationat the CO level (with one or two exceptions), andquantified or clearly documented evidence wasscarce. The concept of outcome evaluation was notfirmly anchored in UNDP--to the extent that COunderstanding of an independent evaluation, and thelevel of support it received, varied greatly fromcountry to country.

UNDP HIV/AIDS projects, which frequently tookthe form of pilot projects, generally lacked evaluationand exit strategies and seemed simply to come to ahalt. One exception in this area was the UNDPEthiopia’s Community Conversations programme.However, without carefully planned and executedevaluation and exit strategies, the chances of sustainingUNDP projects and activities beyond the period ofUNDP financial support are low.

RECOMMENDATIONS

This evaluation has one overarching recommendation:In Southern Africa—where the HIV/AIDS epidemicis the most severe in the world—the COs in the case-study countries must demonstrate a much higherlevel of urgency in their work on HIV/AIDS.

Urgency should be measured, inter alia, by use ofresources, leadership, people, time and money. TotalUNDP spending on HIV/AIDS overall is not largeenough to have a significant impact on the epidemicat the country level. It is therefore particularlyimportant that it use HIV/AIDS resources, bothhuman and financial, in a strategic manner. It is criticalto develop coherent approaches to leveraging partnerresources in order to achieve the scale of outcomesrequired in countries with very severe epidemics.

With support of an agile team drawn from allconcerned headquarters units and the RegionalCentre, each UNDP CO and each of the other unitsconcerned should develop, by September 2006, amonitorable action plan through which to implement thespecific recommendations detailed in the evaluationreport. These specific recommendations are:

COUNTRY OFFICES

Clarify strategic directionCOs should formulate or update UNDP countryHIV/AIDS strategies and integrate them intonational HIV/AIDS strategies and programmes.Strategies should:n

Include UNDP inputs from the Regional Centreand headquarters units, and promote main-streaming, especially the full integration ofHIV/AIDS into poverty reduction strategies.

n

Draw upon initiatives from the headquartersBureau for Development Policy (BDP) and theRegional Centre, where those initiatives arerelevant to the country’s situation.

n

Be based on country demand and need rather thanUNDP supply; take into account implementationof the ‘Three Ones’ principles; support donorharmonization; support integration of HIV/AIDSinto poverty reduction strategies; and associatedactions should feature prominently in UNDPcountry HIV/AIDS strategies and programmes.

n

Integrate all UNDP financial resources forHIV/AIDS, whether managed at country,regional or headquarters level, and whether coreresources or trust funds.

Shift programme focusn

Give central attention to supporting implemen-tation of country HIV/AIDS programmes,especially at decentralized levels.

n

With support from the Regional Centre, assistpartner countries in designing, financing and executing programmes that take actionssuccessfully piloted by UNDP and other externalpartners to scale on a country-wide basis.

n

Assist partner countries with mobilization,disbursement and effective utilization of externalfinancial resources for HIV/AIDS, with supportfrom the Regional Centre.

Strengthen HIV/AIDS capacityCOs should strengthen their HIV/AIDS capacity,with support from the Regional Centre for SouthernAfrica and headquarters. CO HIV/AIDS capacityshould include budgets; staff skills, attitudes and deployment; staff incentives; organization forHIV/AIDS work; and internal and external leadership. Leadership by example rather than bymandate should characterize UNDP cooperationwith UN organizations and other partners. In theirHIV/AIDS work, COs should go beyond UNDPprojects and should plan, draw upon and facilitatedeployment of the entirety of the institutionalresources available to UNDP through UNAIDS andthe UN system.

Foster a culture of monitoring and evaluationSuch a culture should be fostered by strengtheningmonitoring, evaluation, exit strategies, and especiallylearning from experience, with an expectation ofmeasurable results from each UNDP HIV/AIDSproject or intervention. Specific recommendationsinclude:n

Review each ongoing UNDP HIV/AIDSproject or activity for adequacy of its monitoring,evaluation and exit strategy. Projects should not simply end but should have a planned exit strategy involving evaluation and transfer of responsibility.

n

Establish successful work on monitoring andevaluation as a criterion for positive evaluation ofstaff performance.

n

Draw upon the monitoring and evaluation workof the Regional Centre for methodology tosynthesize monitoring and evaluation analysis informs usable by others, and to establish anddisseminate good practices and lessons learned.

REGIONAL BUREAU FOR AFRICA

Assume new HIV/AIDS leadership rolesn

Support stronger HIV/AIDS leadership on thepart of Resident Coordinators and ResidentRepresentatives. The Regional Bureau for Africa(RBA) should support and promote proactiveleadership on HIV/AIDS through job design,staff selection and performance appraisal, andthrough support with other UNDP units andexternal partners.

n

Review and revise SACI and ARMADA strate-gies and mandates in close cooperation with theRegional Centre, to prioritize supportingcountry HIV/AIDS programmes with particularreference to monitoring and evaluation, anddisseminating good practices; support expansionof pilots evaluated as successful; design andsupport public management actions necessary forscaled-up HIV/AIDS programmes; andcontribute to formulating and executing COHIV/AIDS strategies and programmes.

n

Lead a task force for the independent assessmentof HIV/AIDS capacity in COs, the regionalcentre, and RBA with the participation of RBA,BDP, the Bureau of Management, the RegionalCentre, and COs.

BUREAU FOR DEVELOPMENT POLICY

Review corporate HIV/AIDS strategyReview the corporate HIV/AIDS strategy of UNDPin the light of the evaluation report to supportimplementation of country HIV/AIDS programmesand poverty reduction strategies.n

Focus on the two themes of: support to imple-mentation of country HIV/AIDS projects andprogrammes, and support to integration ofHIV/AIDS into poverty reduction strategies.UNDP/BDP HIV/AIDS programmes outsidethe two central themes should gradually beconsolidated and transferred to other partners,except to the extent that they are directly respon-sive to country demand and have been evaluatedas being successful. The revised corporatestrategy should encompass a review of UNDPapproaches to mainstreaming.

n

Assist the Regional Centre, and especially COs,with HIV/AIDS country strategy formulationand implementation.

n

Weigh the HIV/AIDS capacity of BDP,including budgets, staff skills, attitudes, incentives,xvi


xvii


and links with other UNDP units and partners,against the changing needs. BDP should giveparticular attention to capacity for monitoringand evaluation.

BUREAU OF MANAGEMENT

Accelerate implementation of financial management improvement programmeThe financial management strengthening programmeshould make it possible for users in BDP, regionalbureaux and COs to access and effectively use real-time, consistent, comparable financial data on the fullrange of UNDP HIV/AIDS activities.

OFFICE OF THE ASSOCIATEADMINISTRATOR

Clarify working relationshipsExamine and, where necessary, revise internalHIV/AIDS working and reporting relationships andexternal partnerships. The Office of the AssociateAdministrator should position UNDP for increas-ingly effective engagement on HIV/AIDS.n

Take the lead in defining CO standards andprocedures for resolving problems that arise inimplementing the division of HIV/AIDS-

related labour among UN organizations that wasrecently agreed upon in follow-up to the work ofthe Global Task Team on Improving AIDSCoordination. Particular attention is needed toensure effective cooperation between UNDP andthe UNAIDS Secretariat.

n

Review collaboration and reporting relationshipsamong the concerned headquarters offices andbureaux, the Regional Centre and the COs.Establish the principle that the COs aresupported by the other units within theframework of agreed strategies.

n

Review UNDP’s role as PR for the GFATM forconflict of interest. If that role is retained,guidelines should be established to ensure itsseparation from UNDP advisory functions,and there should be a concentrated focus oncapacity development for early phase-out at thecountry level.

EXECUTIVE BOARD

Request a report on the implementation of therecommendations for the annual session in 2007.Monitor implementation of the recommendationsand commission a further evaluation at a convenientmid-point between 2006 and 2015.

THE EVALUATIONCHALLENGE

HIV/AIDS presents profound development challenges throughout theworld, especially in Africa. These challenges transcend the boundaries ofmedicine into governance, human development, economic developmentand growth, employment, culture and traditions. Yet, more than any otherepidemic, HIV/AIDS has also given the global community a renewedsense of purpose—addressing the dual scourge of poverty and disease.

The HIV/AIDS response has led to diverse partnerships betweengovernments, civil society, the private sector, and external agencies, andbetween natural and social scientists. UNDP is a broker and actor near thecentre of this complex and continuously evolving network of relationships.

Since the late 1980s, UNDP has been among the global actors advocatingand mobilizing others in the HIV/AIDS response. It has paid particularattention to the links between HIV/AIDS, poverty and development. In2000, UNDP made HIV/AIDS one of its top institutional priorities. Itaimed to integrate it into broader development programmes and activi-ties, in support of policy and programming coherence for sustainedpoverty reduction. In operational terms, UNDP has launched initiativesat the corporate, regional and country levels. Its aims were to be achievedthrough support to policy change, programme design and implementation,and partnership coordination.

AIDS was considered a vital issue in the second Multi-Year FundingFramework (MYFF) period from 2004-2007. Initiatives from headquarterswere launched to stimulate local AIDS-related leadership development.Regional projects were created. A new Southern Africa Capacity Initiative(SACI) was established to respond to serious capacity depletion. UNDPhas also deployed thematic trust funds and other non-core sources of funding.

In late 2004, the UNDP Evaluation Office launched this evaluation ofUNDP’s role and contributions in the HIV/AIDS response in 10 Africancountries to determine lessons for future application in UNDP support tothe HIV/AIDS response. This report synthesizes the evaluation team’sresults. It addresses the environment for the HIV/AIDS response inAfrican countries; it covers the context necessary to understand UNDP’sroles and contributions to the HIV/AIDS response; and it containsrecommendations for action by UNDP. 1


1

This chapter introduces the evaluation study. It setsforth the challenges faced by the evaluation team. Itsummarizes the epidemic in Sub-Saharan Africa andit shows the great variations among the countries thathave been the focus of the evaluation. The chapterdescribes the goals and methodology of the evaluationand presents lessons derived from the present evaluationfor future UNDP evaluation work. The chapterconcludes with an outline of the evaluation report.

1.1 HIV/AIDS IN SUB-SAHARAN AFRICA

Sub-Saharan Africa, particularly Southern Africa,has been the region most severely affected byHIV/AIDS. According to UNAIDS, in 2004, thetotal number of people living with HIV rose to anestimated 40 million, approximately 5 million peoplewere newly infected with HIV, and globally, AIDSkilled 3 million people that year alone. Sub-SaharanAfrica remains by far the worst affected region,accounting for 25 million people living with HIV atthe end of 2004 and more than three quarters of allwomen living with HIV.

On the surface, the epidemic in Sub-Saharan Africaappears to be stabilizing. Average HIV prevalencewas about 7 percent for the entire region at the endof 2003 (Figure 1.1). The highest prevalence levels are

in Southern Africa, which accounts for approximatelyone third of all AIDS deaths globally.1 Regardless of any stabilization of the epidemic, the social,economic and other costs of HIV/AIDS will continueand increase for many years.

HIV/AIDS has a devastating impact on life andlivelihoods. It represents enormous human develop-ment threats—losing adults in the most productiveage groups, placing great burdens on already strainedcommunity capacity for coping, and furthercontributing to chronic poverty. At a time when theneed for social services is increasing, social servicedelivery capacity is being weakened by the epidemic.The effects of HIV/AIDS have also combined withpoverty, limited capacity for effective governance, andfood crises in several Southern African countries andEthiopia to create a human development crisis thatthreatens the ability of countries to achieve theMillennium Development Goals (MDGs).

1.2 CASE-STUDY COUNTRIESAND THE VARIATIONSAMONG THEM

The focus of this evaluation is at the country leveland recognizes the variations among countries and

2

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIACHAPTER 1. THE EVALUATION CHALLENGE

FIGURE 1. 1 THE AIDS EPIDEMIC IN SUB-SAHARAN AFRICA, 1985-2003

Number of people living with HIV and AIDS (millions)

Nu

mb

er o

f p

eop

le li

vin

g

wit

h H

IV a

nd

AID

S (m

illio

ns)

Year

Percentage HIV prevalence,adult (15–49)

Percen

tage H

IV p

revalence,

adu

lt (15

–49

)

30

25

20

15

10

5

01985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

30

25

20

15

10

5

0

Source: UNAIDS,“2004 Report on the Global AIDS Epidemic,” 2004.

1 UNAIDS,“AIDS Epidemic Update: December 2005.”

3


the concentration of UNDP activities at that level.Nine countries in Southern Africa (Angola,Botswana, Lesotho, Malawi, Namibia, South Africa,Swaziland, Zambia and Zimbabwe) and one countryin the Horn of Africa (Ethiopia) were chosen forcountry case studies. The overall rationale for thisselection was the severity of the HIV/AIDSpandemic in Southern Africa and the wide variationsamong country experiences.

The 10 case-study countries display great differences.Several countries represent environments where theHIV/AIDS epidemic is particularly severe andrequires particularly urgent responses. As shown inFigure 1.2, eight of the countries in this report showHIV prevalence rates among pregnant womenattending antenatal services of 20 percent or more. Intwo of the countries (Botswana and Swaziland)antenatal HIV prevalence rates currently exceed 30percent, and in two countries (South Africa andLesotho) they are nearly 30 percent. In four countries(Malawi, Namibia, Zambia, and Zimbabwe) rates ofapproximately 20 percent reflect a median inSouthern Africa that far exceeds the Sub-SaharaAfrica average of 7 percent. Angola and Ethiopia arethe only two countries in this evaluation with

antenatal HIV prevalence rates of 3 percent and 4percent for 2004, significantly lower than the Sub-Sahara Africa average.

Socio-political conditions differ widely among thecase-study countries. Beyond HIV prevalence,income and population size also vary significantly(see Table 1.1).While Angola is in transition from acivil war that lasted almost three decades, Zimbabweis experiencing a rapid socio-economic decline andpolitical crisis. In other countries, such as Ethiopia,Malawi and Zambia, democratic transitions are innascent stages. These countries are fraught withvacillating relationships between governing andopposition parties. Botswana, one of the most stablecountries politically, shares its political and economicstability with Namibia and South Africa. The onlytwo monarchies, Lesotho and Swaziland, areadjusting differently to pressures for increaseddemocratization.

Governance indicators also reveal wide variationsamong the 10 case-study countries and have shownsome overall decline. Case-study country averages aresomewhat more favorable, compared to Sub-SaharanAfrica as a whole. In a recent study, government

FIGURE 1. 2 HIV PREVALENCE RATES AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINICS IN CASE STUDY COUNTRIES, 20042

Per

cen

tag

e (%

)

50

40

30

20

10

0

Source: UNAIDS-AIDS Epidemic Update: December 2005 Sub-Saharan Africa 5.

Angola Botswana Ethiopia Lesotho Malawi Namibia South Africa

Swaziland Zambia Zimbabwe

3

37

4.4

27

20 20

29.5

42.6

20 21

2 Some countries rates refer to 2003, as 2004 survey statistics are not available.

effectiveness (which reflects the competence of thepublic bureaucracy and the quality of public servicedelivery, including HIV/AIDS services) was assessedto have been stable or improved in only 2 of the 10countries, Angola and South Africa.3

1.3 EVALUATION GOALS AND METHODOLOGY

The purpose of the evaluation was to assess UNDP’srole and contributions in the achievement of keyoutcomes at the country level through review ofpolicy and planning choices made in relation toHIV/AIDS. The terms of reference (Annex 1) calledupon the evaluation to assess whether UNDP wastargeting the right things and doing things right, andto assess outcomes of UNDP’s strategy, programmesand projects in addressing HIV/AIDS at the countrylevel. The terms of reference also called for theevaluation to be strategic and forward-looking. It wasexpected to assist the UNDP country offices (COs)concerned in positioning themselves for an increas-ingly effective role in HIV/AIDS, with appropriatecontributions from corporate units and the RegionalCentre for Southern Africa. The findings were also

expected to contribute to future UNDP strategiesand programmes on HIV/AIDS.

The evaluation covered the period 1999 through2004. The evaluation team did not investigateUNDP activities prior to 1999, even though theirresults and contributions were visible. Because theevaluation was expected to have implications forfuture UNDP activities, the evaluation team did notestablish a rigid cutoff date for new information atthe end of 2004. The report takes into account manycritical developments in the HIV/AIDS response in 2005.

The evaluation applied the principles and tools foroutcome evaluation.4 Broadly defined, the outcomeevaluation approach is one that moves away fromassessing project development results against projectobjectives, towards assessing how these results havecontributed to changes in development conditions.5

The real challenge lies in understanding the nature ofthe changes6 and in grasping the extent of UNDPassociation with any changes. In many cases, as

4


TABLE 1. 1 VARIATIONS AMONG CASE-STUDY COUNTRIES IN ANTENATAL HIV PREVALENCE, INCOME AND POPULATION

Sources: Compiled from data from UNAIDS, World Bank data

Country Greater than30% HIV

prevalence

10-30% HIVprevalence

Less than 10% HIV

prevalence

Middleincome

Low income Extremelysmall

population

Angola X X

Botswana X X X

Ethiopia X X

Lesotho X X X

Malawi X X

Namibia X X

South Africa X X

Swaziland X X X

Zambia X X

Zimbabwe X X

3 Kaufmann D, Kraay A, Mastruzzi M, “Governance Matters IV:New Data, New Challenges,” World Bank, 2005, available atwww.worldbank.org/wbi/governance/pubs/govmatters4.html.

4 UNDP Evaluation Office, “Guidelines for Outcome Evaluators:Monitoring and Evaluation Companion Series #1,” 2002; UNDPEvaluation Office, “Handbook on Monitoring and Evaluation forResults,” 2002; and HIV/AIDS Group, Bureau for DevelopmentPolicy,“Responding to HIV/AIDS Measuring Results,” 2005.

5 UNDP Evaluation Office, “Guidelines for Outcome Evaluators:Monitoring and Evaluation Companion Series #1,” 2002, p. 6.

6 HIV/AIDS Group, Bureau for Development Policy,“Responding toHIV/AIDS Measuring Results,” 2005, p.7.

5


discussed in Chapter 3, it was impossible to delimitoutcomes or results with a high degree of specificity.Thus, this report discussed UNDP contributions aswell as outcomes. One consequence of the focus onUNDP contributions and outcomes was an inabilityof the evaluation to give significant attention toUNDP’s plans and intentions.

The evaluation involved both an internationalconsultant team and national consultants. It requiredthe international team: to establish outcomemeasures that extend beyond traditional records ofthe processes and outputs of project interventions;and to determine plausible associations betweenUNDP’s role and contributions and the outcomes—or lack of outcomes—in the area of HIV/AIDS.

In each of the 10 countries, the evaluation commis-sioned a country case study led by a national consultant.A member of the international team was able to visitsix of the 10 countries during the work of thenational consultant. Resource limitations made itimpossible to visit the other four countries. Thecountries visited were chosen by the EvaluationOffice as follows: Angola—selected on the basis of itsemergence from conflict, a country of lowHIV/AIDS prevalence rates, and a lusophonecountry; Ethiopia—low prevalence of HIV/AIDSbut high absolute number of infected people andreported to have contributed innovative approachesto HIV/AIDS programming, the only case-studycountry in the Horn of Africa; Lesotho—relativelyhigh prevalence of HIV/AIDS, low income, smallpopulation, innovative UNDP experience; Zambiaand Malawi—relatively mature HIV/AIDS epidemics,substantial current rates of infection, and very lowincomes and worsening poverty levels; South Africa—middle-income, relatively high rates of HIV/AIDSinfection, unique UNDP role.

The evaluation followed this sequence:n

Building consensus between the commissionersof the evaluation (the Evaluation Office) and theindependent evaluators about the range of outcomesor ‘results’ to emphasize in assessing progress;

n

Participating in selection, training and collaboratingwith national consultants undertaking countryassessment studies;

n

Gathering evidence on activities, especially onoutcomes, of UNDP’s work at the country level;

n

Analyzing and validating influencing factors atthe country level;

n

Assessing contributions of UNDP to identifiedchanges; and

n

Reviewing findings to identify UNDP’s compar-ative advantages, associated constraints, andmissed opportunities.

In parallel with the country studies, members of theinternational consultant team interviewed key UNDPpersonnel at the regional level. They also interviewedUNDP corporate staff and external partners for theirunderstanding of UNDP’s contributions to country-level results and feedback on UNDP’s strengths,weaknesses, and comparative advantages in HIV/AIDS.7 The full team then held a writers’ workshopto build a common understanding of the evidenceand to allocate roles and tasks in preparation of theevaluation report.

At the inception of the task, the international team had a day of intensive briefings by UNDPHeadquarters staff on its HIV/AIDS work in Africa. These discussions, examination of relevantdocuments, and consultations with the EvaluationOffice led the international consultant team toestablish five outcome themes as the framework forits work (Box 1.1).

Early in the fieldwork, it became apparent that theoutcome theme categories were not exclusive. Someof the national consultants found it difficult to workwithin them, in part because the initial definitionslacked specificity. The outcome themes were definedin more detail at the writers’ workshop, after most

7 See Annex 7 for a synthesis of interviews.

At the inception of the evaluation, the internationalconsultant team, in consultation with the UNDPEvaluation Office, identified five outcome themes forthe evaluation:

1. Governance in relation to HIV/AIDS

2. Leadership for development with an HIV/AIDS focus

3. Capacity development in relation to HIV/AIDS

4. Mainstreaming HIV/AIDS response into development and poverty reduction

5. HIV/AIDS partnership coordination for country results

The scope of each of these themes is discussed inChapter 3.

BOX 1.1 FIVE OUTCOME THEMES

data collection was complete but before drafting ofmajor portions of the report. The final definitions andissues considered under each theme are presented atthe beginning of each section of Chapter 3.

The evaluation gathered evidence for the analysis ofcontributions and outcomes at three levels:

1. Key institutions and individuals at the policy level.This work consisted of discussions in UNDPHeadquarters, with its partner agencies, and withinthe case-study countries—UNDP CO management,development partners, and government, civilsociety and private sector leaders who shapepublic policy and responses to HIV/AIDS.

2. Implementing institutions and individuals at theintermediate level. This included UNDP CO focalpersons and other partners whose programmescontribute to achieving HIV/AIDS resultsrelated to the five outcome areas.

3. Community-level assessments. These focus groupdiscussions explored the perspectives of communityleadership, community-based organizations andpeople who are infected or affected by HIV/AIDS, or are at risk of infection.

The evaluation team compared this evidence withinformation gleaned from documents produced byUNDP and others to establish the veracity ofoutcomes and their plausible association withUNDP. By this approach, the analysis of outcomeswent beyond what UNDP stated as planned or actualoutcomes of its interventions. The evaluation processendeavored to capture changes that might not haveoccurred without UNDP’s role as well as missedopportunities where UNDP might have been able tocontribute to results but did not. Triangulation ofinformation from several data sources at the countryand international levels was used to validateoutcomes and confirm the significance of variousviews on strategic issues for UNDP. At the end ofmost country assessments, a stakeholder workshopwas used to verify the reported changes (outcomes)and their plausible association with UNDP.

On the basis of their country visits and the draftnational consultant assessments, members of theinternational team compiled a detailed matrix ofUNDP contributions and results for each case-studycountry under the five outcome themes for theevaluation. This matrix was an essential transitiontool for drafting of the overall evaluation report.

Members of the international consultant teamreviewed the national consultant assessments in detail.Feedback on the national consultant studies was

obtained from the UNDP CO. The final version of thenational consultant assessment was then completed.While the main report commits the internationalconsultant team, responsibility for the country assess-ments lies with the national consultants.8 Theseassessments are being published separately.

Members of the international team have summarizedthe team’s assessment of UNDP’s HIV/AIDS rolesand contributions in each of the case-study countriesin Annex 6. In an endeavour to provide furtherguidance to UNDP and its COs, the team hasprepared a brief box at the beginning of each countrysummary on the international consultant team’sviews of strategic issues and key implications of the evaluation study for UNDP action in thatcountry. In some cases, these lessons may also havewider application.

1.4 LIMITATIONS OF THE EVALUATION AND LESSONSFOR FUTURE EVALUATIONS

The contributions and outcomes analyzed in theevaluation reflect notable changes that were identified.However, at the time of the evaluation, many changeswere intermediate, incremental and/or limited inscale and scope. Validation of contributions andoutcomes and their association with UNDP waslargely based on triangulation by the evaluation team. Frequently and strongly articulated views ofinformants were an important factor. Further validation was often not possible due to scarcity ofquantitative or other clearly documented evidence.Weaknesses in monitoring and especially inoutcome-oriented evaluation at the CO level greatly impeded the successful accomplishment ofthe evaluation task. Additional limitations wereencountered because UNDP was often only one ofseveral players. Indeed, associations with UNDPwere generally difficult to discern in the case-studycountries, because other influential players also tendedto be engaged in areas of UNDP involvement. Thismade it impossible in most cases to specify howUNDP made a difference, with detailed disaggregationof the roles of UNDP and other partners. Finally, ina number of instances, there were gaps in knowledgeof UNDP work among some key stakeholders andinformants. Nonetheless, the evaluation teamconsiders the review of outcomes to be sufficientlyrobust to permit presenting a number of conclusionsand raising key strategic issues that are likely to be

6


8 In a few cases, members of the international consultant teamhave joined as co-authors of the National Consultant reports.

7


valid and have implications for strengthening rolesplayed by UNDP in the HIV/AIDS response.

The evaluation has probably underestimated theimportance of UNDP’s country partners in thechanges that it reports. This is a consequence of theevaluation’s focus on UNDP and its roles and contri-butions, rather than on the case-study countriesthemselves. The evaluation was also largely unable toassess the ultimate impact of UNDP contributions to theHIV/AIDS response, even when it was able to reachoutcomes. In light of the overall importance of UNDPcontributions in key areas, such as the development ofthe National AIDS Commissions, this is an area forfuture evaluations that might be considered by UNDP.

In addition to assessing UNDP’s role and contribu-tions in the HIV/AIDS response at the country level,the evaluation also sought to contribute to themethodology for results-oriented evaluation. UNDPis seeking to position itself as a broker of ideas, acatalyst for innovation, and a guardian of principlesof country-owned development. The evaluation teambelieves that UNDP can and should integrate lessonslearned from the evaluation in the design, staffingand budgeting of future evaluations.9

One major finding of the evaluation is that, althoughthere is a commitment to shift away from traditionalproject evaluation at the corporate level, outcomeevaluation methodology is not yet firmly anchored inUNDP. At the country level, outcome evaluation is avery recent innovation. Generally, it is still viewed asan outside consultant exercise, rather than part of aprocess of learning and knowledge managementintegral to the work of UNDP COs. The level ofsupport for the evaluation varied from country tocountry. This seemed related to CO capacity andunderstanding of outcome evaluation.

The familiarity and capacity of national consultantsto use the outcome evaluation methodology was aconstraint. Although a training workshop wasconducted prior to launching the country assessments,considerable further effort was required to establish a shared understanding of the concepts and tools.Even then, gaps in understanding remained, whichdelayed completing the national consultant assess-ments. Of the 10 countries, the international teamwas able only to visit six. This limitation may alsoaccount for some disparities in the consistency ofevidence gathered and analyzed and in the quality ofthe country assessment reports.

Several other important constraints and limitationsshould be considered in interpreting findings andconducting future evaluations:n

The timing of the evaluation can imposeimportant limitations. In this evaluation, thebrief and highly variable period of implementa-tion of many UNDP interventions limited theability of the evaluation team to identify theemergence, scale, depth and sustainability ofchanges and outcomes.

n

Specific programmes and activities were notanalyzed separately, and analysis focused on‘what changes UNDP made’ in the five outcometheme areas. Use of broad outcome theme categoriesand open-ended enquiry as the starting point forassessment is, arguably, methodologicallydesirable: It helps to identify unintendedoutcomes and the most prominent outcomesrather than what is ‘expected,’ and it also reducesrisk of focus on programme evaluation ratherthan outcome evaluation. However, thisapproach led to frustrated expectations at thecountry and programme level. Some stakeholderswished a more project-based approach, with moreexplicit acknowledgement of processes, activitiesand outputs, and more specific guidance andcommentary on country-level programming10.

n

Limitations of monitoring and evaluation(M&E) data related to inputs, processes andoutputs also imposed important constraints onthe evaluation. More conventional M&E datacan add substantially to the ability to drawconclusions about association, attribution, scaleand depth of outcomes, but their infrequentavailability at the country level became a majorlimitation. Where such data were available, as inrecent evaluations conducted in some countries,such as Zimbabwe, and by UNDP’s Bureau ofDevelopment Policy (BDP), their results wereused to enrich the analysis of outcomes andUNDP contributions.

n

The Regional Centre and the AdvancingResource Mobilization and Delivery for Africa(ARMADA) and SACI initiatives have thepotential to play major roles in achievingdevelopment outcomes and addressing thestrategic issues emerging from the challengesposed by HIV/AIDS in Southern Africa.However, at the time of this evaluation, theywere still being established and defining theirroles. The ability of the evaluation team to draw

9 A separate and more detailed discussion of the terms of reference, methodology and constraints was submitted to theEvaluation Office at its request as part of the Draft Report.

10 This frustration was expressed by a number of stakeholders,especially CO and some Headquarters staff, who subsequentlyprovided useful additional information to facilitate furtherunderstanding of outcomes. The focus of the evaluationremained at a strategic rather than project level.

conclusions on outcomes of their work wastherefore limited, although clearer definition oftheir roles should be facilitated by the findingsand recommendations of the evaluation.

Reflecting on the terms of reference for the evaluation,the evaluation team drew three overall conclusions:

n

While the team has been able to carry out anoutcome-oriented evaluation of UNDP’s roleand contributions, the original terms of referencewere overly ambitious. The full terms of reference(only a summary is presented in Annex 1) amountedto more than 12 pages. To explore fully a numberof issues in the terms of reference would haverequired methodologically distinct evaluations ordetailed sub-evaluations.11

n

The evaluation required resources in time,personnel and funds significantly in excess of thoseinitially planned by UNDP. Future evaluationsshould anticipate a need to provide for moretraining of national consultants, more engagementof the international team with national specialistsat all stages of the evaluation, and a period ofjoint analysis of results. The evaluation teamconsiders a writer’s workshop an essential tool tobring evaluation personnel together from distantcountries and experiences to compare and shareexperiences, to build a common understanding ofthe raw evaluation data, and to agree on assignmentsfor drafting of the evaluation report.

n

Early desk compilation of relevant data, includingfinancial data committed to programmes at thecountry level were difficult to obtain, and whenthey were available, revealed grave inconsistencies.Future evaluations will need to be informed bysuch documentation, prepared by UNDP staffrather than external consultants, prior to thecommencement of the assignment.

Overall, the evaluation mandate to focus on roles,contributions and results, combined with the devastatingimpact of HIV/AIDS and the great differencesamong the case-study countries, constituted aformidable challenge. Box 1.2 highlights someadditional lessons for future UNDP evaluations.

1.5 OUTLINE OF THE EVALUATION REPORT

The following chapters synthesize the findings of theevaluation. Chapter 2 sets UNDP’s role and contri-butions in the rapidly changing global context ofHIV/AIDS responses. The chapter examines theevolution of global consensus around the millennium

challenges, the momentum built around HIV/AIDS,and the evolving role and associated challenges toUNDP. It contains basic information on UNDPAIDS-related programmes and activities at thecountry level, and comparative data.

Chapter 3 analyzes major UNDP contributions andoutcomes associated with support to country-levelresponses to HIV/AIDS. This Chapter is organizedaround the five main themes of the evaluation. Itanalyzes changes that can be plausibly associatedwith UNDP as well as missed opportunities thatmight have improved results.

Chapter 4 summarizes major findings of the evaluationteam, reviews UNDP’s comparative advantages inaddressing HIV/AIDS at the country level, andpresents recommendations for future UNDP action.

8


This evaluation’s experience suggests several lessonsfor future UNDP evaluations.

n

Choose timing carefully. The present evaluationtook place so early in the execution of many UNDPinterventions that it proved very difficult to collectdata on UNDP outcomes.

n

Manage expectations of all stakeholders. SeveralCOs expected the present study to focus more onindividual projects and programmes than on theresults of UNDP work.

n

Guard against excessively ambitious evaluationmandates. The original terms of reference for thisevaluation called upon the international team toundertake methodologically distinct evaluationsand sub-evaluations that were not feasible withinthe time and other resources available.

n

Plan more carefully, particularly for work bynational consultants. More training and supportivesupervisory engagement by the international teamwould have been appropriate in the present case.

n

Assemble, collate and review available UNDPinformation before launching an evaluation.In the case of this evaluation, the internationalteam—at a comparative disadvantage relative to UNDP staff—devoted substantial time late inthe work on the report to collecting and reviewinginformation that should have been available atthe outset.

BOX 1.2 METHODOLOGY LESSONS FOR FUTURE UNDP EVALUATIONS

11 Activities of other donor partners at the country level are a casein point. While the international team was able to collect overalldata on partner financial engagement in the health sector insome of the case-study countries, as shown in Chapter 2, thework of team members with donor partners at the country level inevitably had to concentrate on their perception of UNDPactivities instead of the activities of the partners.

This chapter examines the role of UNDP, within the context of rapidworldwide change, in the HIV/AIDS response and provides an overviewof UNDP’s engagement in HIV/AIDS in the case-study countries. Itsummarizes the growing importance of HIV/AIDS in the global politicaldialogue, identifies significant changes in the institutional landscapeconcerning HIV/AIDS, provides data on recent massive increases in externalfinancial support for the fight against HIV/AIDS, and examines shifts indonor programming policies and practices. It includes information on donorengagement in the case-study countries. It also summarizes UNDP’scorporate, regional and country-level strategies and UNDP activities inthe HIV/AIDS response in the case-study countries. The chapterconcludes with the evaluation team’s assessment of the urgency accordedto HIV/AIDS by the UNDP COs in each of the case-study countries.

2.1 CONTEXT: RAPID CHANGE IN THE ENVIRONMENT

2.1.1 GROWING IMPORTANCE OF HIV/AIDS IN THE GLOBAL POLITICAL DIALOGUE

During the period under review, HIV/AIDS has become an increasinglycentral theme in the global political dialogue. In January 2000, the firstdiscussion of a single disease—HIV/AIDS—took place in the UnitedNations Security Council. The MDGs emerged from the work of theUnited Nations General Assembly at its Millennium Summit inSeptember 2000. The MDG targets for 2015 include halting the spreadof HIV/AIDS and beginning to reverse it. In June 2001, world leadersgathered in the General Assembly of the UN to hold a special session (theUnited Nations General Assembly Special Session on HIV/AIDS[UNGASS]) and adopted a Declaration of Commitment (see Box 2.1).12

The Declaration contributes to HIV/AIDS awareness among politicalleaders and has substantially informed UNDP’s activities in the countriescovered by this evaluation.

9


2UNDP’S ROLE

AND ACTIVITIESIN THE HIV/AIDS

RESPONSE

12 UN, “The UN General Assembly Declaration of Commitment on HIV/AIDS—Global Crisis-Global Action,” Document A/RES/S-26/2, 2001.

In its 2000 report, the High Level Panel on Threats,Challenges and Change established by the UNSecretary-General included HIV/AIDS as a threatfaced by the international community. The Panelcalled on the Security Council to examine the futureeffects of HIV/AIDS on states and societies, to generateresearch on the problem, and to identify critical stepstowards a long-term strategy for diminishing thethreat to international peace and security.13

Regular discussion of HIV/AIDS has taken place atthe Summit meetings of the G7 and G8 majorindustrial countries. In 2001, together with the UNSecretary-General the G7 launched the Global Fundto fight AIDS, Tuberculosis and Malaria (GFATM).14

In July 2005, the leaders at the G8 Summit agreed toaim as close as possible to universal access to

treatment of HIV/AIDS in Africa by 2010. Theyalso agreed to double official development assistanceto Africa between 2004 and 2010.15

In December 2004, the UN Millennium Projectsubmitted its report to the Secretary-General. It arguedthat the MDGs should serve as the foundation forcountry development strategies and for the determi-nation of the level and allocation of external develop-ment assistance support. It called for each donor toincrease Official Development Assistance (ODA) to0.7 percent of gross national product (GNP) by2015, with 0.54 percent devoted to the MDGslargely as grants-based budget support.16

In March 2005, the UN Secretary-General releasedhis report ‘In larger Freedom’ in follow-up to theMillennium Summit and the report of the HighLevel Panel on Threats, Challenges, and Change,and in preparation for the September 2005Millennium Summit Plus Five review by the UNGeneral Assembly. The report highlighted HIV/AIDS and called on the international community toprovide resources for an expanded response, asidentified by UNAIDS and its partners, and toprovide full funding for GFATM.17 The OutcomeDocument for the Millennium Summit Plus Fivereview re-committed political leaders to theUNGASS Declaration. It called for countries tocome as close as possible to the goal of universalaccess to AIDS treatment by 2010. It engagedleaders in working actively to implement the ‘ThreeOnes’ Principles,18 and welcomed and supported therecommendations of the Global Task Team onImproving AIDS Coordination.19

2.1.2 CHANGES IN THE INSTITUTIONAL LANDSCAPE

There have been many changes in the internationalinstitutional landscape concerning HIV/AIDSduring the period under review, including:

10

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIACHAPTER 2. UNDP’S ROLE AND ACTIVITIES IN THE HIV/AIDS RESPONSE

In June 2001, the United Nations General AssemblySpecial Session on HIV/AIDS (UNGASS) declared acommitment by political and other leaders toimplement multisectoral national AIDS strategiesand integrate HIV/AIDS into the mainstream ofdevelopment planning, including poverty reduction,by 2003. The UNGASS Declaration of Commitmentsaw care, support and treatment as fundamentalelements of an effective response. It called for therealization of human rights and fundamentalfreedoms for all, including empowering of women,as essential to reducing HIV/AIDS vulnerability.The Declaration expressed the view that to addressHIV/AIDS is to invest in sustainable development.It stated that the HIV/AIDS challenge cannot be met without new, additional and sustained resources.The Declaration supported the establishment of the Global Fund and anticipated a world-wide fund-raising campaign by 2002. It called for conductingperiodic national reviews of progress in meetingcommitments in the Declaration with the participationof civil society. A high-level UN meeting in May-June2006 is expected to review progress on the Declarationof Commitment and to keep attention focused onHIV/AIDS globally and at the country level.

BOX 2.1 THE UN GENERAL ASSEMBLYDECLARATION OF COMMITMENT ON HIV/AIDS—GLOBAL CRISIS-GLOBAL ACTION

13 High Level Panel on Threats, Challenges, and Change, “A MoreSecure World: Our Shared Responsibility,” UN DocumentA/59/565, December 2, 2004.

14 University of Toronto G8 Information Centre, “Introduction toG7/G8 Commitments, 1975-2002, Appendix B, list of IndividualCommitments.”Available online at www.g7.utoronto.ca/datasets/allcommitments/app_b_cycle4.html, accessed April 9, 2005.

15 Available online at http://www.fco.gov.uk/Files/kfile/PostG8_Gleneagles_Africa,0.pdf, accessed August 10, 2005.

16 Available online at http://www.unmillenniumproject.org/reports/recom_07.htm, accessed April 23, 2005.

17 UN,“Report of the Secretary General: In Larger Freedom: TowardsDevelopment, Security and Human Rights for All,”DocumentA/59/2005, pg. 16.

18 The Three Ones Principles include the following: a single agreedstrategic framework, a single national AIDS coordinating authority,and a single agreed country-level monitoring and evaluation system

19 UNGA, “2005 World Summit Outcome,” Document A/RES/60/1para. 57.

11


n

The creation of the GFATM is a particularlynotable development.

n

Both the Bill and Melinda Gates Foundationand the Merck Foundation have each donatedUSD 50 million for AIDS in Botswana.20

n

The Clinton Foundation is giving particularattention to AIDS care mainly in Africa underthe general umbrella of its health securityprogramme.21

n

The George W. Bush initiative of the UnitedStates has taken institutional form in thePresident’s Emergency Plan for AIDS Relief(PEPFAR), with support targeting 15 focuscountries, including 5 of the 10 countries coveredby this evaluation.22

From the standpoint of UNDP, the most significantinstitutional change during the period of this evaluationis the striking growth in UNAIDS—a jointprogramme co-sponsored by 10 UN agencies,including UNDP and the World Bank. UNAIDShas developed its role in advocacy, in the facilitationof coordinated action, and in technical support. TheUNAIDS Secretariat has increased its field presenceto facilitate support to enhance national responses.While the core Unified Budget and Workplan(UBW) resources for the Secretariat have not grown,the budget for country-level work grew 76 percent inthe UBW for 2004-2005. The core UBW for 2006-2007 foresees 28 percent overall growth over the2005-2006 period, to a total of USD 320 million.23

In many countries, the UNAIDS Secretariat hasrecruited full-time Country Coordinators whereasUNDP has only part-time HIV/AIDS focal points.

The growing importance of the civil society, globallyand within individual developing countries, is anotherimportant element of the changing institutionalHIV/AIDS landscape. In South Africa, a widevariety of civic groups, including organizationsformed by those infected or affected by HIV/AIDS,constitute a growing militancy. In several othercountries, such as Botswana, the emergence of civil society has been more oriented towards themobilization of resources and partnerships, as well as

direct service roles in HIV/AIDS. UNDP hasreflected this growing importance of civil societyroles through support to civil society organizations inthe case-study countries.

2.1.3 INCREASES IN EXTERNAL FINANCIAL SUPPORT FOR THE FIGHT AGAINST HIV/AIDS

Pledges and commitments of external financialsupport for the fight against HIV/AIDS have growngreatly in the 1999-2004 period. In 2000, the WorldBank initiated its Multi-Country AIDS Programme(MAP), to provide grants and soft loans to supportAIDS programmes in Sub-Saharan Africa. ByJanuary 2004, the World Bank had committed morethan USD 820 million to 24 countries under theMAP Programme. In early 2003, United States PresidentGeorge W. Bush pledged USD 15 billion to respondto AIDS in low and middle-income countries.Approximately USD 9 billion of this sum is newmoney, earmarked for 12 African countries plus Guyanaand Haiti.24 By the end of 2003, the GFATM hadapproved 227 grants totaling USD 2.1 billion in 124countries. Approximately 60 percent of theseresources were earmarked for AIDS programmes,and 60 percent of the total is allocated to Africa.25

By early 2005, GFATM had approved $1.8 billion ingrants to Sub-Saharan African countries.26

2.1.4 SHIFTS IN DONOR HIV/AIDSPROGRAMMING AND PRACTICES

In the mid to late 1990s, donor funding priorities inHIV/AIDS tended to focus on delivering publicgoods and services, such as surveillance, and onprevention interventions, including behaviourchange. Since the late 1990s, greater focus has beenplaced on mainstreaming HIV/AIDS into programmesand policies across a variety of sectors in order tomake use of their comparative advantages tostrengthen national responses to HIV/AIDS. Therehas also been increasing emphasis on the need toaddress issues such as governance and poverty in order to reduce vulnerability to HIV/AIDS.However, recent focus on treatment has led to apartial redefinition of HIV/AIDS as a health issue.

20 Available online at http://www.achap.org/index.htm, accessedApril 23, 2005.

21 Available online at http://www.clintonfoundation.org/programmes-hs.htm, accessed April 23, 2005.

22 Available online at http://www.usaid.gov/our_work/global_health/aids/, accessed April 23, 2005.

23 UNAIDS, Programme Coordinating Board, “Unified Budget &Workplan 2006-2007,” Geneva, Document UNAIDS/PCB(17)/05.4,June 27-29, 2005.

24 UNAIDS,“2004 Report on the Global AIDS Epidemic,” July 2004.25 Ibid.26 Data from Global Fund website, accessed April 23, 2005. In some

cases, AIDS and TB are shown together, and in these cases theentire sum is allocated to AIDS.

In 2004, UNAIDS and its partners adopted theThree Ones Principles—a single agreed strategicframework, a single national AIDS coordinatingauthority, and a single agreed country-level M&E system.27 Exemplifying these trends, theMarch 2005 Paris Declaration on Aid Effectivenesscommitted participants to address “insufficientintegration of global programmes and initiatives intopartner countries’ broader development agendas,including critical areas such as HIV/AIDS.”28

Moving donor funding from a project to aprogramme approach is increasingly being accepted,in principle. At the country level, donors are trying to work within the framework of AIDS Sector WideApproaches (SWAps),29 involving common donormodalities in support of a given sector programmeand, where possible, pooling funds into a commonaccount. Malawi is a case in point, where donors havepooled resources to support a unified national planfor HIV/AIDS.

2.1.4 DONOR ENGAGEMENT IN CASE-STUDY COUNTRIES

Total commitments of official developmentassistance for HIV/AIDS in the case-study countrieshave averaged about USD 280 million per year.31

Total approved grants from GFATM in case-studycountries for HIV/AIDS amount to more than USD400 million (Annex 5c).

There is enormous variation in the engagement ofdonors, including the principal external financiersGFATM, PEPFAR and MAP, in HIV/AIDSprogrammes in the case-study countries (Table 2.1).GFATM is the only principal financier engaged in all10 case-study countries, but there has also beenconsiderable variation in its grants by round. Onlytwo of the case-study countries are receiving fundingfrom all three principal external HIV/AIDSfinanciers—Ethiopia and Zambia.

The significant growth in overall external financingavailable for HIV/AIDS in developing countries hasits counterpart in dramatic increases in external HIV/AIDS financing and in total public expenditures onhealth in some of the case-study countries (Figure2.1). In Zambia, for example, the programmedincrease in annual external HIV/AIDS funding from2000-2002 to 2002-2004 was estimated to be nearly700 percent (Figure 2.2). The consequences of thisdramatic increase in financing include newchallenges in managing public finances and ensuringrespect for country priorities, which risk beingdistorted as a result of new external resources. Inaddition, there are a number of challenges in movingfrom pledged and programmed resources to legalcommitments, to disbursements to the country, toeffective utilization for widespread service provisionand positive development results.

These shifts in the environment for developmentcooperation have profound implications for UNDP.While the specific consequences vary from countryto country, there is a global shift in the needs ofUNDP’s developing country partners from advocacyto implementation (including effective use of newlyprogrammed and pledged external financial resources).

12


TABLE 2. 1 ENGAGEMENT OF PRINCIPALEXTERNAL HIV/AIDS FINANCIERS AMONG CASE-STUDY COUNTRIES

Source: Donor agency reports

Country GFATM Round30

USPEPFAR

WorldBank MAP

Angola 4 X

Botswana 2 X

Ethiopia 2,4 X X

Lesotho 2

Malawi 1 X

Namibia 2 X

South Africa 1,2,3 X

Swaziland 2,3,4

Zambia 1,3 X X

Zimbabwe 1

27 UNAIDS,“2004 Report on the Global AIDS Epidemic.”28 High Level Forum, “Paris Declaration on Aid Effectiveness:

Ownership, Harmonization, Alignment, Results and MutualAccountability,” March 2, 2005. Participants in the Paris meetingincluded five of the case-study countries for this evaluation—Botswana, Ethiopia, Malawi, South Africa, and Zambia—and all ofthe main bilateral donors. The 26 participating organizationsincluded the UN Development Group.

29 Sector Wide Approach refers to the coordination of multi-donorsupport to a country’s development programme in a given sector.

30 Round 3 was for Tuberculosis, but is mentioned here because ofthe inclusion of combined AIDS/TB components. 31 Data from OECD/DAC database; see Annex 5.

13


FIGURE 2. 1 EXTERNAL AIDS FUNDING’S IMPACT ON PUBLIC EXPENDITURE ON HEALTH 32

USD

mill

ion

s

n

External HIV/AIDS financingn

Public expenditure on health250

200

150

100

50

02002–2004

Ethiopia2002–2004

Lesotho2002–2004

Malawi2002–2004Swaziland

2002–2004Zambia

FIGURE 2. 2 CHANGES IN EXTERNAL HIV/AIDS FUNDING FOR CASE-STUDY COUNTRIES33

Exte

rnal

HIV

/AID

S fu

nd

ing

(US$

mill

ion

s)

n

2000–2002 averagen

2002–2004 average

5 percent increase 5698%

5951%

5283%

5115%

51100%

150

120

90

60

30

0Ethiopia

42,422,37591,158,864

101,158,864

Lesotho552,580

6,629,62516,629,625

Malawi16,488,58063,216,60073,216,600

Swaziland1,561,485

16,413,41526,413,415

Zambia15,647,850

124,847,261134,847,261

2000–2002 average2002–2004 averageIncrease

32 Lewis M, “Addressing the Challenge of HIV/AIDS: Macroeconomic, Fiscal and Institutional Issues,“ Working Paper 58, Centre for GlobalDevelopment, April 2005.

33 Ibid.

2.2 UNDP’S HIV/AIDS RESPONSE: CORPORATE AND REGIONAL STRATEGIESAND PROGRAMMES

During the period covered in this evaluation,UNDP’s role in HIV/AIDS has substantiallyincreased. HIV/AIDS has gained higher priority inUNDP, with many new activities. Initially, HIV/AIDS fell under the category of ‘Economic andsocial policies and strategies focused on the reductionof poverty’–the second of UNDP’s six corporategoals. Only at the level of sub-goal one, which calledfor comprehensive strategies to prevent the spreadand mitigate the impact of HIV/AIDS,34 did AIDShave early prominence. When the Annual Reportsfor 2002 and 2003 were issued, HIV/AIDS rose inpriority, as one of six independent practice areas,though there was no systematic discussion of resultsin this area.35 The 2005 Annual Report emphasizesleadership and capacity development, developmentplanning centered on HIV/AIDS, and advocacy andcommunication.36 HIV/AIDS has been highlightedrepeatedly by the UNDP Administrator as a corporatepriority and as “an unparalleled crisis.” 37

Working as a co-sponsor of UNAIDS, UNDPestablished a corporate HIV/AIDS strategy that givesparticular attention to creating the policy, legislativeand resource environment essential for effectivedevelopment planning, and for a multisectoralresponse to the AIDS epidemic. The strategy calledupon UNDP to be fully mobilized at the countrylevel to meet its obligations as a UNAIDS co-sponsor.UNDP proposed to make a difference by promotingleadership and developing capacity to respond to theepidemic at all levels, by strengthening developmentplanning and systems to address HIV/AIDS, and bygenerating responses that are gender-sensitive andrespectful of people’s rights. The strategy set out threeservice lines: leadership and capacity development;development planning, implementation and HIV/AIDS responses, including mainstreaming; andadvocacy and communication.38

The 2004 evaluation of the 2nd Global CooperationFramework by the UNDP Evaluation Officedescribed UNDP corporate strategy and service linesas founded on the organization’s strengths, andconsidered them to have provided a solid foundationfor actions to address the epidemic. The report calledfor the strategy to “be expanded globally and scaledup within countries.” However, evidence collected by theevaluation team suggests that, as of late in 2004, mostinterventions remained at limited project and pilotlevels. This is discussed in more detail in Chapter 3.

UNDP’s statement in the UNAIDS 2006-2007UBW presents an expansive vision of UNDP’s rolesand expected results in relation to HIV/AIDS,including: strengthened leadership and capacity ofgovernments, CSOs, development partners,communities and individuals, to respond to AIDS;implementation of AIDS responses as multisectoraland multilevel national, district and communityactions that mainstream AIDS into nationaldevelopment plans, budgets and instruments;reduction of stigma and discrimination; human andinstitutional capacity building for AIDS programmes;and support to the UN Resident Coordinator system.Further insight into UNDP’s vision of its role inHIV/AIDS is contained in the division of labour,specifying core functions of various UN Agencies inthe fight against HIV/AIDS. This was concluded infollow-up on the work of the Global Task Teamestablished early in 2005 under the auspices ofUNAIDS. UNDP was designated as the lead agencyfor ‘HIV/AIDS and development, governance andmainstreaming, including instruments such as PRSPsand enabling legislation to address human rights andgender.’ 39 In addition, UNDP was identified as a“main partner” on 5 of 17 other areas in the agreeddivision of labour. While this effort has reaffirmedthe role of UNDP as the lead agency for AIDS anddevelopment, AIDS-related governance, andHIV/AIDS capacity development, it is unclear to theevaluation team how the many roles specified in theUBW statement could be absorbed within UNDP’sexisting human resource and financial constraints.40

14


34 Goals and sub-goals as cited in ROAR 2001, UNDP, 2002. Availableat www.undp.org

35 UNDP,“Annual Report 2002;” UNDP,“Annual Report 2003.”36 UNDP,“A Time for Bold Ambition—Together We Can Cut Poverty

in Half,” UNDP Annual Report 2005.37 Message of the UNDP Administrator Mark Malloch Brown for

the World AIDS Day, December 1, 2004. World AIDS DayStatement, 2004.

38 UNDP,“Corporate Strategy on HIV/AIDS—Leadership for Results,”no publication date.

39 UNAIDS, “Technical Support Division of Labour, Summary andRationale,” 2005.

40 UNAIDS, “Report of the Global Task Team on Improving AIDSCoordination among Multilateral Institutions and InternationalDonors,” June 2005.

15


At the regional level, UNDP’s second RegionalCooperation Framework (RCF) for Africa 2002-2006, identified the reduction of the HIV/AIDSthreat in Africa as one of five strategic areas.41 Underthe umbrella of a large project providing AIDS-related services in 7 of the 10 countries covered bythis evaluation,42 UNDP has supported fourHIV/AIDS objectives targeted in the RCF. Theseare to: harmonize and strengthen national strategicplans; research, develop and disseminate cross-country methodologies and approaches; strengthencapacities of regional institutions; and build regionalconsensus on strategies for managing the epidemic.

Beyond the RCF, UNDP has initiated cooperationon HIV/AIDS with countries covered by this evaluation under SACI and the ARMADA Project.Covering all of the case-study countries but Angola43

and Ethiopia, SACI endeavors to respond to the threats to African capacity from HIV/AIDS.However, the project is too new for this evaluation tobe able to report outcomes.44 UNDP’s ARMADAProject is even newer than SACI, as the ProjectDocument was only signed in November 2004. TheProject aims to strengthen the capacity of UNDPCOs for financial and procurement managementunder external assistance.

2.3 OVERVIEW OF UNDP’S ROLE AND ACTIVITIES IN THE HIV/AIDS RESPONSE

This section examines the UNDP country cooperationframeworks (CCFs) in the case-study countries,summarizes available data on UNDP activities, andpresents information on UNDP spending on HIV/AIDS projects and programmes.45 The chapterconcludes with a comparative assessment of theurgency accorded to HIV/AIDS in the work of eachof the case-study COs of UNDP.

2.3.1 COUNTRY COOPERATIONFRAMEWORKS, STRATEGIES AND HIV/AIDS PROGRAMMES

The evaluation found it difficult to obtain a clearpicture of UNDP’s country HIV/AIDS strategies,programmes and activities in the case-studycountries. UNDP’s overall CCF documents havegiven increasing attention to HIV/AIDS in the case-study countries, as seen from extracts in Annex 3.Nonetheless, HIV/AIDS in some countries stillseems to be a less-than-central element in the CCFs,when viewed in the light of UNDP’s corporatepriority on HIV/AIDS and, especially, the hugenegative development effects of the disease in nearlyall of the case-study countries. Reviewing the CCFsagainst actual experience at the country level, theevaluation team found that the CCFs often gave alimited idea of what was intended. Planned objectivesand results were very general, with scant definition of‘intermediate’ results. Consequently, the CCFs havenot necessarily been consistent or adequatelycaptured what UNDP has actually planned andexecuted at the country level. For example, in the caseof Lesotho, there has been much more activity, andmany more outcomes, than would be expected evenfrom the revised CCF for 2002-2004.

Beyond the CCFs, which are understood to beformulated at a fairly high degree of generality, theteam examined available overall data on UNDPcountry-level HIV/AIDS programmes (collated inAnnex 4). This material did not include allprogramme components, including cornerstonessuch as the Leadership Development Programmeand Community Conversations. These disconnectsbetween CCF and programme statements, comparedto actual activities, might indicate adaptation,evolution, and flexibility in UNDP’s response.However, they also suggest possible disjunctionsamong the paradigms and strategies of UNDP COs,its Headquarters, and its Regional Centre.

2.3.2 WHAT DID UNDP DO AT THE COUNTRY LEVEL?

Table 2.2 summarizes UNDP’s areas of support and activities at the country level from the countryassessments,46 the country summaries (Annex 6), andthe country visits of evaluation team members. It

41 UN, “Second Regional Cooperation Framework for Africa (2002-2006),” UN document DP/RCF/RBA/2, November 21, 2001.

42 Angola, Malawi and Namibia are the exceptions.43 The Resident Representative in Angola expressed concern that

Angola is not eligible for SACI support.44 The first SACI annual report and the work of this evaluation team

at country level indicate that the SACI activities are only at theinitial stage. Source: UNDP, “Southern Africa Capacity Initiative,First Annual Report, March 2004-March 2005.”

45 Elements of the UNDP response to HIV/AIDS in each case-studycountry are set out in more detail in Annexes 3, 4, and 5. 46 To be published separately.

shows UNDP engaged in a wide range of HIV/AIDS-related activities and roles. However, the tablereveals that UNDP has not been active in each areain each country. It also shows that UNDP is doingwhat it said it would do and supporting what it saidit would support.47 The table does not capture theprominence, depth, or financial commitments ofUNDP in each area, nor does it present the rolesplayed by the UNDP CO beyond financing ofHIV/AIDS activities.48 Thus, it must be consideredindicative rather than exhaustive.

2.3.3 FINANCIAL DATA ON UNDP HIV/AIDSPROJECTS AND PROGRAMMES

In attempting to place UNDP HIV/AIDS activitiesand outcomes at the country level in context, theevaluation team reviewed financial data on theamount and share of programming resources devotedto HIV/AIDS at the country level.49 Obtaining

consistent, timely financial data on UNDP HIV/AIDS projects and programmes in the case-studycountries proved impossible within the resources intime and money allocated to the evaluation. Theevaluation team is concerned that this situation raisesissues of UNDP’s capacity to be accountable and tomanage resources for optimal effect.

To the extent that the evaluation team could gatherrelevant information, UNDP HIV/AIDS projects inthe case-study countries and their planned spendingfor the period 1999-2004 are shown in Annex 5a.50

The grand total of UNDP planned spending onthese projects, from its own resources, is USD 17million, or approximately USD 3 million per year.Cost-sharing resources bring the total to almostUSD 39 million, or approximately USD 6.5 millionper year. Actual spending data on the projects werenot available.

On the basis of reports from the UNDP COs, theevaluation found significant differences among thecase-study countries in the amounts and shares ofHIV/AIDS spending in the total UNDP country

16


TABLE 2. 2 UNDP SUPPORT AND ACTIVITIES IN CASE-STUDY COUNTRIES

Country LDP CC NAC DecentralizedHIV/ AIDSstructures

Policyand

Rights

CSO Knowledgegeneration

Mainstreamingand develop-

ment planning

Work-place

response

Partnershipstructuresand roles

Angola X X X X X X

Botswana X X X X X X X X X

Ethiopia X X X X X X X X X X

Lesotho X X X X X X X X

Malawi X X X X X

Namibia X X X X X X X

South Africa X X X X

Swaziland X X X X X X X X X

Zambia X X X X X X X X

Zimbabwe X X X X X X

Total countries 5 3 9 6 8 6 8 10 8 9

Source: Country assessments and evaluation team country visits.Note: Areas of support are not exclusive. Thus one UNDP country-level activity may actually fall in two areas of support.Abbreviations: LDP—Leadership Development Programme; CC—Community Conversations; NAC—National AIDS Commission/Council;CSO—civil society organization.

47 Beyond answering the question whether UNDP “did the rightthing,”as the evaluation does here, the evaluation was also askedto answer the question whether UNDP “did things right.” Theteam was unable to answer this second question, because itwould require a level of familiarity with UNDP processes andmanagement policies that external consultants could notachieve without undertaking a separate, special study.

48 The non-financial roles of UNDP leaders and CO staff are, however,discussed in this chapter under the appropriate outcome themes.

49 Gathered from UNDP COs and Gateway and Atlas databases.

50 UNDP Headquarters maintains financial data on UNDP projects,in two databases, Gateway and Atlas, covering different periods;these data are not mutually consistent among themselves, norwith data from other sources.

17


programme spending (Table 2.3).51 These datarepresent a reasonable, but imperfect and difficult tointerpret, approximation of the priority accorded toHIV/AIDS in UNDP country programmes. Thesmall levels and shares of UNDP’s spending in somecountries, as reported by the COs, raise questions

about whether actual resource allocation adequatelyreflected UNDP corporate strategy and priority onHIV/AIDS at the country level. The very high sharein other countries suggests that determined leadershipby the UNDP Resident Representative or UN ResidentCoordinator can make a difference.52

It appears that UNDP spending on HIV/AIDSduring the period covered by this evaluation hasincreased overall in absolute terms and fluctuated inshare of the UNDP programmes in the case-studycountries. In seven countries, the level of spendingincreased from 2002 to 2004, and in three countriesit decreased over this period. Similarly, in sixcountries, the share of HIV/AIDS activities in UNDPspending rose from 2002 to 2003, and in fourcountries it declined. From 2003 to 2004, however,

TABLE 2. 3 UNDP SPENDING ON HIV/AIDS IN CASE-STUDY COUNTRIES, 2002-2004

Source: UNDP country offices.Notes: N/A indicates not applicable. 1) All currency is in US dollars, at current exchange rates. 2) For some countries, 2004 spending data are preliminary, not final. 3) Excludes UNDP CO staff and other overhead costs; to this extent it represents a lower bound of UNDP programme spendingon HIV/AIDS. 4) Includes country-specific spending on regional projects, such as the Southern Africa Capacity Initiative, to the extent that it is included in country programme accounts maintained by the country office. 5) Table includes all programme spending on HIV/AIDS, regardless ofsource of funds; thus it includes trust funds. 6) Country programme shares are based on total country programme spending on HIV/AIDS, exceptfor Swaziland, where the programme total used to calculate the share is limited to the poverty reduction and mainstreaming programme and doesnot include expenditure by the governance and gender mainstreaming programme.Thus the average HIV/AIDS share figures should be consideredto represent an upper bound, and could be somewhat lower. 7) Namibia figure represent core resources only. 8) Since the unit of concern is thecountry, average shares are computed by country by weighting population.

Country 2002 HIV/AIDSamount (USD)

2002 HIV/AIDSshare of total

UNDP countryprogramme (%)

2003 HIV/AIDSamount (USD)



2004 HIV/AIDSamount (USD)



Angola 15,541 <1 562,937 7 720,257 7

Botswana 3,085,324 61 3,416,443 57 1,980,693 62

Ethiopia 353,350 3 907,908 9 1,000,628 6

Lesotho 88,676 5 521,406 17 921,738 42

Malawi 309,705 5 689,126 9 885,643 6

Namibia 40,515 5 360,152 22 207,941 9

South Africa 2,875,417 37 2,465,223 36 3,352,447 30

Swaziland 167,135 39 132,135 28 70,914 18

Zambia 1,034,701 37 1,411,313 47 1,529,000 28

Zimbabwe 737,398 11 423,952 6 2,227,026 22

Total 8,707,762 NA 10,890,595 NA 12,896,287 N/A

Average N/A 20 N/A 20 N/A 23

51 Note: Upon review of a draft of this study, the UNDP FinanceOffice reported variances between its data and informationreceived from some COs sufficiently important to take the position that it cannot endorse the expenditure data in thisreport. It observed that the variances would require furtherinvestigation and reconciliation with the COs. The evaluationteam spent many weeks endeavoring to obtain complete andconsistent data from the Finance Office and COs. Since it has notbeen feasible to complete the reconciliation of data during theperiod of this evaluation with the available resources, the evalu-ation team has chosen to rely on the CO data as a reasonableapproximation and to retain the information on planned projectsand spending in Annex 5A as indicative. The UNDP Finance Staffwere able to reconcile Headquarters data with the CO data fromsome but not all of the countries in Table 2.3. The Finance Staffreported that UNDP has taken steps to ensure that financialreporting by substantive area will improve. Project trees havebeen set up in Atlas that capture UNDP’s goals, service lines andcore results.All UNDP projects are to be tied to these trees,allowingbudgetary and expenditure reporting by substantive area.

52 The comprehensive summary in Annex 5B of UNDP’s countryprogramme on HIV/AIDS in Lesotho in the context of its totalcountry programme, is a case in point. If time and availablehuman resources had allowed, this table should have been completed by each CO.

the share increased in only four countries, and itdeclined in six countries. It would be difficult toconclude from these data that—overall—the COs inthe case-study countries gave great urgency toUNDP spending on HIV/AIDS during the periodcovered in this evaluation.53

Table 2.3 indicates that UNDP’s total spending onHIV/AIDS is not large enough to have a significantimpact on the epidemic. This makes strategic use ofits HIV/AIDS resources particularly important.

2.3.4 URGENCY OF HIV/AIDS IN THE WORK OF UNDP COs

Pulling together the wide range of availableplanning, programming and financial information onUNDP’s work on HIV/AIDS through the COs, theevaluation team prepared a comparative assessmentof the urgency accorded to HIV/AIDS in UNDP’swork at the country level. The results (Table 2.4)show modest growth in the urgency accorded toHIV/AIDS in the 10 countries during the periodcovered by the evaluation. Eight COs showed low

urgency, one (Malawi) exhibited medium urgency,and one (Botswana) demonstrated a high level ofurgency to HIV/AIDS early in the period. By theend of the evaluation period, the COs revealingmedium urgency grew to eight and high urgency totwo (Botswana and Lesotho).

2.4 CONCLUSION

There were dramatic increases in global politicalattention to HIV/AIDS during the period covered inthis evaluation, along with significant increases inexternal funding for HIV/AIDS globally and in thecase-study countries. It is not clear how successfulUNDP has been in strategically adapting itsHIV/AIDS responses to the dramatically changingglobal and country-level environment forHIV/AIDS programmes. While UNDP corporatestrategy gives priority to HIV/AIDS, the breadth ofUNDP’s HIV/AIDS-related activities, in relation toits limited human and financial resources, raisesquestions for the evaluation team concerning theadequacy of focus and continuity.

The evaluation team was unable to identifydocumentation that brought together at the countrylevel the various strands of UNDP HIV/AIDS18


TABLE 2. 4 URGENCY ACCORDED TO HIV/AIDS BY UNDP COUNTRY OFFICES, 1999-2004

Source: Judgment of international consultant team, based on Table 2.2 (UNDP spending on HIV/AIDS in case-study countries), Annex 3 (UNDPCountry Cooperation Frameworks in case-study countries), Annex 4 (UNDP HIV/AIDS Programmes in case-study countries), Annex 5a (UNDPHIV/AIDS projects in case-study countries, 1999-2004), and Annex 6 (Country Summaries).* The evaluation team has not assigned years to the columns because of inter-country variation and to avoid creating an impression of unjustified specificity.

Country Earlier in evaluation period* Later in evaluation period*

little medium high little medium high

Angola X X

Botswana X X

Ethiopia X X

Lesotho X X

Malawi X X

Namibia X X

South Africa X X

Swaziland X X

Zambia X X

Zimbabwe X X

Total 8 1 1 0 8 2

53 It should be noted that during the period in question, theamounts of external resources available from other external part-ners of the 10 countries for HIV/AIDS rose greatly, much morethan UNDP’s spending.

19


activities sponsored from UNDP Headquarters, fromthe Regional Centre for Southern Africa, and fromthe COs. There was little evidence of integration ofcorporate, regional and country-level strategies andactivities—this integration is both an importantchallenge and a future opportunity for UNDP.

The priority given by UNDP to HIV/AIDSincreased overall, and especially at Headquarters andregional levels, during the evaluation period. However,this higher priority was much less clear at the countrylevel, from the country-level documentation analyzed in

this chapter.54 In light of the stated corporate priorityfor HIV/AIDS, of the potential synergy betweenresponses to HIV/AIDS and other developmentchallenges, and of the development disaster that thedisease now represents in nearly all of the case-studycountries,55 the evaluation team concluded that HIV/AIDS should receive significantly greater urgencyand prominence in the work of UNDP at the countrylevel, with clearly integrated country-level strategiesand activities and increasingly strategic use of UNDP’slimited resources.56 Urgency should be measuredinter alia by resources in people, time and money.

54 The recently completed UNDP Evaluation Office examination ofgender mainstreaming by UNDP found, similarly, that “thestrength and emphasis of the AIDS programme directed fromNew York did not seem to be matched by work at the countrylevel.” UNDP, “Evaluation of Gender Mainstreaming in UNDP,”January 2006.

55 Angola may be an exception, since HIV/AIDS prevalence is low. InEthiopia, prevalence is also relatively low but translates into alarge absolute burden due to the country’s large population.

56 The urgency given HIV/AIDS by UNDP in the work of its COs is notautonomously determined by the COs,since the UNDP programmeis determined in consultation with the public authorities andpartner governments.

This chapter analyzes key contributions and outcomes of UNDP in theHIV/AIDS response at the country level in the 10 case-study countriesunder the five themes presented in Chapter 1—HIV/AIDS in relation togovernance, leadership, mainstreaming, capacity development, andpartnership coordination. Reviewing the contributions and outcomes bytheme, each section of the chapter begins with a definition of the themefor the purpose of this evaluation. A box summarizes key contributionsand outcomes under the theme. Strategic issues and ongoing challengesrelating to the theme are presented at the end of each section. Countrycases are cited in the text, with examples in boxes to illustrate innovativeapproaches and specific experiences and constraints.

3.1 GOVERNANCE

For the purposes of this evaluation, the governance theme encompassed:n

Strengthening of policy and strategic frameworks that shape andmanage HIV/AIDS responses. These include national HIV/AIDS-related policies, strategies, laws and regulations, and policies andplans that reflect the UNGASS agenda.

n

HIV/AIDS planning, including operational planning and decentral-ized planning.

n

Institutional reform decisions, including changes to National AIDSCouncils/Commissions (NACs) and other fora, and allocation ofresponsibilities.

n

Action on human rights, women and gender dimensions, stigma anddiscrimination, including greater involvement of people living withHIV/AIDS (PLWHA).

n

Public-private partnerships in the fight against HIV/AIDS,including policy and attitude shifts among business, media and policymakers that facilitate these partnerships.

n

Civil society empowerment, inclusion and participation, includingsupport to non-state actors to influence policy and actions, andresponses related to arts and media.

n

Public resource allocation decisions, including allocation of budgetsand human resources. 21


3KEY CONTRIBUTIONS

AND OUTCOMES OFUNDP IN THE HIV/AIDS

RESPONSE AT THECOUNTRY LEVEL

The evaluation team discerned three significantUNDP contributions and outcomes to governance atthe country level. This does not suggest that UNDPwas inactive or ineffective in other areas, only that the results stand out in three specific areas—strengthening national policies and strategic frame-works for managing HIV/AIDS, strengtheningdecentralized HIV/AIDS institutions, and increasingthe presence and voice of CSOs and vulnerablegroups in advocacy and participation.

3.1.1 STRENGTHENING NATIONALHIV/AIDS POLICY AND STRATEGIC FRAMEWORKS

Although there has been substantial inter-countryvariation, UNDP has actively engaged in advocacyand support for sound public policy and strategicframeworks for managing the HIV/AIDS pandemicin Southern Africa and Ethiopia. At the nationallevel, UNDP was often influential, during the periodcovered in this review, in promoting development ofpolicies and plans related to HIV/AIDS. UNDPcontributed to developing or refining nationalHIV/AIDS strategic planning frameworks inBotswana, Ethiopia, Lesotho, Malawi, Namibia,Swaziland, and Zimbabwe. While the extent of

UNDP influence and the final results of UNDP’sinvolvement were difficult to discern, the evaluationteam concludes that they have led to increasingsoundness and coherence in national responses to thepandemic in case-study countries.57

UNDP’s signal accomplishment, revealed in thecountry case studies and the evaluation team’s visits,lies in moving HIV/AIDS paradigms from biomedicalperspectives towards development perspectives. Thiswas the case in all case-study countries except SouthAfrica. While this shift was part of a global change,UNDP was considered by many informants to havebeen instrumental in successfully advocating for thisparadigm shift within countries and for institutionalizingthis shift in development planning and management.Support at the country level in systematicallypromoting the shift has been significant. It hasencompassed a mix of interventions, includingimpact studies, situation analyses, start-up of newinstitutions such as the NACs, planning support tomake these institutions functional, and actions of COleaders and staff. In part due to UNDP involvement,the evaluation team found AIDS strategies in thecase-study countries to be relatively less health-sectorfocused than prior to UNDP involvement and to givemore emphasis to decentralized systems to manageand coordinate national HIV/AIDS responses.

UNDP contributions seem to be limited in the areasof legislative and regulatory change. The slow paceof associated national processes was cited as anexplanation for delays in Namibia and Ethiopia.

In each of the case-study countries, except forAngola and South Africa, UNDP is reported to havebeen instrumental in helping orient developmentpolicy and planning towards the UNGASS agenda.This may have led to increased government focus on AIDS-related donor policy and planning, butthere were minimal indications as to how far suchinitiatives have led to changes in country prioritiesand practice, or contributed to accelerating progresstowards targets.

Reforming public sector institutions for coordinatingpolicy and managing resources has been a crucial aspectof UNDP’s governance support in relation toHIV/AIDS. UNDP contributions across allcountries under review, except South Africa, have

22

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIACHAPTER 3. KEY CONTRIBUTIONS AND OUTCOMES OF UNDP IN THE HIV/AIDS RESPONSE AT THE COUNTRY LEVEL

UNDP has contributed substantially to three outcomesrelated to HIV/AIDS governance:

n

Strengthening policies and strategic frameworksfor managing national responses to HIV/AIDS.

n

Strengthening decentralized HIV/AIDS planning.

n

Increasing the presence and voice of civil societyorganizations and vulnerable groups, includingPLWHA and women, by advocating for their rightsand facilitating their participation. Empowermentof women was noted as a prominent contributionin communities targeted by UNDP’s CommunityConversations.

Governance issues in relation to HIV/AIDS remain agreat challenge. Despite support from UNDP andother partners, AIDS policies and institutions remainweak and, in some cases, relatively ineffective. UNDPhas not fully exploited its strong relationships withgovernments, and many opportunities exist to helpto strengthen governance, particularly at decentralizedlevels, in relation to gender issues and in facilitatingdevelopment of civil society and community involve-ment in HIV/AIDS governance.

BOX 3.1 KEY CONTRIBUTIONS AND OUTCOMES OF UNDP IN HIV/AIDS GOVERNANCE

57 The evaluation team does not suggest that relevant nationalpolicies and institutions are entirely sound and coherent, onlythat UNDP has contributed to greater soundness and coherencethan would otherwise be the case.

23


helped facilitate the establishment of new nationalmechanisms for coordinating multisectoralHIV/AIDS responses. These mechanisms generallyhave a similar governance character. Typically there isa NAC chaired by a senior politician or public figure.It usually consists of representatives of key institu-tions and sectors—government, private sector, andcivil society. There is also a Secretariat managed byprofessionals, sometimes located within the Ministryof Health and sometimes under a higher cabinet leveloffice or the Presidency.

These UNDP-supported institutional reforms haveresulted in the establishment of platforms for

multisectoral and development-oriented HIV/AIDSplanning at the highest levels of government.However, these institutions are still evolving. Criticalgovernance challenges remain, as NACs have oftenhad difficulty establishing their roles, authority andcapacity, and are sometimes seen as donor-driven. Inmany cases, including Botswana and Zambia,technical assistance and other support from UNDPhave helped to address such problems and consoli-date change, but the effectiveness of NACs remainsproblematic in many of the study countries.58

In Zimbabwe, UNDP has contributedsubstantially to maintaining sup-portive HIV/AIDS governance underchallenging circumstances.

The national HIV/AIDS responseduring the period under review has been undermined by a drasticdeterioration in the economy,political conflict, a ‘brain drain’ ofskilled personnel, and reduction of support by a number of devel-opment partners. In this environ-ment, UNDP has had a prominentrole in interactions with the gov-ernment and other stakeholders inHIV/AIDS. UNDP has used upstreampolicy advocacy and capacitydevelopment to strengthen nationaland local governance institutionsto effectively coordinate a multi-sectoral and multilevel response to HIV/AIDS.This has contributed toa more supportive governanceenvironment related to HIV/AIDSthan would otherwise have beenexpected.

At the national level, UNDP supportplayed a critical role in maintainingHIV/AIDS programme sustainability.Contributions included supportingthe NAC’s ability to plan and imple-ment the national multisectoraland multilevel response, includingdevelopment of functional admin-istrative and financial systems. Animportant contribution of UNDP wasalso advocacy to parliamentarians,which facilitated the establishment

of the National AIDS Levy,a 3 percentpayroll tax. The Levy has providedsome resources to maintain thenational response. Further, UNDPwas appointed as Principal Recipientof Zimbabwe’s Global Fund Round1 grant. The grant provides accessto resources that many feelZimbabwe could not have securedwithout UNDP.

Further contributions to a supportiveHIV/AIDS environment includeUNDP’s critical role in enablinggovernment ministries to developpolicies, plans and capacity throughappointment of focal persons andtask forces. In addition,UNDP helpedto mainstream HIV/AIDS into keydevelopment policies through support to the national MDG taskforce, developing the influentialZimbabwe Human DevelopmentReport 2003 ‘Redirecting ourResponses to HIV/AIDS TowardsReducing Vulnerability—The UltimateWar for Survival’, and backstoppingthe macroeconomic frameworkdevelopment process.

At the decentralized level, UNDPplayed a key role in contributing toenhanced capacity of sub-nationalHIV/AIDS structures at provincial,district, ward and village levels. Amajor input was the deployment ofnational UN Volunteers (UNVs) to10 provincial offices. They workedclosely with provincial administratorsand were the driving force behind

the provincial planning and imple-mentation processes that encom-passed both the provincial and the village level. UNDP also helpedto implement participatory plan-ning, starting from the communitylevel and moving upwards, thatincorporates the views of variousstakeholders at each level. This produced a five-year NationalStrategic Plan as well as strategicand annual plans for every districtand province.

Despite these UNDP contributions,Zimbabwe’s capacity, resources andsystems remained too limited toplan and implement an adequateHIV/AIDS response. Many struc-tures from the national to the locallevel functioned poorly. Obstaclesperceived during the evaluationincluded prevailing macroeconomicconditions; limited effectiveness ofnational and sub-national structuresin articulating and carrying outtheir coordination roles; location ofthe NAC within the Health Ministry,which predisposed policy to medicalapproaches; the NAC’s limited ability to retain key staff; and limited coordination with civil society groups active in HIV/AIDS.Regular, critical review of UNDPstrategy will be required to ensurethat UNDP contributes optimally to meeting Zimbabwe’s HIV/AIDS-related needs under suchchallenging circumstances.

BOX 3.2 ZIMBABWE: MAINTAINING SUPPORTIVE HIV/AIDS GOVERNANCE UNDER CHALLENGING CONDITIONS

58 Detailed assessment of NAC effectiveness was beyond the scopeof the evaluation but would be worth pursuing in light of UNDP’swidespread support for NACs.

In Botswana, Ethiopia, Lesotho, Swaziland, Zambia,and Zimbabwe, UNDP has helped influencedecisions by Ministries of Finance and other sectorsto allocate percentages of line ministry budgets toHIV/AIDS. However, it is not clear how successfulsuch budget interventions have been. There wereindications that funds have been insufficient to meetneeds and were often used ineffectively. Nonetheless,budget work is an important area for the future, incooperation with other partners and especially wherethe international financial institutions are not engaged.

3.1.2 STRENGTHENING DECENTRALIZEDPLANNING FOR AN EFFECTIVEHIV/AIDS RESPONSE

National AIDS coordinating structures often havedecentralized equivalents at all levels of governance—provincial, district and, in some cases, community.Progress in establishing sub-national AIDS planning

and structures has been unsystematic. At the time of theevaluation, many were either dormant or functioningsub-optimally. UNDP has made important contributionsto addressing these problems.

In Botswana, some success was achieved in decentral-ized HIV/AIDS planning through support to DistrictMultisectoral AIDS Committees (DMSACs) (seeBox 3.3). In Zambia, UNDP deployed nationalUNVs within District Commissioners’ Offices andprovided other support to facilitate the HIV/AIDSresponses of District Development CoordinatingCommittees (DDCCs) and District AIDS TaskForces (DATFs). The evaluation found that AIDS-related planning and coordination infrastructure wasbeing better integrated into district developmentefforts. In turn, greater functionality of DATFs hasenhanced citizen demands for HIV/AIDS servicesand rights in district work plans and improvedfinancial resource flow to support HIV/AIDS

24

EVALUATIONOF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIA

CHAPTER 3. KEY CONTRIBUTIONS AND OUTCOMES OF UNDP IN THE HIV/AIDS RESPONSE AT THE COUNTRY LEVEL

In Botswana, UNDP has contributedgreatly to development of HIV/AIDSgovernance since the late 1990s.

Initially, UNDP supported the AIDS/STD Unit in the Ministry of Health,which at that time drove thenational response to HIV/AIDS.UNDP had a key role in helping to redefine institutions and todevelop a more participatory,decentralized approach to themanagement and implementationof the national response.

UNDP advocacy and support contributed substantially to estab-lishing and strengthening Botswana’sNAC, National AIDS CoordinatingAgency (NACA), Department Com-mittees and more decentralizedstructures and support groups.UNDP advocacy contributed to thePresident’s decision to chair andprovide leadership in the NAC. Theauthority of HIV/AIDS structureshas also been enhanced by situatingNACA in the Office of the StatePresident, elevating the NACANational Coordinator’s position toPermanent Secretary level, andappointing District Commissionersor Council Secretaries as the Co-

Chairs of DMSAC. UNDP also sup-ported processes to develop andrefine the National Policy on HIV/AIDS and the National StrategicFramework, which provide guide-lines on the roles and responsibili-ties of these institutions.

At the district and communitylevel, DMSACs and Village AIDSCommittees facilitate coordinationand implementation of HIV/AIDSinterventions. UNDP providedtechnical support to 10 districts(later expanded to 16) to establishDMSACs and to develop districtbased HIV/AIDS interventions.UNDP placed a UNV in each of thedistricts, and provided finance,training and technical assistancethrough the AIDS/STD Unit of theMinistry of Health to strengthendecentralization. Funds were alsoused to support the formation ofCommunity Home Based Care andPLWHA support groups. Severaldistricts were assisted by UNDPand SIDA to conduct situation andresponse analysis and to developstrategic plans. District AIDSCoordinators have been appointedto coordinate district level HIV/AIDS

programmes. In some districts, theyhave taken on roles previously heldby UNVs.

A key role that UNDP played throughtraining,workshops and other meansof information dissemination waschanging the perception of policyand programme leaders of HIV/AIDS as only a health issue, not adevelopment issue.

At the time of the evaluation, therewas still lack of clarity on the insti-tutions’ roles and responsibilities,and effective functioning of manycomponents of the AIDS-relatedgovernance system was an ongoingchallenge. However, overall, UNDPsupport resulted in improved coordi-nation and community mobilization,along with greater involvement ofcivil society organizations, localauthorities and private sector insti-tutions in decisions and policymaking at each level. Ownership ofinterventions was gradually movingto the communities, and PLWHAwere increasingly assuming leader-ship roles in programmes at nationaland community level.

BOX 3.3 BOTSWANA: STRENGTHENING HIV/AIDS GOVERNANCE AT NATIONAL AND DECENTRALIZED LEVELS

25


projects at the community levels. When asked aboutthe nature of communities’ relationships with theDistrict Council in rural Zambia, a womancommunity leader pointed to a Zambian UNV astheir link to the District, demonstrating how key theUNV is within the District governance structure.Nevertheless, effective planning and implementationhave been hampered by limited linkages of theseinstitutions to the local government system,including formalization of accountability andauthority. This is either a missed or emergingopportunity for UNDP to use its governance experi-ence to address such problems.

The experience of UNDP support for CommunityConversations (CC) in Limpopo Province, SouthAfrica is another example of ways to increase supportfor community-driven systems and responsibility forHIV/AIDS accountability. CC brought localgovernment officials to interact with communityleaders around issues of municipal services for thepoor and the marginalized. These interventionsresulted in communities holding dialogues anddeveloping action plans to address their ownHIV/AIDS problems.

3.1.3 INCREASING THE VOICE OF CIVILSOCIETY AND VULNERABLE GROUPSIN THE HIV/AIDS RESPONSE

Increasing inclusion of PLWHA and their rights inHIV/AIDS policy and planning processes is anoutcome of UNDP engagement. While there hasbeen substantial variation among case-study countries,in each of the countries, there was some evidence of increased recognition of the rights, roles, andcontributions of PLWHA in HIV/AIDS governance.In many cases, UNDP has been strengtheningHIV/AIDS governance through advocacy andprogrammes for greater involvement of people livingwith HIV/AIDS (GIPA), helping to establish andsupport PLWHA organizations, media interventionsto reduce stigma and discrimination, and interfaceswith government for policy and planning inputs. InSouth Africa, UNDP supported GIPA programmesfor both the public and the private sector, whichcontributed to reduced stigma and discrimination inthe workplace while simultaneously providingincome to PLWHA.

In Zambia, UNDP support to the Zambian Networkof People Living with HIV/AIDS (ZNP+) and

recruitment of PLWHA as part of the District AIDSPlanning Task Forces helped enhance PLWHA rolesand visibility and inputs into plans and programmes.Support for other vulnerable groups has also been enhanced. Also, in Zambia, support for non-governmental organizations (NGOs) has increasedeffective advocacy and recognition of rights forworkers and orphans and children affected byHIV/AIDS. In targeted communities in Ethiopia,CC has led to increased involvement, organizationand community support of PLWHA.

The evaluation team found that the inclusion andparticipation of CSOs in HIV/AIDS governance hasalso improved, but the extent varied among the case-study countries, as has the role and contributions ofUNDP. Participation and resolution of tensions inrelations with government have not always beencomprehensive. Examples were cited particularly inZimbabwe, but also in Ethiopia and Swaziland. Yet,the increased advocacy of CSOs and their interactionwith other governance institutions at the national level,including NACs and parliaments, have contributedto greater openness and plurality of debate about thedirection and content of national responses.

Below the national level, good practices are emergingfrom UNDP pilot projects that enhance communityvoice in demanding services and respect for rights. TheCCs have initiated dialogue on governance at thecommunity level and raised the potential forsustained citizen demand of services and rights.However, these initiatives tended to be highlylocalized. Their impacts at the country level wereminimal at the time of the evaluation. Moreover,the capacity of the government to facilitate andsystematically respond to these demands and realizerights was often low and not specifically a subject ofUNDP support. Although a minority view, somegovernment officials in Zambia complained thatmore support was being provided to civil society thanto the public sector.

A focus on gender issues and involvement andempowerment of women in combating HIV/AIDSwas reinforced as a key theme of the UN and UNDPduring the period covered by this review. Gendermight be a specific area in which UNDP has acomparative advantage. In Ethiopia, Swaziland, andSouth Africa, empowerment of women was aprominent outcome in communities targeted by CC.In Ethiopia, the method led to open discussion and

signs of actual change around entrenched communitynorms such as female genital mutilation. In Botswanaand Ethiopia, specific initiatives have systematicallyenhanced gender mainstreaming into HIV/AIDSprogrammes including formation of women’s organi-zations and coalitions to lead HIV/AIDS responses,and strengthening of government ministries toaddress gender in HIV/AIDS responses. Similarly,in Namibia, UNDP advocacy led to increasedrepresentation of women as leaders. Women havebeen appointed regional AIDS coordinators andhead most community-based organizations.

UNDP advocacy, research, human developmentreports and training were specifically noted to haveresulted in greater inclusion of gender issues inHIV/AIDS responses in Botswana, Lesotho andSwaziland. Specific activities or outcomes in relationto gender were mentioned in half of the case-studycountries. However, it was difficult to establishoverall that UNDP programmes had achievedchange in gender-related issues concerningHIV/AIDS on a significant scale. In Botswana andZimbabwe, gender was mentioned as a specific areain which UNDP had missed opportunities to usegender to strengthen HIV/AIDS responses.

3.1.4 STRATEGIC ISSUES AND ONGOING CHALLENGES

UNDP has helped to stimulate paradigm shifts andgreater commitment of governments and theirpartners to developing sound processes, structures,policies and strategies that shape national responsesto HIV/AIDS. However, the quality, effectivenessand sustainability of these shifts were mixed. Thereare ongoing challenges to enhance roles andperformance of NACs and decentralized structuresand participation of key stakeholders, includingvulnerable groups. In addition, the quality of strate-gies in the case-study countries could be improved,and operational plans to translate these strategiesinto action were not well developed.59 Further effortson gender and HIV/AIDS are clearly needed—a

finding consistent with the recent evaluation ofgender mainstreaming in UNDP.60

Overall, there is a large ‘delivery gap’ in translatinggovernance contributions into actions that mitigateand eventually reduce the incidence and impacts ofthe HIV/AIDS pandemic. Leveraging policy andstrategic change has been easier in words than in action.One opportunity that seems to have been under-used isUNDP’s generally strong relationship with governments.While UNDP’s reputation for strong links withgovernment looms large, its influence on HIV/AIDSgovernance decisions was mixed. More emphasiscould have been placed on leveraging this influence.

UNDP has the potential to make important contribu-tions in a number of areas of governance. Particularlyinteresting planning innovations have been developedat decentralized levels, where other donor activity was

26


59 For recent views on NACs and HIV/AIDS planning see the followingsources: Putzel J, “The Global Fight Against AIDS: How Adequateare National Commissions?,”Journal of International Development,2004, 16:1129-1140; Mackay B,“Putting the ‘Three Ones’ to Work:National AIDS Commissions,” Futures Group Briefing, February2005; Mullen P, “Review of National HIV/AIDS Strategies forCountries Participating in the World Bank's Africa Multi-CountryAIDS Programme (MAP),” (A Background Paper for the WorldBank Operational Evaluation Department evaluation of WorldBank AIDS assistance), September 25, 2003.

UNDP has achieved results in strengthening HIV/AIDS-related leadership through the UNDP COs,through programmatic interventions building leader-ship among politicians and government officials atvarious levels, among community and civil societybodies, and among some private sector entities.There are many inspiring examples of leadership‘breakthroughs’ in the case-study countries. However,at the time of the evaluation, it was uncertainwhether UNDP interventions, including the LeadershipDevelopment Programme (LDP), have achieved ascale and depth of leadership development that has,or could achieve,outcomes that represent substantial,efficient responses to leadership needs. Thereremains a great need to enhance HIV/AIDS-relatedleadership in the case-study countries.

More in-depth monitoring and evaluation of UNDPleadership initiatives is desirable to ensure thatstrong interventions receive adequate support andfunding, to review interventions if needed, and toensure support to interventions that represent trueareas of comparative advantage for UNDP in relationto its other HIV/AIDS work. In addition, in refiningapproaches to leadership development, use ofindividualistic leadership paradigms may need to becomplemented by greater emphasis on collectiveparadigms. The approach of pooling leaders fromvarious sectors together in LDP training sessions is astart. More sustained follow-up to assist and supportthese clusters of leaders in functioning is required.

BOX 3.4 KEY CONTRIBUTIONS AND OUTCOMES OF UNDP IN HIV/AIDS LEADERSHIP

60 UNDP, “Evaluation of Gender Mainstreaming in UNDP,”January 2006.

27


limited. Many other development partners havebecome involved in strengthening national HIV/AIDSstructures and governance, often with larger financialand human resources. Therefore, UNDP will need tobe increasingly strategic in providing further supportin HIV/AIDS governance.

3.2 LEADERSHIP

The evaluation understood HIV/AIDS leadership to cover:n

Leadership by the UNDP CO that galvanizesnational leadership into action.

n

Political and government officials’ leadership atvarious levels.

n

Private sector leadership.n

Community and civil society leadership.

In each of these areas, the evaluation sought evidenceof demonstrated exercise of leadership, includingleadership in commitment, support and/or advocacy,HIV/AIDS programmes or activities, planning andmainstreaming, and non-hierarchical leadership. Ingeneral, leadership results were extremely difficult to measure.

3.2.1 LEADERSHIP FROM THE COUNTRY OFFICE

The type of UNDP leadership on HIV/AIDS at thecountry level affected the national response in avariety of ways. Individuals can make an integraldifference in crisis situations and responses. Theleadership facilitation role of the Lesotho UNDPResident Coordinator and CO was a strikingexample of supporting a major shift from inertia toaction, and the transformation of policies and institu-tions to govern the national response for HIV/AIDS.Each crisis presents an opportunity to contribute.This can yield large dividends by supporting govern-ments to seek and implement innovative approachesto respond to the great development challengesposed by HIV/AIDS.

In Angola, Botswana, Ethiopia, Lesotho, Malawiand Swaziland, the UNDP CO played a notable rolein providing or facilitating leadership to strengthenthe national or UN family response to HIV/AIDS.Most prominent leadership has been through theactions of the Resident Representative in countriessuch as Ethiopia, Lesotho, and Malawi. But UNDP

focal points and programme personnel also playedimportant roles in some countries, such as Angola.Turnover of key staff in countries such as Angola andEthiopia disrupted UNDP’s ability to sustain strongleadership roles in the donor community and its ownresponse to the epidemic.

3.2.2 LEADERSHIP DEVELOPMENT WITHINGOVERNMENT, CIVIL SOCIETY AND THE PRIVATE SECTOR

At the most basic level, all UNDP COs have raisedawareness among leaders in government, civil societyand the private sector, about the imperatives forconcerted actions on HIV/AIDS. The instrumentsfor creating awareness have varied, includingseminars, direct consultations, and institutionalsupport for leaders to interact with partners at thenational and international levels and share experi-ences that inform policies. Through the UNDPLeadership for Development Results (LDR) trainingsessions in Ethiopia and other countries, a process ofawareness building was initiated, where participantswere provided analytical and experiential learning tools.The expectation was that they would use the tools totransform their own decision-making and influencetheir organizations in a way that would deepen theirengagement in the national response for HIV/AIDS.

There were indications that UNDP facilitatedstronger leadership among national level politiciansand officials in Botswana, Ethiopia, Lesotho, Malawi,Swaziland, and Zimbabwe. Unfortunately, the scaleand depth of this were often difficult to determine. Insome countries, it was clearly difficult to influencenational level leadership, as in the case of SouthAfrica, where UNDP’s collaborative arrangementswith government restricted UNDP leadershipinfluence to the district level.

LDP, other training, advocacy and support fororganizations have also targeted leadership in lowerlevels of government, faith-based organizations, civilsociety, the private sector, traditional structures andcommunities. In Botswana, Ethiopia, Lesotho, Malawi,Swaziland and South Africa, these interventionsseem to have positively affected leadership inimportant target groups.

Many examples of striking changes in leadership andresulting actions arose from the LDP in this evaluationand more detailed assessments in Botswana, Lesotho,

South Africa, and Swaziland. In addition, inEthiopia in particular, the evaluation found substan-tial demand from stakeholders to extend the LDPmethodology, including requests to extend leadershiptraining methodologies into general civil servicetraining. This suggests that changes have undoubt-edly occurred as a result of the LDP. In addition,regional capacity has now been developed to conductfurther leadership training.

While, in some countries, substantial numbers ofpeople participated in leadership training and haveattested to its value in invigorating their commitmentto HIV/AIDS, it was difficult to assess whetherleadership ‘breakthroughs’ will have a broad impact.There is concern about possible effects of the loss ofLDP “graduates” from ongoing involvement inHIV/AIDS activities, and about the need toreinforce gains through follow-up mechanisms suchas alumni groups.

The financial resources allocated for LDP were animportant influence on the scale of outcomes. Impactof leadership development in Botswana was greatlyenhanced by supplemental government funding forthe programme. Such synergies might be needed togive greater impetus to the innovations beingintroduced and to reinforce the national responsebeyond UNDP-managed pilots.


There is a clear need to enhance leadership onHIV/AIDS in many sectors and at many levels in thecase-study countries. UNDP interventions canenhance such leadership. Some UNDP COs havedemonstrated strong leadership, but others havemissed opportunities.

Recent assessments of LDP are encouraging, andthere are many examples of leadership arising from 28


In Namibia, beyond an active roleat the national level, UNDP has con-tributed leadership in advocacy forprivate sector engagement on HIV/AIDS and for involvement of women.

Namibia set the tone for leadershipin AIDS advocacy by playing impor-tant roles in elaboration of the UNMillennium Declaration.The Presidentand Prime Minister of Namibia servedas co-chairs of the MillenniumSummit and UN General Assembly.The UNDP CO used its position aschair of the UN Theme Group onHIV/AIDS to manage a consultativeand multisectoral approach for thepreparation of Namibia’s HIV/AIDSMedium Term Plan III,while ensuringthat the objectives of the MDGs,National Development Plan II andVision 2030 were synchronized tomeet national development goals.In addition, UNDP led the cam-paign that resulted in the decisionto appoint focal persons for HIV/AIDS in all government ministries.NGOs and other private sectororganizations were expected to follow suit.

UNDP grant support to the privatesector,through the National Business

Coalition on HIV/AIDS (NABCOA)contributed to the mobilization ofthe private sector on AIDS issues.NABCOA has assisted firms in creatingawareness by training employeesto develop and distribute toolkits.The toolkits were used to generateadditional funds to scale up theprogramme. The programme wasreplicated at the municipal level bythe Alliance of Mayors Initiative forCommunity Action on AIDS at theLocal Level (AMICALL). Municipalofficials were able to create aware-ness, conduct research, carry outoutreach programmes, and to provide home-based care in theircommunities.

UNDP’s campaign and advocacyfor the rights and empowerment of women has resulted in moreinvolvement of women in AIDSadvocacy. More women have been appointed Regional AIDSCoordinators and head most community-based organizations.They are widely consulted to provide direction to their commu-nities on AIDS activities.

The contributions and particularlythe outcomes of the UNDP CO on

HIV/AIDS have been limited by the duration of its involvement inHIV/AIDS programming in thecountry. AIDS only became a highpriority during the second CCF for 2002-2005. The establishmentand staffing of the HIV/AIDS Unitwas only accomplished in 2003.Implementation of activities waslimited to several years at the timeof the evaluation. In addition, theprogramme has been beset withstaff shortages. The plan to hire1,800 UNVs to build capacity, someof them earmarked for HIV/AIDS,had not materialized when thecountry assessment was prepared.Only 18 UNVs were hired. It wastherefore difficult to meet some ofthe programme goals. UNDP hasalso missed some opportunities.UNDP’s advocacy on the rights ofthe poor and vulnerable groupshas not been translated intoHIV/AIDS action in the case of its support to public-private partnerships for the urban poor.A UNDP programme to increasebasic environmental services to the urban poor failed to integrateHIV/AIDS.

BOX 3.5 NAMIBIA: LEADERSHIP IN ADVOCACY FOR PRIVATE SECTOR AND GENDER EMPOWERMENT

29


the programme, including the application of selectivetargeting to enhance the capacity of women inLesotho.61 However, from the information availableto the evaluation team, it was difficult to assess thedepth, breadth, and sustainability of the leadershipcreated by these programmes. While remarkableresults are reported, the current and potential impactof the overall leadership interventions remainsuncertain. Results were reported as ‘breakthroughs’and reach was extrapolated to include ‘potential cycleof influence.’ This language may mask limitedoutcomes and sustainability of pilot initiatives.Further assessment of LDP outcomes is needed toensure that strong interventions receive adequatesupport, to enhance effectiveness, and to ensure thatLDP becomes an area of comparative advantage forUNDP in the HIV/AIDS response and for individ-ual country programmes, or are shifted to otheragencies better placed to achieve large scale results.

Currently, an ‘individualistic’ paradigm of ‘the leader’ underpins the notion of leadership and itsdevelopment in many UNDP CO strategies. TheLDP can contribute in this area. The profoundchallenges posed by the HIV/AIDS pandemic may,however, need to be complemented by a more cultur-ally defined notion of leadership, which goes beyondthe individual to “clusters of leaders.” AcrossSouthern Africa, community-based organizationsneed to be animated to emerge and confront thepandemic. Traditional healers, known and respectedfor their wisdom and skills in divination, counselingand care are charismatic as individuals, but need to beorganized and mobilized to share the common valuesand knowledge that bind them.62 There is a search forleadership in government, at central, provincial andmunicipal levels, but there is limited emphasis onleadership across government and between govern-ment and civil society. Where notions of leadershipand its development have transcended the individualto the organizational level, there have been signifi-cant shifts in the emergence of a more robust andsystematic approach to addressing responses toHIV/AIDS, as illustrated in Box 3.6.

3.3 MAINSTREAMING OF HIV/AIDS

For the purposes of the evaluation, mainstreamingencompassed:n

Acceptance of the development and multisec-toral nature of the epidemic.

n

Inclusion of HIV/AIDS activities—beyond theHIV/AIDS ‘sector’—in policies, plans andaction relating to poverty reduction, food security

61 Development Works, “Documenting the LDP in Lesotho,” March2005 (draft); Pretorius J, Poppleton B,“Documenting L4R Results,”October 2004; Caplan G, “Towards a UNDP CO of the Future—Lessons from Lesotho,” November 10, 2004 (processed, report forthe UNDP CO).

62 These were derived from conclusions of a focus group discussionamong participants in the LDR programme in Limpopo Province,South Africa, February 26, 2005.

In Malawi, UNDP supported the NGO Salima AIDSSupport Organization (SASO) as it moved away fromreliance on leadership by an individual towardseffective and more sustainable leadership by theorganization as a whole.

In 1994, Catherine Phiri, a nurse who was infected byHIV/AIDS started a small support network, SASO,to raise HIV/AIDS awareness and mitigate the impactof the disease in a remote district in Malawi whereher town, Salima, is located. Organizing a network ofvolunteers, SASO initiated a series of programmesthat included: home-based care; linked orphan careto the traditional system of extended families; andinitiated, for the first time, outreach activities thatconfronted ignorance and prejudice in society byraising awareness, and advocated behavioral change,especially among the youth.

The charismatic leadership of Catherine attractedattention worldwide. She won the ‘Race againstPoverty Award’ in 2002. In a bid to support andinstitutionalize this leadership, UNDP helped SASOdevelop systems for managing its finances andincreasing volunteers and personnel. However, thesupport needed at the time appeared to have beendifferent—the community needed to develop moreleaders, and, according to one of the leaders, to be“known, seen and counted.” Having an efficientinstitution with financial and administrative systemswas not the priority. However, the combination ofbroadening the leadership base and strengtheningthe organization meant that, at the time of theevaluation, long after Catherine Phiri’s passing, SASOwas a haven for community leaders committed tofighting HIV/AIDS and included 66 volunteersworking in the service centre at Salima, more than2,000 volunteers within villages, and 50 home-basedcare givers. After expanding and consolidating itsleadership, by the time of the evaluation, SASO hadcredibility to negotiate with the District authoritiesand delivered badly needed services to thecommunities, which the District AIDS CoordinatingCommittee (DACC) had no capacity to deliver.

BOX 3.6 MALAWI: FROM INDIVIDUAL TO ORGANIZATIONAL LEADERSHIP

and, more generally, national development.n

Enhanced roles of non-governmental partners.n

Integration of HIV/AIDS into other country-level UNDP programmes and activities.

n

HIV/AIDS workplace programmes in publicand private sector bodies.

Mainstreaming is defined by UNAIDS as a process.63

The term is also frequently used to refer to thecontents of activities aimed at integrating HIV/AIDS issues across a wider spectrum of developmentactivity, beyond the HIV/AIDS sector. In the presentdiscussion, the idea of mainstreaming is used in thiswider sense, as both process and result.

The evaluation found positive contributions andoutcomes to mainstreaming, as well as missedopportunities, as discussed below.

3.3.1 ACCEPTING HIV/AIDS AS A DEVELOPMENT AND MULTISECTORAL ISSUE

By increasing awareness and knowledge at the inter-national and national levels, UNDP has facilitatedthe acceptance of HIV/AIDS as a development andmultisectoral issue. This leads to recognition of theneed for mainstreaming. One informant in Zambiaremarked, “I am a doctor. Working with UNDP [onHIV/AIDS] has led to a complete shift in me from amedical to a development perspective.” This mayseem a limited outcome at this stage in the pandemic,however, persistence of limited awareness, only basicknowledge, and minimal acceptance at national andlower levels was noted in several countries. Thus,reinforcement of this acceptance remains a validobjective in many countries.

In Angola, Botswana, Ethiopia, Lesotho, Malawi,and Swaziland, UNDP roles and contributions inincreasing acceptance were substantial. Some of theearliest outcomes in this area were achieved throughUNDP contributions in Botswana. Advocacy andimpact studies helped to shift the national responsefrom a health focus towards a multisectoral andmultilevel participatory approach to HIV/AIDS.Marked changes have also occurred in Lesotho.Here, UNDP has been influential in the internalizationof HIV/AIDS as a cross cutting human developmentissue, with the formal adoption of a multisectoralapproach by government. In Swaziland, advocacy,policy support and impact studies supported byUNDP were important contributors to the broaderunderstanding and acceptance of the epidemic.

Mainstreaming was hardly recognized as an issue inEthiopia prior to 2003. UNDP’s subsequentmainstreaming initiative helped to place it on theagenda of the government, sectoral agencies, anddonors. UNDP action led to the formation of aMainstreaming Task Force with multisectoralrepresentation. In Malawi, UNDP involvement indeveloping national strategic frameworks andstructures was important in effecting a qualitativeshift from a biomedical to a multisectoral approach.

However, in Zimbabwe, UNDP missed opportunitiesto promote development and mainstreamingagendas, and in Zambia, it was not clear whetherchanges could be attributed to UNDP.30


UNDP has contributed to:

n

Acceptance of the multisectoral nature of theepidemic and of the need for mainstreaming.

n

Some degree of inclusion of HIV/AIDS in policies,plans and action in government responses beyondthe HIV/AIDS sector.

n

Enhancement of the roles of non-governmentalpartners in multisectoral responses.

n

Emergence of workplace programmes in UN COs,and in public and private sector entities.

Despite the initiatives of UNDP and its partners,integration of HIV/AIDS issues into broader develop-ment programmes, projects and strategies was still at an early stage in most case-study countries,especially in key areas such as poverty reduction.The very limited mainstreaming into other UNDPprogrammes and activities found by the evaluation isa particular concern. It suggests limited ownership ofthe HIV/AIDS agenda among UNDP CO staff beyondthose immediately responsible for HIV/AIDS.

A review of UNDP work on mainstreaming is needed.This should provide a solid, evidence-based analyticframework for UNDP country mainstreaming strategiesto ensure that UNDP can meet the challenges oftranslating awareness of mainstreaming intoeffective strategies for implementation and intoaction in the field. Key issues include possibletargeting of areas where mainstreaming is mostcrucial or likely to succeed, UNDP’s own capacityrequirements to support its mainstreaming role, andclearer definition of where UNDP’s comparativeadvantages lie in this area.

BOX 3.7 KEY CONTRIBUTIONS AND OUTCOMES OF UNDP ON HIV/AIDS MAINSTREAMING

63 UNAIDS, UNDP, and World Bank, ”Mainstreaming AIDS inDevelopment Instruments and Processes at the National Level –A Review of Experiences,” September 2005.

31


In Botswana, Lesotho, Malawi, Swaziland, and Zambia,UNDP has played a role in facilitating transitions tothe multisectoral national HIV/AIDS structures thatreflect a move away from approaches to the epidemicdominated by the health sector. However, it wasapparent that in these and other countries, there werepersistent tensions and difficulties of coordination.

3.3.2 INCLUDING HIV/AIDS IN POVERTYREDUCTION STRATEGIES, NATIONALDEVELOPMENT PLANS, AND OTHER NON-HIV/AIDS SECTORS

UNDP, and many other partners, have been able toeffect relatively few changes in translating awarenessand acceptance into effective inclusion of HIV/AIDSinto policy, plans and actions beyond the HIV/AIDS

sector. UNDP Regional Centre staff describedimplementation of mainstreaming in this area as stillbeing at the stage of raised awareness in most countriesand sectors. Only a few countries have started to movebeyond the stages of reflection and internalization tocomprehend its implications for planning.

At the national level, in seven case-study countries—Botswana, Ethiopia, Lesotho, Malawi, Namibia,Zambia and Zimbabwe—UNDP support to thedevelopment of national AIDS policies, strategiesand frameworks helped to strengthen a multisectoralapproach. National level frameworks were clearly keysteps in national responses. However, gaps betweennational level plans and the requirements forpractical implementation at local levels tended to belarge and were often not addressed.

UNDP has achieved positive resultsin mainstreaming HIV/AIDS in theeducation system in Angola.

In 2002 UNDP started a projectwith the Ministry of Education,Strengthening the Education Systemin Angola to Combat HIV/AIDS.The project aimed to fight the epidemic and causes of its growthby reducing its impact on thecountry’s education system. Itfocused on three areas:

1. Training social actors, includingteachers, community leaders,the armed forces, the church,and the media, in human rights,peace, gender and HIV/AIDS.

2. Building and strengthening com-munity social networks wherethese themes are discussed andservices provided to adolescentmothers, orphans, and womenand men living with HIV/AIDS.

3. Strengthening capacity to designculturally sensitive educationalmaterials for use by schools andthe media.

Project activities include curriculumdevelopment,training of social actorsto carry out prevention work throughawareness raising, and producinglearning materials. The project alsosponsored a study of HIV/AIDSimpact on the educational system.

The project first set up coordinationstructures. A national coordinationteam was established in Luanda.At the time of the evaluation, theteam was building technical capacityfor project continuity (Grangeiro,2005). A group was created todevelop and implement public policy concerning control of theepidemic in the education system.The project used the opportunityof ongoing curricular reform in the Angolan education system tointegrate HIV/AIDS.

After effective establishment at the national level, the project wasdecentralized.Provincial nuclei werecreated, based in provincial HealthDelegations. They were composedof teachers, civil society personnel,the media, the military, and com-munity and religious leaders. Thenuclei were subsequently responsiblefor identifying communities andsocial actors as well as coordinatingand monitoring implementation atthe provincial level.Partnerships withcivil society were established by theproject, particularly with organiza-tions directly involved with PLWHA.The decentralization process allowedfor greater community participa-tion and capacity building at theprovincial level, and for increasedcoordination and implementationof HIV/Sexually Transmitted Infection

control measures.

The project offered social actors a78-hour training course over twoweeks, which uses participatorymethodologies with group dynam-ics. The content includes teachingmethodologies and techniques,facts on HIV infection, human rights,gender, sexuality and ethics. Thetraining also addresses planning ofprevention activities and actionplans for the following year.Participants have to submit animplementation report at the endof each year. In 2003 and 2004, 237people were trained in five provinces.They included 160 teachers, 22 students and representatives of the military, the police, the media,health professionals and civil societyorganizations. Once the socialactors were trained, they carriedout prevention activities in theform of awareness raising in theircommunities, schools, NGOs, militarybases and religious institutions.Thelevel of implementation of theaction plans has varied from oneprovince to the next.

The project was well regardedamong key Angolans. Unfortunately,the project had been poorly documented at the time of theevaluation and seemed destined toremain at the level of a promisingprovincial pilot.

BOX 3.8 ANGOLA: MAINSTREAMING HIV/AIDS IN THE EDUCATION SYSTEM

Particularly in Botswana, but also in Angola,Ethiopia, and Swaziland, UNDP has alsocontributed to planning, research, and otherprocesses that have facilitated more focusedmainstreaming of AIDS into other sectors andgovernment departments. These include publicservice management, labour, education, agricultureand finance. In Botswana, early responses facilitatedby UNDP included the appointment of HIV/AIDSfocal persons in ministries and the development ofsector plans. UNDP was also instrumental inmainstreaming HIV/AIDS into education in Angola(see Box 3.8) and Ethiopia. Leadership training wasreported in Botswana, Ethiopia, and Swaziland tohave resulted in the clarification of roles of differentsectors, and some inspiring anecdotes of individualinitiatives to address AIDS within some sectors werereported in Swaziland (see Box 3.9).

There was a high degree of variability in the extent ofHIV/AIDS mainstreaming across countries andsectors. It was difficult to establish that various initiatives have been consolidated and have led toeffective multisectoral HIV/AIDS planning andaction on a significant scale. In some countries, suchas Ethiopia, UNDP mainstreaming initiatives werestill at an early stage at the time of the evaluation.This further complicated assessment of the effects ofcurrent UNDP approaches to mainstreaming.

The evaluation found that UNDP has made somelimited progress in mainstreaming HIV/AIDS intodevelopment and poverty reduction strategies.HIV/AIDS tend to be covered in the majority ofPoverty Reduction Strategy Papers (PRSPs), andUNDP was influential in achieving this result inAngola, Botswana, Ethiopia, Lesotho, and Swaziland.Many National Development Plans and recent economicplanning in Zimbabwe, which was supported byUNDP, have also taken HIV/AIDS into account. Anotable exception, Malawi, was due to review itsPRSP at the time of the evaluation. However, muchremains to be done on mainstreaming HIV/AIDSinto broader national development planning in thecase-study countries, including especially theirpoverty reduction strategies and processes.

Overall, substantial impact seems unlikely on thebasis of the UNDP mainstreaming contributionsmade during the period of the present evaluation, asthe breadth and depth of substantial integration ofHIV/AIDS into economic policies and povertyreduction strategies and thinking were very limited.

Several PRSPs included AIDS as a brief chapter, butdid not integrate it into other aspects of the plan. Insome cases, such as Zambia, a persisting bio-medicalbias in HIV/AIDS sections was noted, probably dueto the health sector’s continuing role as coordinatorof the national response.The Regional Centre has issuedbasic guidelines on HIV/AIDS mainstreaming inPRSPs but noted that refinements in approach arelikely to be needed.64

UNDP has enhanced mainstreaming and multisectoralinvolvement in HIV/AIDS at district and local level in

32


In Swaziland, UNDP has stimulated mainstreamingHIV/AIDS in the police force.

The Assistant Commissioner of Police, Mr. SiphoDlamini, attended UNDP training on mainstreamingHIV/AIDS in 2003. Upon completion, he initiated anumber of interventions that have led to markedchanges in the police force’s response to thepandemic. A Committee on HIV/AIDS was set up inthe police force to initiate, coordinate and monitoractivities aimed at addressing HIV/AIDS. In all fourregions of the country, the police have initiatedawareness and education training for all policeofficers.Training of police counselors was undertakenso that police can counsel all officers on variousaspects of HIV/AIDS. From their experience, theAssistant Commissioner reported that although thecounselors have been well trained by the Institute ofDevelopment Management, most police officerswere still unwilling to attend counseling unless theywere already sick. Awareness of HIV/AIDS and theimportance of testing were, however, steadilyincreasing. According to Mr. Dlamini,“more and morehealthy police officers are beginning to test for HIV.”Police stations have condom dispensers and seniorpolice officers are encouraged to use them, and toinfluence junior officers by example.

Other planned initiatives included attempts toaddress the increasing numbers of orphaned childrenof police force members, and the development of anHIV/AIDS policy for the police force. The police forcepolicy, however, had to await the development of the national HIV/AIDS policy. Mr. Dlamini assertedthat if the government took too long to formulate a national policy the police might be forced to go ahead and formulate their own “because peopleare dying.”

BOX 3.9 SWAZILAND: MAINSTREAMINGHIV/AIDS IN THE POLICE FORCE

64 Unfortunately, the Regional Centre was not involved in a jointworkshop in South Africa on integrating HIV/AIDS in povertyreduction strategies conducted late in 2005 by UNDP, UNAIDSand the World Bank.

33


several countries. In Zambia, UNDP training, toolsand other support to DATFs and DevelopmentCommittee involvement have led to a more multi-sectoral response at the local level. Similarly, inBotswana, UNDP DMSAC initiatives have been acatalyst for enhanced understanding, planning and action at the District level. In South Africa,UNDP increased understanding of HIV/AIDSmainstreaming among provincial and local planners.In these countries and others, however, it was notedthat obstacles remain to effective multisectoralaction. So far, action by targeted authorities wasuneven and often limited. Even when local govern-ment took note of HIV/AIDS, there was oftenlimited change from a health-sector focus in HIV/AIDS projects and activities at that level.

3.3.3 SUPPORTING MULTISECTORALRESPONSES THROUGH ENHANCED ROLES OF NON-GOVERNMENTAL PARTNERS

In all of the case studies except South Africa andZimbabwe, UNDP achieved positive but varied resultsin promoting mainstreaming among NGOs, faithbased organizations and private sector organizations.Details of NGO performance and scope of workwere often not available. However, in Botswana,Malawi, and Swaziland, contributions have beenmade to a more holistic response to HIV/AIDSthrough UNDP support for umbrella NGOnetworks. In Botswana, Ethiopia, Malawi, Namibia,Swaziland, and Zambia, UNDP has enhanced activitiesof CSOs in HIV/AIDS at community and higherlevels. In Botswana and Malawi, UNDP helped toachieve greater clarification of the roles of CSOs inthe national response. In Angola, UNDP’s work withthe Ministry of Education helped create precedents forNGOs and PLWHA working with the governmenton HIV/AIDS. In Ethiopia, UNDP has helped tomobilize a promising formal programme of majorfaith-based organizations to address HIV/AIDS,although it was too early to assess results at the timeof the evaluation.

3.3.4 MAINSTREAMING HIV/AIDS ACROSSOTHER UNDP PROGRAMMES AND INTERVENTIONS

Progress in mainstreaming HIV/AIDS acrossUNDP non-AIDS programmes and interventions,including governance, economic planning and poverty

alleviation, was disappointing. Nevertheless, someresults had begun to emerge. In Zambia, Ethiopiaand Malawi, changes had started to occur fromleveraging other UNDP programmes, such asdecentralization and civil service reform, to enhanceHIV/AIDS responses. In Angola and Namibia,examples of integration of HIV/AIDS into UNDPagriculture, poverty, gender, decentralization andmagistrate training programmes were identified.

Unfortunately, the evaluation was unable to drawclear conclusions on the effectiveness of these actionsin generating substantial results. The was littleindication that mainstreaming support by UNDPhas been effectively used. An innovative effort tomainstream HIV/AIDS into Information andCommunication Technology programmes took placein Swaziland, but there was no clear evidence aboutits effectiveness. In South Africa, opportunities havebeen missed in sharing innovations that wereworking well within HIV/AIDS programmes withother UNDP programmes related to poverty.

3.3.5 PROMOTING WORKPLACE HIV/AIDS RESPONSES

UNDP leadership has triggered some importantchanges through the UN’s ‘We Care’ WorkplaceProgramme, which was launched by UNDPHeadquarters. In Angola, Lesotho, and SouthAfrica, UNDP has had a key role in this area. Inother countries, We Care did not feature highly inUNDP reports of achievements. In some of thesecases, UNDP was seen more as a participant thanleader in UN workplace programmes, as in Ethiopia,or action was reported to be weak, as in Zimbabwe.In Swaziland, limited resources and acceptance byUN partners were obstacles. There were also missedopportunities for UNDP COs and other UNpartners to learn from and motivate each other to become model employers in this regard. Theexpectation of Headquarters that the COs wouldsystematically integrate this activity into their ownactivities and programmes within a short period oftime, following initial subsidization from New York,seems to have been over optimistic.

Beyond its own employees, UNDP has helped tofacilitate the development of ministry workplacepolicies and programmes in Angola, Botswana,Ethiopia, Lesotho, Malawi, and Zimbabwe. Initiationof workplace responses to HIV/AIDS seemed to be

easier to achieve than mainstreaming into moregeneral sectoral planning. This was especially strikingin Ethiopia, where other aspects of mainstreaming wereminimal. In several case-study countries, such asBotswana, Malawi and Swaziland, UNDP has assistedthrough supporting public service impact studies,development of policies and manuals, and motivatingthe designation of focal persons. In Botswana, Lesotho,Namibia, South Africa, Zambia, and Zimbabwe,support for groups such as labour, PLWHA andbusiness coalitions has stimulated private sectorawareness on workplace issues. In Botswana andZimbabwe, UNDP has helped to promote theprovision of antiretroviral treatment by employers.

Greater involvement of PLWHA has been an importantcontribution of UNDP workplace initiatives, alongwith greater awareness and adoption of rights-basedapproaches and interventions in the world of work.In South Africa, use of the GIPA principle appearsspecifically to have helped to produce results inreducing stigma in targeted UN and public andprivate sector workplaces. In Zambia, support forZNP+ and the Zambian Business Coalition achievedsome outcomes. Unfortunately, at the time of theevaluation, the GIPA programme appeared to havelapsed or was lapsing in a number of countrieswithout much urgency in renewing or extending itinto all UNDP activities.

Despite the efforts of governments, UNDP, andother development partners, the implementation ofworkplace interventions remained uneven and quiteweak in many countries. For private sector initiatives,ability to substantiate results beyond awareness-raising and establishment of coalitions was oftenlimited, although sometimes specific tool developmentand actions had occurred. This suggests a need tocontinue strengthening strategic approaches andmethodologies in future workplace interventionssupported by UNDP and other partners.


Despite its successes, particularly in creatingawareness of the development nature of HIV/AIDSand the importance of mainstreaming, UNDP hasnot yet made full use of its apparent comparativeadvantages in promoting mainstreaming. While basicadvocacy and training are likely to be relevant forsome time, new challenges are raised by the need to

translate awareness into action. Experience suggeststhat managing the inter-sectoral coordination ofHIV/AIDS programmes, especially including therole of the health sector, is likely to continue to poseformidable challenges to UNDP and its country andinternational donor partners.

The very limited mainstreaming into other UNDPprogrammes, such as governance and poverty alleviation,represented an important and quite visible missedopportunity, especially since UNDP has greatercontrol in this area than elsewhere. In general, thereare opportunities for better coordination from theperspective of HIV/AIDS across UNDP countryprogrammes, regional programmes (such as PRSPsupport), and activities promoted from Headquarters.

A review of UNDP strategy and methodologiesaround mainstreaming seems needed. It can build onthe assessment of mainstreaming experience recentlycompleted jointly by UNDP, UNAIDS, and theWorld Bank.65 The review should, inter alia, examinewhether focus should be on generating or facilitatingimpact, and the possibility of prioritizing areas wheremainstreaming is likely to be most effective. It couldalso assess the UNDP capacity requirements and servicesneeded to consolidate and implement mainstreaming,which may differ from those provided by the UNDPregional project. Greater clarity is also needed todetermine exactly where UNDP’s comparativeadvantages for mainstreaming lie, and whether UNDPshould endeavor to address mainstreaming throughoutsocieties and economies or focus only on morelimited aspects such as poverty reduction strategies,priority sectors and workplace interventions.

3.4 CAPACITY DEVELOPMENT

For the purposes of this evaluation, capacity developmentwas considered to include skills development, organi-zational development, institutional strengtheningand planning, management and development ofhuman resources. More specifically, it encompassed:n

Increasing national government ministerialcapacity to respond to HIV/AIDS.

n

Strengthening national HIV/AIDS coordinatingstructures.

n

Strengthening capacity for decentralizedplanning, management and implementation of

34


65 UNAIDS, UNDP,World Bank,“Mainstreaming AIDS in DevelopmentInstruments and Processes at the National Level: A Review ofExperiences,” September 2005.

35


HIV/AIDS responses, at provincial, regional,district and local authority levels.

n

Developing capacity of CSOs and community-level capacity development and empowerment toaddress HIV/AIDS.

n

Empowering PLWHA and other people vulnerableto the effects of the epidemic.

n

Generating, managing and disseminating HIV/AIDS-related knowledge.

Progress was recorded in each of these areas. Thenature and extent of results varied greatly. Overall,

there was a widely held opinion at the country levelthat capacity had been strengthened significantly byUNDP. Certain limitations of outcomes and missedopportunities were, however, apparent. Capacitydevelopment, particularly for strategic planning andmanagement, was frequently cited as a particularstrength or comparative advantage of UNDP inSouthern Africa and Ethiopia.

3.4.1 INCREASING NATIONAL GOVERNMENT MINISTERIALCAPACITY TO RESPOND TO HIV/AIDS

At the national government ministerial level inBotswana, Ethiopia, Lesotho, Malawi, and Swaziland,UNDP has been instrumental in building skills andstructures, such as ministry AIDS coordinating units,that have enhanced the capacity of government torespond to HIV/AIDS. In these countries, UNDPoften took the lead when other donor support inthese areas was quite limited.

In Botswana, capacity enhancement throughUNDP-supported training, planning exercises andtechnical assistance to various ministries improvedHIV/AIDS planning and led to the formation ofAIDS coordinating units. In Malawi, the public sectorHIV/AIDS impact assessment and ongoing UNDPadvocacy and policy development support gave importantmomentum to the formation of key capacity toaddress the epidemic. A number of ministries hadappointed focal persons and started workplaceprogrammes as a result of UNDP interventions.66

In Ethiopia, Lesotho, and Swaziland, LDP wasspecifically mentioned as having developed leadershipskills, attitudes and institutional change withinnational ministries that enhanced HIV/AIDSresponses. In Lesotho, LDP contributed to therecognition by the government of the need toimprove capacity utilization of senior policy officialsby placing HIV/AIDS at the centre of policies andplans. In Ethiopia, LDP was a catalyst for theformation of national level bodies such as EthiopianMedia Volunteers against AIDS and the Women’sNational Coalition on AIDS, which has strong

While results differed among countries, UNDP hascontributed to enhanced individual and institutionalcapacity in:

n

NAC and national government capacity to respondto HIV/AIDS.

n

Capacity for decentralized planning, managementand implementation, in relation to HIV/AIDS.

n

Capacity of HIV/AIDS-related CSOs and community-level capacity to address HIV/AIDS.

n

Empowerment of PLWHA and other people vulnerable to effects of the epidemic.

n

Greater knowledge relating to HIV/AIDS to guide responses.

Innovative achievements in community anddecentralized level capacity development wereparticularly notable, and should be considered for further support in CO and overall strategies.UNDP missed opportunities to deal with larger scalecapacity problems related to human resourceplanning, development and management.

UNDP needs to improve exit strategies to ensure thatinitiatives are consolidated and sustainable, and totake successful innovations to scale. Important issuesrelated to these concerns include fostering strategicpartnerships with other donors, more efficient andreliable systems to support implementing partners,and strengthened knowledge generation,managementand communication.

The scale and range of capacity challenges in thecase-study countries is huge. It will be important toprioritize and consolidate capacity developmentagendas to ensure that impact is not compromisedby overextension. In an increased role, the UNDPRegional Centre for Southern Africa could possiblyharmonize experiences in capacity development and deploy dedicated support to cross-countryexperience sharing.

BOX 3.10 KEY CONTRIBUTIONS AND OUTCOMES OF UNDP ON HIV/AIDS CAPACITY DEVELOPMENT

66 A Permanent Secretaries’ task force has been formed to ensurethat ministries responded to the epidemic more effectively. Thearmy and most line ministries have implemented workplace pro-grammes and HIV/AIDS have been incorporated in nearly half ofthe public institutions in the country.

involvement of senior politicians. In Swaziland, L4Rhelped to increase the momentum of national privatesector HIV/AIDS bodies.

UNDP also missed opportunities to strengthencapacity to plan and implement HIV/AIDS-relatedpolicies, plans and programmes. As illustrated by thelimited degree of effective sectoral mainstreaming,more sustained support is needed to build adequatecapacity and skills for action. In Namibia, forexample, missed opportunities appeared to be due, atleast in part, to lack of resources to fund needs fortechnical assistance or deployment of UNVs.Additional missed opportunities also seemed to bedue to limited impact of policy dialogue aimed atcreating demand for better multisectoral planning on HIV/AIDS.

3.4.2 STRENGTHENING NATIONAL HIV/AIDSCOORDINATING STRUCTURES

UNDP support has enhanced the capacity ofnational AIDS coordinating bodies in Botswana,Malawi, Swaziland, Zambia, Zimbabwe, and—withless clear results—in Lesotho. Many NACs havebeen weak during the period under review, and morestill needs to be done to overcome their weaknesses.However, this does not negate the significance ofUNDP’s support. Much of this has been achievedthrough direct support, such as training, deploymentof UNVs, technical assistance and the provision offunds for projects and operations. Institutionalcapacity has also been developed simply by enablingNACs and key stakeholders to ‘learn by doing,’ aswell as through support in resolving dilemmas andconflicts that have arisen around where to locate theauthority to coordinate inter-sectoral responses.

UNDP often supported NAC capacity developmentat a stage when the institutions were new, andsupport from other donors was limited.n

In Zambia, UNDP contributed a major proportionof NAC finances at a time when support fromalternative sources was minimal. UNDP alsoprovided flexible support in the form of technicalassistance and funding of basic operationalrequirements such as computers and transport.This was essential to the ability of the NAC tomaintain a basic level of function and to refineand understand its role (Box 3.11).

n

In Botswana, UNDP supported the NationalAIDS Coordination Authority and the Ministryof Health’s HIV/AIDS STD Unit through

training, deploying UNVs and other technicalassistance. This has had a substantial role in organizational development and capacity36


In Zambia, UNDP has made important contributionsto institutional development in the NAC.

UNDP provided Programme Acceleration Fund (PAF)support to the NAC in 2000-2002.The resources weremeant to help initiate or strengthen a broad range ofcatalytic projects. The funds were disbursed todifferent institutions in different provinces anddistricts—11 districts were supported on a pilotbasis. Funds were also meant to support the NACdirectly, especially in developing its monitoring andevaluation system. Other support went to ZNP+, GirlGuides, faith based organizations,Youth Alive, specialpopulations (such as CSW, military and refugees),Zambia Business Coalition,World Aids Day and homebased care.

A senior NAC official commented: “The PAF fundswere the lifeline of the National AIDS Council. UNDPcame in at a time when we had nothing and nowhereto go. However, most importantly PAF made itpossible for NAC to learn what to do and what not to do.... NAC, having little experience and not being able to distinguish between implementation andcoordination, learnt some valuable lessons when weattempted to do both and burnt our fingers. We gotbogged down in details and discovered we hadneither the time nor expertise to monitor, evaluateand ensure accountability if we were being animplementer and a coordinator. Not only that, butthere were issues of alienating stakeholders who didnot understand the criteria for programme selectionand it was difficult to justify to the satisfaction of everyone. Accountability of funds due to the constrained human resource situation was problematic… It was from the experiences of the PAFinitiative that we learnt how to focus on coordinationand ensure that we support implementing agenciesfrom that context…At the same time however,we wereable to commence initiatives such as galvanizing theprivate sector response through the formation ofZBCA….build a relationship with the FBOs….”

At the time of the evaluation, the effectiveness ofZambia’s NAC continued to be undermined by anumber of obstacles. However, by maintaining a basiclevel of function and allowing lessons to be learned,the NAC was better positioned to receive supportfrom other donors and to play its role in the ‘ThreeOnes’ approach to national HIV/AIDS responses.

BOX 3.11 ZAMBIA: UNDP CONTRIBUTIONS TO NATIONAL AIDSCOUNCIL INSTITUTIONAL DEVELOPMENT

Source: Chitah B, “Evaluation of the UNDP HIV/AIDS Programme inZambia,” National consultant study for the present evaluation, 2005.

37


enhancement for executing coordination andother roles, including support to the antiretro-viral rollout.

n

In Malawi, UNDP has had a substantial role inthe emergence of the NAC under the Office ofthe President, including the mobilization ofresources and facilitation of appointments to key positions.

n

In Lesotho, UNDP was a major influencebehind revamping Lesotho AIDS ProgrammeCoordinating Authority and contributed to thegovernment’s decision to create the newlyestablished NAC, with an enhanced mandatesanctioned by Parliament to coordinate thenational response.

n

In Swaziland, UNDP is considered to have had arole in strengthening the National EmergencyResponse Council on HIV/AIDS’s organiza-tional development and staff capacity for its rolesin coordination, mobilization of resources, andpolicy development.

By assuming the PR responsibility in GFATM-financed projects in Angola and Zimbabwe UNDPassumed a major HIV/AIDS capacity developmentrole. However, concerns were raised about UNDP’srole as PR and the implications of PR activity for UNDP’s broader role, including whether the role creates a conflict of interest with other UNDPactivities. This could not be assessed in this study, butthe implications of UNDP’s PR role clearly needcareful examination by UNDP management.

3.4.3 STRENGTHENING CAPACITY FOR DECENTRALIZED PLANNING,MANAGEMENT AND IMPLEMENTATION

The most recognizable capacity development contri-butions and outcomes in several countries werewithin HIV/AIDS structures at the regional, districtand local levels. These results of UNDP support areparticularly notable because capacity at these levels isa major gap in many countries, as well as in theHIV/AIDS responses of other development partners.

The most marked results have been achieved inBotswana and Zambia. In Botswana, UNDP playeda groundbreaking and critical role in the developmentof DMSACs early in the period under review. Anumber of DMSACs have proved to be sustainable,effective players in the HIV/AIDS response. Theclearest recent outcomes at the time of the evaluation

were in Zambia, where the success of UNDP supporthas been reflected in increased action at decentralizedlevels, increased funding flows to districts, collaborationwith other donors, and government requests for rolloutto all districts. UNDP’s role was central to thesesuccesses, through contributing UNVs, training,assistance in planning, and resources for Informationand Communication Technology and transport.

In Zimbabwe, UNDP had a significant role in thedecentralization of NAC functions, including thedevelopment of an apparently successful system of‘bottom-up’ budgeting and planning. As part of theUNDP project with the Ministry of Education inAngola, some decentralized capacity for projectmanagement was created. In South Africa, training oflocal authorities raised awareness for mainstreaming.However, capacity development to translate this intoeffective planning and action through the localauthority Integrated Development Plans was limited.This is a missed or emerging opportunity.

In several other countries, capacity development atdecentralized level has also occurred, thoughgenerally on a smaller scale. In Lesotho, UNDP trainingwith the Ministry of Local Government led toimproved capacity to plan and manage local AIDSprogrammes by DATFs. However, it appears thatopportunities were missed to involve DATFs moresystematically in other UNDP initiatives; some perceivedthat UNDP was unwilling to use its programmes toempower some local structures. In Swaziland, L4Rhas led to substantial involvement of local chiefs ininitiating local action, with some noticeable changesat organizational and community levels.

In Ethiopia, LDP has improved capacity, particularlyin Southern Nations, Nationalities and PeoplesRegion, but also in other regional HIV/AIDSPrevention and Control Offices. However, severaldonors felt that UNDP had missed an importantopportunity to more systematically strengthen lowerlevel government capacity for HIV/AIDS responses.UNDP’s decentralization programme to strengthenlocal government planning systems in Malawi hasalso contributed to enhancing citizen engagement inplanning at the lowest levels. However, this work hasnot been linked with the ability to addressHIV/AIDS issues, nor have the newly-establishedDistrict AIDS Councils been connected with theexperiences in other countries in participatoryplanning so successfully supported by UNDP.

3.4.4 DEVELOPING CAPACITY OF CIVILSOCIETY ORGANIZATIONS, ANDCOMMUNITY-LEVEL CAPACITYDEVELOPMENT AND EMPOWERMENT

The importance of civil society for effective nationalHIV/AIDS responses was widely noted. UNDPinitiatives stimulated NGO, faith based organizationand other CSO activity on HIV/AIDS throughdirect financial and technical support. In six of thestudy countries, UNDP achieved results in buildingthe capacity of CSOs. The exceptions were Angola,Lesotho, South Africa, and Zimbabwe, where civilsociety strengthening was not a major feature of theUNDP HIV/AIDS programme. CSO capacitydevelopment for the HIV/AIDS response was aparticularly notable achievement in countries wherecivil society was previously very weak.

In Botswana, Malawi, and Swaziland UNDPcontributed to establishing and strengthening strate-gically placed civil society umbrella or coordinating

bodies. In these countries and others, such as Ethiopiaand Zambia, it also stimulated formation andstrengthening of significant individual organizationsin areas such as media, PLWHA AIDS services,labour, and women’s coalitions on AIDS. In Ethiopiaand Swaziland, organizational leadership wasstrengthened, specifically through LDP, and thecapacity of CSOs was enhanced through involvementas implementers of CC and for delivering specificservices. Assessment of the effectiveness and sustain-ability of this capacity development could only bemade on a limited basis as part of the present evalua-tion. However, some clear, immediate and strategicbenefits for the HIV/AIDS response were identified.

In Botswana, Ethiopia, Malawi, Swaziland andZambia, a notable feature of UNDP involvement hasbeen strengthening organizations and the involvementof PLWHA either at national level or at the local levelthrough participation and support groups linked tointerventions such as CC. In general, this producedprogress in representation, involvement, visibility,

38

EVALUATIONOF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIA

CHAPTER 3. KEY CONTRIBUTIONS AND OUTCOMES OF UNDP IN THE HIV/AIDS RESPONSE AT THE COUNTRY LEVEL

In South Africa, UNDP has strength-ened capacity for community-drivenresponses to HIV/AIDS and empow-ering the poor and vulnerable.

UNDP support to the AIDSresponse in South Africa hasfocused on sub-national levels,particularly at provincial, districtand community levels, targetingthe poor and especially vulnerable.The main thrust of UNDP’s actionsin these areas has been in theemployment of UNDP corporatetools—the LDR and CC Programme.At the national level, the govern-ment assumed the coordinationrole and did not require upstreampolicy support.

UNDP’s interventions at the districtand local council levels recognizedthe critical role councils need toplay to ensure adequate servicedelivery to their constituents toaddress the impact of HIV/AIDS.The LDR and CC processes wereused to sensitize leadership at thenational, district and local council

levels. This contributed to a greaterunderstanding of the multidimen-sional nature of the epidemic andthe need for a concerted and multi-sectoral response. CC reinforcedthe need for community-drivenresponses and solutions. Emergingresponses by municipalities indicatedUNDP’s success in this area. LocalCC brought the government closerto the people and started to yieldresults as communities began touse conversations on HIV/AIDS asentry points for critical reflectionson the broader issues of what canbe done to fight poverty.

CC demonstrated that communitieshave capacity to analyze their ownproblems, find solutions and assumeresponsibility for addressing problemsassociated with poverty and HIV/AIDS, provided there is a supportivesocial, political and economic envi-ronment. UNDP established thetone for the dialogue betweengovernment and communities, andamong community members. Theresult was a renewed confidence

at the local level to hold thoseresponsible accountable for thelocal action needed to address theimpact of HIV/AIDS.

UNDP’s success with LDR and CC in mobilizing action at the sub-national level has been hamperedby the unique circumstances surrounding UNDP’s collaborativearrangements with the Govern-ment of South Africa. UNDP has notbeen able to expand this successinto its support to civil society toadvocate for the rights of the poorand vulnerable.UNDP has supportedcapacity development initiativesthrough GIPA and employment forHIV-positive youth. But, UNDP hasnot been able to lend a voice to theadvocacy and agitation of CSOs forincreased access to treatment andcare for the poor. This was a missedopportunity, especially in a politicalenvironment where the governmentwas described to be in denial of thetreatment needs and requirementsof the poor.

BOX 3.12 SOUTH AFRICA: STRENGTHENING CAPACITY FOR LOCAL AND COMMUNITY-DRIVEN RESPONSES FOR EMPOWERING THE POOR AND VULNERABLE

39


de-stigmatization and enhanced support, despitereports of organizational and other limitationsinhibiting the integration of these achievements intogovernment planning and implementation processes.

UNDP involvement included initiatives to enhancearts and media involvement on HIV/AIDS issuesthrough engagement with journalists’ associationsand the promotion of positive role models. InEthiopia and Swaziland, this improved the quantityand quality of media involvement and reporting onHIV/AIDS. However, there was little clear indica-tion of the extent of improvement and the need toreinforce results should be addressed.

While significant capacity development occurred,some important limitations and missed opportunitieswere identified in UNDP’s support for civil societycapacity development. In three countries—Angola,Lesotho, and Zimbabwe—UNDP concentrated onengaging with the government but had limitedengagement with civil society, even where there wasa clear need for CSO and PLWHA involvement inthe national response and for capacity development.

In countries such as Ethiopia and Swaziland, anumber of the CSO initiatives stimulated by UNDPwere still at an early stage and results were stillevolving. There were frequent comments acrosscountries that many of the CSO activities did nothave the ability to become sustainable and effectivewithout further support. UNDP’s mode of providingsupport to CSOs was also described as laborious,requiring enormous time and effort, and posingchallenges for sustained CSO access to theseresources. In brief, UNDP implementation processesand procedures represented an obstacle to effectiveUNDP support for CSOs. Furthermore, UNDPoften had inadequately developed or communicatedexit strategies for organizations that it supported.This put their effectiveness and sustainability at risk.

Community level capacity development andempowerment, including the development ofcommunity level capacity to address HIV/AIDS,were a prominent result of UNDP programmes inEthiopia, South Africa, Swaziland, and Zambia. Themost dramatic and widely acknowledged effects atcommunity level were achieved through CC. UNDPhas been the driving force behind developing CC,which represents an interesting example of adapta-tion of previous community development method-

ologies and applying them to HIV/AIDS. InEthiopia, CC strengthened community skills,motivation and mechanisms for action in relation toHIV/AIDS (Box 3.13). This led to marked changesin community norms and behaviours related to HIVrisk and PLWHA, as well as increased assertivenessin relation to local and other authorities to tackleHIV/AIDS issues. In addition, CC has had positivespillover effects in addressing gender and broaderpoverty and development issues.

In South Africa, CC has changed knowledge,attitudes and practices among communities and theirleaders. In addition, CC has led to actions thataddress the link between poverty and HIV/AIDS,including establishing ‘self-help’ initiatives, formingcommittees to channel demands to municipalities,and engaging in dialogue with service providers toimprove service provision. However, although CC

UNDP has improved community capacity to respond toHIV/AIDS in Ethiopia through its pilot CC programme.

The UNDP CC programme was launched, on a pilotbasis, in Alaba in late 2002 and Yabello in mid 2003.The participatory CC process has led to significantchanges in the pilot sites. Changes includedimproving knowledge, breaking the silence aboutHIV/AIDS, reduction in stigma and greater supportfor PLWHA, increased voluntary counseling andtesting, and evidence of changes related to harmfultraditional practices including norms around havingmultiple sexual partners and female genital muti-lation. Risk factors such as market hours meaningwomen have to travel home after dark were alsoaddressed. Spin off benefits of empoweringcommunities to address other local developmentalchallenges, and of changing gender relations werealso reported.

External observers and communities agreed that theCC process has started dramatic changes. Outcomesin pilot areas led several other donors and thegovernment to start adopting CC methodologies aspart of their strategies and programmes. However,final outcomes of UNDP’s initiative will becomeclearer only after initiatives begun at the time of theevaluation around exit strategies, sustainability, andscale-up have been implemented. The need tomanage risks of conflict with stakeholders who feelthemselves threatened by the methodology was also raised.

BOX 3.13 ETHIOPIA: IMPROVING COMMUNITY CAPACITY TO RESPOND TO HIV/AIDS THROUGHCOMMUNITY CONVERSATIONS

has direct relevance to strategic gaps in the nationalresponse, little attention was given to ensuring that the government is aware of and acts on themethodologies that have been developed.

Other UNDP initiatives, such as enhancing district-level and NGO capacity to support communityinitiatives, L4R, and specific youth or other projects,have also improved community capacity to respondto HIV/AIDS. In Swaziland, L4R initiativesbrought about observable changes in capacity,competencies and actions in organizations andcommunities targeted by the programme, althoughthe scale of outcomes is not completely clear.Mobilization of youth stimulated youth involvementmarkedly in targeted communities and led to theformation of youth groups, increased uptake ofvoluntary counseling and testing and sexuallytransmitted disease treatment, condom use, andgreater openness. Other components of L4Renhanced capacity of chiefs and other local players toact more effectively at community level. In Botswana,enhanced community capacity to prevent andmitigate HIV/AIDS resulted from UNDP supportfor development of District and Village multisectoralHIV/AIDS committees. Increasing involvement oflocal leadership in community-based initiatives, andmore recent implementation of CC in five districts,reinforced this. In Lesotho, UNDP support forcapacity development, community meetings, workshops,and social mobilization had noticeable effects oncommunity level progress towards AIDS competence.

3.4.5 GENERATING, MANAGING, ANDDISSEMINATING KNOWLEDGE

A number of UNDP country-level initiatives havecontributed to the generation and dissemination ofinformation, knowledge, methodologies and tools tosupport HIV/AIDS responses. These included impactstudies, other publications and research, and thedevelopment of innovative projects and interventions.

Impact studies have made significant contributionsto mobilizing awareness and support for HIV/AIDSresponses in Angola, Botswana, Malawi, andSwaziland, particularly at early stages in national orsectoral responses. Some of these studies have alsocontributed to subsequent specific actions, includingpolicy on rollout of antiretroviral therapy inBotswana and mainstreaming in public service andsectoral ministry programmes. A notable example of

effective use of UN/UNDP-led publications andinformation to achieve results was the Lesotho study‘Turning a Crisis into an Opportunity.’ The govern-ment adopted the study as a working and advocacytool for scaling up the national response.

In nearly half of the case-study countries (Botswana,Swaziland, Zambia, and Zimbabwe), impact studies,MDG progress reports, and National HumanDevelopment Reports (NHDRs) have providedinformation that has had ongoing value in advocacyand planning, and have helped focus attention on key issues, such as the HIV/AIDS-poverty link.However, in some countries, the impact studies,NHDRs and other UNDP publications had limitedoutcomes at the country level. Factors contributing to these limitations include conflicting advocacy and planning agendas, and limitations of localcommitment to study results. The unreliability ofdata and, in particular, the capacity limitations indeveloping responses to new information limited theutility of the NHDRs. In Malawi and South Africa,country partners challenged the appropriateness ofmethods and findings of the HDRs. One UNcountry official, reflecting sentiments heard in severalcountries, remarked that the development of NHDRsneeded to be more participatory to enhance use andcredibility, as currently, “It remains a UNDP report,and it is used at the international level, but not reallyby government and others.”

UNDP’s contribution to knowledge through innovationand pilot projects has had substantial secondary effects.Prominent examples include CC and initiatives tostrengthen district HIV/AIDS structures. Earlierprojects in areas such as home-based care and truckerprevention programmes were also noted to haveinformed UNDP strategies. Other donors, govern-ments and CSOs have also adopted methodologies,tools and manuals developed out of UNDP HIV/AIDS capacity development projects. For example,CC is now being used by UNICEF and other partnersin Ethiopia and Swaziland. In Ethiopia, LDP is beingintegrated into general civil service training. UNDP’sability to use broader development experience andmethodologies, such as CC and LDP, to enhanceHIV/AIDS responses was an important feature.

In Botswana, UNDP initiatives were specificallynoted to have resulted in better information sharing,for example through leadership programme networksand publications. However, there were also missed40


41


opportunities to transfer knowledge and communicationbetween and within countries, as well as within the donorcommunity. For example, learning from Botswana’sDMSAC initiative did not explicitly feed into otherdistrict and regional initiatives in countries such asZambia and Ethiopia. The effectiveness of manyconventional UNDP projects and best practices andhow they contributed to buy-in, follow-up support forpiloted initiatives, and results was also questioned.


UNDP has achieved substantial results in variousareas of capacity development in the case-studycountries. Data deficiencies and the limited period ofcertain interventions, however, made it difficult forthe evaluation team to develop a clear assessment ofthe scale and depth of capacity development and,therefore, overall HIV/AIDS capacity developmentoutcomes in each country. From the evidencegathered, UNDP appears to have been influential inhelping to catalyze a “re-thinking” of the needs,context and direction of capacity development withregard to HIV/AIDS. However there are areas whereUNDP’s capacity development role can be strengthened.These include missed opportunities and limitationson efficiency, sustainability, scale-up and—ultimately—achievement of impact.

UNDP has made particularly notable achievementsat the community level through CC and at decentral-ized levels of government. This suggests that UNDPmay have a strategic role in consolidating the use ofthese methodologies in more places. Possibleinterventions include further development of tools,information dissemination, technical support forimplementation in diverse contexts, and qualityassurance. Limited ability to promote activity at theselevels is often a major gap in national responses.Other donors are increasingly supporting centralNACs, making UNDP’s role there less pivotal.

These considerations point to the need for a morestrategic approach to UNDP HIV/AIDS capacitydevelopment innovations, to ensure appropriatechoice, sustainability and impact:n

In the case of CC, limited attention was paid toissues relevant to scaling-up and sustainability,such as costs, recruitment of other fundingagencies, capacity requirements, exit strategies fromUNDP support by transferring responsibility to

others, differing requirements for skills andmanagement in large programmes, and manage-ment of quality and possible conflicts with key stakeholders.

n

Decentralization interventions highlighted thepivotal role of UNVs, particularly local UNVs incountries where there is substantial localunderutilized capacity outside government.The UNV role was highly desirable to achieveurgent results, even if it represented a temporary‘capacity substitution’ rather than skills development and transfer. However, the need todevelop a more strategic approach going forwardis needed. In some cases, UNVs are making adifference but are hamstrung by limited clarityon mandate, and inadequate skills development,support, and basic resources, such as transport.There are also concerns about sustainability andexit strategies. These issues will be important forSACI to systematically address, to avoid risks ofcreating inefficient precedents.

n

Similar issues were raised in relation to UNDPtraining in several countries. In Botswana,Ethiopia, Namibia, Swaziland, and Zambia itwas noted that, when training had not beensituated within a well-considered process offollow-up and support, outcomes were oftenlimited. This applied both to short courses andlonger ones such as LDP.

As mentioned in the discussion of governance, someoutcomes related to gender issues have been achievedthrough developing capacity and involvement ofwomen. However, results in this area have notfeatured prominently in many countries. Thissuggests an opportunity to increase focus on capacitydevelopment for HIV/AIDS-related gender issues,or at least more specific monitoring of gender-specificand gender-disaggregated outputs and outcomes.

The CC and district interventions also suggest thatUNDP can have a valid role as a lead agency indeveloping methodologies that can be taken to scaleor leveraged by other partners. The reorganization ofthe Regional Centre for Southern Africa to provide aunified service in methodological refinements,testing new tools, and professional support to COsincreases the potential for these tools to be refinedwith a common vision and disseminated throughoutthe region. The Zambia district interventions andEthiopia CC were examples of helping to leverageWorld Bank and other partner support to enhance

responses and coverage at these levels. Recent initiatives to address the issues of sustainability andscaling up in Ethiopia may provide some importantlessons for wider application.

Other notable outcomes have been achieved throughsupport for civil society capacity development. A morestrategic approach is important to ensure effectiveness,sustainability and impact, if similar interventions areused in future. Key issues to address include reliability,efficiency and coherence of support and exit strategies.

An area of capacity development that is increasinglyprominent is building country capacity to mobilize andmanage external HIV/AIDS resources. Particularemphasis is needed on moving such resources beyondthe national level to decentralized and communitylevels. UNDP has begun to grapple with this issue,particularly through its GFATM PR roles. However,definition of desirable and feasible roles for UNDPin this area is likely to need further attention instrategic planning. Work on financial managementand procurement under ARMADA represents only abeginning. More concrete modalities for externalresource management and the strengthening ofcapacities at the level of District AIDS Committeesor Task Forces are needed to complement thecomplex procedures for management established byNACs at the national level.

A further strategic issue is the missed opportunity forUNDP to play a more focused role in human resource(HR) planning, management and development, whichmay be taken up under SACI. In several countries(Botswana, Malawi, Swaziland), UNDP has usedimpact studies and other means to raise awarenessabout the human resource challenges presented byHIV/AIDS for the health and other sectors.Governments and other donors have begun to act onthis awareness and data. However, prior to the recentSACI initiative, UNDP has done little to capitalizeon this awareness in order to more systematicallyaddress capacity constraints arising from deficientHR planning, development and management strategies.Where UNDP lacks the staff capacity, it could atleast actively monitor developments.

Country and CO experience indicates that transfer ofknowledge and learning within and between countriesaround innovative ideas and other projects has beenweak and should be enhanced. This suggests animportant role for the Regional Centre, and possible

limitations of centrally driven initiatives where thestaff concerned may not be sufficiently familiar withprecedents and country contexts.

3.5 PARTNERSHIP COORDINATIONFOR COUNTRY RESULTS

For purposes of the evaluation, partnership coordina-tion for country results was defined to cover UNDPcontributions relating to:n

Mobilization of financial resources for HIV/AIDS at the country level.

n

Strengthening of interagency synergy among UNagencies and with official development partners.

n

CO staffing and coordination, and resources forHIV/AIDS in the CO.

The evaluation examined UNDP roles and contributionsin the UN Country Team, Thematic Working Groupson HIV/AIDS, and in relation to other donors.

UNDP has achieved positive outcomes in donorpartnership coordination for country results in nineof the case-study countries. The exception is SouthAfrica. The outcomes vary greatly from country tocountry, and it was not easy for the internationalteam to assess these aspects. In some countries, theevaluation team’s work also led to the identificationof missed opportunities.

42


UNDP played important roles and made importantcontributions at the country level in partnershipcoordination for the achievement of country results.This was most evident in financial resource mobiliza-tion from the GFATM in Angola and Zimbabwe. UNDPalso made important contributions in strengtheninginteragency synergy among UN agencies and withofficial development partners in Ethiopia and Lesotho,among other countries.

Many stakeholders would like UNDP to play moreassertive roles in this area of HIV/AIDS responses.Strategies to strengthen partnership developmentroles will require consideration of several factors.These include:specific circumstances and opportunitiesin each country; capacity of COs and the characteristicsof specific Resident Representatives, Resident Coordi-nators and staff; clarification of roles between UNAIDSand UNDP at country level; and improved design andcommunication of UNDP CO AIDS strategy.

BOX 3.14 KEY CONTRIBUTIONS AND OUTCOMES IN PARTNERSHIP COORDINATION FOR COUNTRY RESULTS

43


UNDP has a key position in relation to partnershipsin most countries, in large part due to its role asResident Representative and in the ResidentCoordinator system. An official’s remark that“UNDP is the agency we all look to for leadership”was representative of many others.

3.5.1 FINANCIAL RESOURCE MOBILIZATION AT THE COUNTRY LEVEL

The most important identifiable partnership contri-bution from UNDP in the case-study countries liesin the mobilization of resources from other externalpartners. In five of the case-study countries, successfulresource mobilization has occurred where UNDP hasbeen associated. In Angola, the active engagement ofthe UNDP CO is widely thought, particularly in thedonor community, to have been central to thecountry’s first success in obtaining a grant from theGFATM under Round Four. The UNDP focal pointfor HIV/AIDS played a central role in bringingCSOs into the GFATM proposal preparationprocess and in continuous follow-up. UNDP nowserves as PR of the grant.n

In Botswana, the UN Theme Group workedwith the government on the development of theGFATM grant proposal, and it assisted withadvocacy to attract more donors to HIV/AIDSwork in the country.

n

In Malawi, UNDP’s support and coordinationwere viewed as important in the development ofan AIDS SWAp arrangement with the country’sdevelopment partners (although the evaluationwas unable to document details).

n

In Zambia, UNDP leveraged resources frommultiple partners to support district andcommunity-based initiatives and responses toHIV/AIDS. These results were attributed toUNDP, and particularly to UNVs.

n

In Zimbabwe, UNDP manages the GFATMgrant under Round One, a grant that might nothave been awarded without UNDP’s role as PR.UNDP was also instrumental in mobilizingresources for HIV/AIDS in Zimbabwe from theUnited Nations Foundation.

While the overwhelming outcome in resourcemobilization was positive, this result was notuniversal. In Ethiopia, UNDP was seen as beingweak in financial resource mobilization for HIV/AIDS, despite the well-regarded donor coordination

arrangements in the country and strong signs ofincreasing adoption of the CC methodology by otherdonors. In Lesotho, while UNDP’s active leadershipmay have contributed to resource mobilization,policy guidance, such as was provided by UNDP,was not enough to ensure effective operational use ofa UNDP guidance manual. Similarly, in Malawi,UNDP was, at the time of the evaluation, on thesidelines in the creation and operation of a pooledfund of donor resources to support AIDS programmes,after substantially coordinating the earlier phases ofawareness-raising concerning the need for increaseddonor resource commitments to HIV/AIDS.67

3.5.2 STRENGTHENING SYNERGY AMONGDEVELOPMENT PARTNERS

UNDP played an important role in strengtheninginter-agency synergy for partnership results in six ofthe case-study countries, but also missed someopportunities. In Botswana, UNDP was instrumentalin the formation of a Partnership Forum thatincludes donors, the private sector and the CSOsector. The Forum had improved information sharingand collaboration on interventions, though the level of interaction with the large US PEPFARprogramme could not be ascertained. In Ethiopia,the UNDP Resident Representative played a key rolein the UN Theme Group, strengthened harmonizationand efficient inter-agency coordination within theUNDAF and the joint government-donor DevelopmentAssistance Group (DAG), and improved donor-government relationships. However, UNDP’s rolewas perceived to have diminished, and informantsfelt that resurgence of a more assertive and strategicrole was desirable. In Lesotho, the UNDP ResidentRepresentative gave an entirely new dynamic tointer-agency cooperation (Box 3.15). As a result, UNagencies agreed that AIDS would represent a keystrategic area for all agencies in Lesotho.

In Malawi, UNDP’s work created greater synergy insupport of the NAC. In Swaziland, UNDP leadershipthrough the Round Table, the UN Country Team,and the HIV/AIDS Theme Group made a difference,especially with bilateral donors. In Zambia, UNDP

67 Between 2000 and 2001, UNDP was the prime mover in conveningnational conferences in Malawi to raise awareness among donorsfor coordinated resource mobilization. It later played limitedroles in the new pooled funding arrangement, in part becauseUNDP funds were not in the pool. UNDP guidance permittingUNDP participation in pooled funding was issued at the beginningof 2006.

mobilized partnerships to help in rolling outHIV/AIDS initiatives at the provincial and districtlevels, following the successes of the UNDP pilots.UNDP also increased the effectiveness of the smallerUN agencies, such as the International LabourOrganization. In Ethiopia and Zambia, the internaltechnical capacity of the UNDP CO HIV/AIDSteam was an important strategic resource to thegovernment and some other agencies. Unfortunately,tensions between UNDP and UNAIDS somewhatundermined synergy in two countries.68

Certain other UNDP initiatives have assisted increating awareness and attitudes that enhancepartnerships. In Ethiopia, UNDP facilitated increas-ingly participatory processes for HIV/AIDS policyand strategic planning, although limitations onstakeholder inputs remained.

3.5.3 COUNTRY OFFICE STAFFING,COORDINATION, AND RESOURCES FOR HIV/AIDS

The capacity of the UNDP CO—financial resources,leadership, staffing, skills, incentives, and attitudes—was a critical variable in the creation of effectivepartnerships for results in the case-study countries.There were wide variations in the technical andorganizational capacity of the COs to supportnational HIV/AIDS responses, as well as in the willand determination of CO managers and staff to takeaction on the matter.

In Angola, the staff re-profiling exercise of 2001seriously restricted CO HIV/AIDS capacity, throughbudget reductions, but in Lesotho the ResidentRepresentative seized the opportunity of the staff re-profiling to alter the CO skills profile (see Box3.15). In Ethiopia, the UNDP CO increased its44


In Lesotho, the forceful leadershipof a new UNDP Resident Represen-tative strengthened and developednew partnerships with governmentand other donors.

The Resident Representative estab-lished credibility by brokeringamong actors in domestic politicaldisputes, and drew upon UNDP’sconsequentially increased standingto launch many new HIV/AIDS ini-tiatives. At the time of her arrival,despite a declaration by the Kingthat HIV/AIDS was a national disaster,the national HIV/AIDS responsewas weak. Between 2002 and 2004,the Resident Representative engagedin a flurry of activity. At her initiative,UNDP supported the Ministry ofLocal Government with decentral-ized planning, including voluntarycounseling and testing. The PrimeMinister and Resident Representativeflew together to a small town,Qacha’s Nek, in the eastern moun-tains of the country, to launch andlater to close the kick-off events. In2003, the Resident Representativehad a five-hour meeting with the

Prime Minister, his entire cabinetand all Principal Secretaries. By theend of the meeting,the governmenthad accepted the urgent need forscaling up. UNDP produced a 300page reference manual, ‘Turning aCrisis into an Opportunity:Strategiesfor Scaling Up the NationalResponse to the HIV/AIDS Pandemicin Lesotho,’ widely referred to as‘The Bible.’ The Prime Minister publicly launched it. ‘Know YourStatus’ was the slogan for a nation-wide campaign for voluntary counseling and testing. It culminatedin a major session led by the UNDPResident Representative, with theMinister of Health in attendance.With UNDP support, Lesotho’sPrincipal Chiefs launched a pro-gramme to make themselves HIV/AIDS competent, in order to educatelocal people about the pandemic.

The Resident Representative sys-tematically used her position topromote partnerships for countryresults.HIV/AIDS were mainstreamedinto all aspects of UNDP’s CountryProgramme, and UNDP promoted

transformational leadership work-shops wherever there was anopportunity. An Expanded ThemeGroup was established includingCSOs and bilateral donors, co-chaired by one of the main bilateraldonors. According to CO data,HIV/AIDS rose dramatically as ashare of UNDP’s total programmespending in Lesotho, from 5 percentin 2002 to 42 percent in 2004. Thestaff re-profiling exercise is reportedto have been taken as an occasionto align staff skills and aptitudeswith the needs of the country programme, giving increasingattention to HIV/AIDS.

Despite these successes, partner-ships continued to pose challengesin Lesotho at the time of the evaluation. Implementation weak-nesses hampered the effectivenessof UNDP’s programme, and staffingchanges diluted the UNDP partner-ship coordination role. Finally,tensions created by the veryprocess of aggressive UNDP leadership needed to be resolved.

BOX 3.15 LESOTHO: A UNDP RESIDENT REPRESENTATIVE CREATES NEW PARTNERSHIPS, WITH RESULTS

Sources: Caplan G,“Towards a UNDP CO of the Future—Lessons from Lesotho,” November 10, 2004 (processed, report for the UNDP CO);country programme spending data provided by CO.

68 The evaluation team found it inappropriate to name the countries concerned in an evaluation intended to be strategic incharacter and not to have the character of a performance audit.

45


HIV/AIDS capacity in recent years, but limitedHIV/AIDS programme capacity still constrainedpartnerships and the rollout of pilots. In Malawi, itwas uncertain whether the CO was sufficientlyequipped to support scaling up the HIV/AIDSresponse, and in Namibia, there were important gapsin staffing the CO to support HIV/AIDS activities.

In several countries, including Angola and Namibia,the individual responsible for both poverty andAIDS in the CO was described as over-burdened andcould not effectively cope with both responsibilities.In Zambia, the limited capacity of the highly capableHIV/AIDS programme staff to perform both projectfunctions and communication and coordination roleswas an obstacle to UNDP effectiveness.

The substantial variations in UNDP CO capacityand effectiveness were not only the consequence ofthe differences between countries’ perception of the significance of HIV/AIDS as a health anddevelopment problem. They were also heavilydependent on the personality and disposition of theUNDP Resident Representative. Changes in ResidentRepresentative and staff assignment discontinuitieswere frequent sources of weakness in the UNDP COHIV/AIDS response. At the same time, the Lesothoexperience suggests that changes in the assignmentof the UNDP Resident Representative can also be a powerful stimulus for action, depending on the personality, commitment and vision of theResident Representative.


UNDP has the ability to be a key role player instrengthening partnerships for country results onHIV/AIDS, particularly in resource mobilizationand management and in inter-agency cooperation.Effective functioning of Expanded HIV/AIDSTheme Groups in some countries is a case in point.A key strength of UNDP is its good relationshipswith host governments, which adds to its credibilityand potential effectiveness as a coordinator of partnerships.

The positive contributions documented above werethought to have been accomplished with less-than-adequate CO staff and coordination withHeadquarters and the Regional Centre. This viewwas shared not only among CO staff but also among

many development partners. At the same time,questions were raised about the apparently largeUNDP staff presence in individual case-studycountries, and their roles, competence and credibility.Thus, the ‘adequacy’ of UNDP CO HIV/AIDSstaffing, sometimes captured as a complaint abouthaving only a part-time HIV/AIDS focal person,turned out to be a more complex issue of COHIV/AIDS strategy, administrative budget, staffskills, staff numbers and allocations, incentives,leadership, and attitudes.

The roles and relative responsibilities and relation-ships of Headquarters, Regional Centre and CO staffwere also sometimes unclear. There were alsoconcerns about repeated requests from Headquartersfor action on what were perceived as unfundedinternational mandates. There were wide variationsamong COs in this respect, and the evaluation teamwas unable and not mandated to examine the issue indetail. The Regional Centre was seen as an importantcomplement to the COs, but its roles, activities,coordination with CO initiatives, were not wellunderstood by COs and partner staff. CO capacitymight be strengthened by ‘projectizing’ support andthereby removing it from the constraints of theUNDP CO administrative budget.69

Wide differences among UNDP Headquarters staffin their personal commitment to the corporateHIV/AIDS agenda are an important part of theexplanation of the inter-country differences in theHIV/AIDS response of UNDP. One observersuggested a gap in New York between the high levelof commitment of the UNDP top management andworking level officials, on the one hand, and theapparently half-hearted responses of some UNDPofficials in middle and senior management who have the ability to ensure follow-through on thecorporate agenda.

Several other obstacles to effective partnerships were identified:n

Inadequate communication. In Angola, opportunitiesfor synergy were missed due to UNDP’sinadequate definition and communication of theUNDP CO’s role and HIV/AIDS strategy toother development partners. While a strongpartnership exists between UNDP andDevelopment Cooperation Ireland in building a

69 USAID has done this very successfully at its headquarters.

formidable programme for UNVs at theProvincial and District levels across Zambia,other donors suggested that better communica-tion about this strategy would have increasedsynergies with the roll out of the UNV work atdistrict level.

n

Agency role definition and tensions. In two countriestensions between UNDP and UNAIDS were aserious obstacle.70 In others, there were indica-tions of lack of clarity of roles. Fortunately, thereare recent, focused attempts to articulate clearpolicy on UNAIDS and UNDP roles at countrylevel. Associated processes for resolution ofproblems in practice may still be needed.71

n

Limited UNDP assertiveness. In Ethiopia andZambia, UNDP was described as too ‘diplomatic’in its approach, and could have taken a firmerposition on some issues with the public authoritiesand certain donors, for more coherent andeffective HIV/AIDS responses.

n

Project focus. Obstacles could arise when UNDPcountry HIV/AIDS activities are largely ‘projec-tized.’ This could lead to missed opportunitiesfor UNDP to provide overall strategic perspec-tives and guidance in its coordination role, as thelimited CO resources end up being devoted toproject support and resolution of urgent crisesrather than longer-term important issues ofpolicy, strategy and coordination.

3.6 CONCLUSIONS ON COUNTRY-LEVEL CONTRIBUTIONS AND OUTCOMES

UNDP roles and activities have contributed in manyways to HIV/AIDS being a development rather thansolely a health issue. While the issue might beperceived solely as mainstreaming, the theme ofHIV/AIDS as a development issue ran through theentirety of the UNDP HIV/AIDS work reviewed bythe study team. UNDP interventions led to substantivechanges in government and grass-roots mobilizationwithin specific targeted areas and groups. Someimportant precedents have been established. Manyinterventions have been innovative and havecontributed to important paradigm shifts andknowledge generation. Overall, UNDP has achievedimportant outcomes in all the main outcome theme

areas related to the HIV/AIDS response in case-study countries.

In addition to identifying positive contributions, theevaluation team’s analysis identified missed opportunities.Given the prominent associations between povertyand HIV/AIDS, integration of HIV/AIDS intopoverty reduction strategies is particularly relevant toUNDP. The potential for UNDP to mainstreamHIV/AIDS in poverty alleviation and other sectorswas one of UNDP’s key comparative advantages.UNDP can offer particular technical capabilities andbroader development perspectives, as well as theadvantages of linkages with political leadership in keyministries, such as finance and developmentplanning. Despite the finding that HIV/AIDS isincluded in poverty reduction strategy statements,this work is just beginning.

There has been substantial variation in outcomes amongcountries. In general, country level outcomes and evenoutputs of UNDP activities up until the end of 2004are probably more moderate and smaller in scale thansome previous ROARs and other reports havesuggested.72 In addition, the depth and sustainabilityof change and resulting action tended to be difficultto substantiate with available M&E data. Theevaluation team therefore considers the ROARstatements to be at risk of hyperbole that couldundermine the credibility of the good work done.73

Despite the relatively broad understanding of UNDPcontributions and outcomes used in this chapter, thisviewpoint might not do full justice to the work ofUNDP during the period under review. Implementationof key programme components has only startedrecently in many countries. This meant limited timefor changes to manifest themselves, even if a numberof potentially significant processes and outputs couldbe reported by country teams.

46


70 Naming these countries would be inappropriate in the evaluation, since its role is not to single out individuals but toraise strategic issues.

71 UNAIDS, “UNAIDS Technical Support Division of Labour—Summary and Rationale,” UNAIDS, August 2005.

72 ROAR 2001 refers to “growing evidence of the impact of UNDPwork on HIV/AIDS in SSA ….. as a major achievement,” and alsorefers to “clear indications” in many countries of SSA that “comprehensive UNDP interventions are contributing to significantcountry-level progress in government and grass-roots mobilizationto respond to HIV/AIDS.” ROAR 2001 refers to capacity buildingresults in 2001, without detail, in all of the case-study countriesexcept Angola. It mentions mainstreaming results in Botswana,Malawi, and South Africa, and promotion of human rights inresponse to HIV/AIDS in Botswana, Malawi, and RBA’s regionalprogramme. It also mentions results of information disseminationand awareness-raising on HIV/AIDS in Botswana and Swaziland.The UNDP Annual Reports for 2002, 2003, and 2004 do not takethe form of the ROARs.

73 The evaluation of the Second Global Cooperation Framework ofUNDP also mentions, in reference to HIV/AIDS work, that “The useof hyperbole and inflated language do not add much to thedevelopment debate nor the UNDP role in it.”

47


Limited scale or even absence of clear, significantoutcomes should not be interpreted as meaning thatinterventions have failed or should not receivefurther support. In fact, it may indicate a need forgreater and more sustained support for certaininterventions. Similarly, the strategic issues identifiedfor attention are intended to enhance potential forsubstantial outcomes and impact arising from goodwork and dedication of many CO, regional andheadquarters staff.

There were wide discrepancies between UNDPstatements of policy and its performance at the countrylevel. Specifically, the evaluation team is concernedabout problems in the implementation of UNDP’sown interventions and the adequacy of its COs forthe interventions of UNDP. In country after country,concerns were repeatedly expressed about delays inapproval and subsequent implementation of UNDPHIV/AIDS projects and activities. These problemswere attributed to bureaucracy; unclear roles andrelationships among Headquarters, the RegionalCentre, and COs; and within the Headquarters andthe Regional Centre itself.

Substantially sound UNDP initiatives sometimeshad the appearance of being UNDP-driven, ratherthan partner-driven. Where the client wasunambiguously in charge, as in the case of nationallyexecuted projects, UNDP staff were concerned aboutthe implications for further implementation delays.CO adequacy concerns relate to staff, budgets,leadership, knowledge management, and strategy.They suggest significant gaps between the strongstatements of UNDP corporate strategy and seniormanagement statements, and the capacity of COs torespond adequately to them. The balance sheet onCO staffing and coordination that results from thisevaluation should not, however, be seen as entirelynegative. There are cases, as cited in this chapter,where UNDP COs played critical roles in importantUNDP accomplishments.

The central importance to UNDP effectiveness of theResident Representative and Resident Coordinatorsystem was underscored repeatedly. However, therewere wide variations in the roles and activities ofResident Representatives and Resident Coordinators.

In examining next steps, experience of the case-studycountries indicates that UNDP will need to address anumber of general limitations on its ability to achieve

more substantial outcomes in the case-studycountries. These include the following:n

Programmes and activities gave limited attentionto identification and exploitation of UNDP’sstrategic focus and areas of comparativeadvantage in the country. Since these vary fromcountry to country, they merit identification atthe country level.

n

Mainstreaming of HIV/AIDS within UNDPitself was not well developed at country, regionaland headquarters levels, and made it difficult tobring overall comparative advantages to bear.

n

Many programmes and projects had yet toconsider fully issues related to exit strategies,consolidation and sustainability for particularinterventions, as well as strategies for scaling upof successful interventions.

n

Communication and coordination with otherdevelopment partners and COs was often toolimited in creating awareness of lessons learnedfrom UNDP programmes and other initiatives toleverage their resources to achieve greater depthand scale of outcomes.

n

Tendencies to become too project-focused coulddilute strategic thrust, distract from areas whereUNDP has clearer comparative advantages, andlimit synergy among programmes, developmentpartners and countries.74

n

Under-developed monitoring and evaluationsystems created risks that effective interventionswould not receive appropriate ongoing support,and that limitations would not quickly berecognized and addressed. Dramatic claims ofsuccess with little clear substantiation mighthinder the understanding of how to intervenemore effectively to resolve problems, anddiscourage other partners from supportingsustainable initiatives and roll out of UNDP-initiated innovations.

These conclusions have implications for thedirections that UNDP might assume in deepening itssupport to the HIV/AIDS response at the countrylevel in Southern Africa and Ethiopia.

74 A number of smaller projects in various case-study countries,in areas such as home based care, prevention programmes forkey target groups, and voluntary counseling and testing havenot featured prominently in the above discussion of UNDP contributions and outcomes. In the early years of nationalresponses, such initiatives may have led to important learning byUNDP and its partners. However, it is difficult to argue that inmore recent years they have built on UNDP areas of comparativeadvantage or represent effective strategy.

SUMMARY OF FINDINGS AND

RECOMMENDATIONS

This chapter summarizes major findings of the evaluation, reviewsUNDP comparative advantages in addressing HIV/AIDS in the case-study countries, and sets out recommendations for action by UNDP.

Overall, the evaluation finds that UNDP has been instrumental inincreasing awareness about HIV/AIDS and has facilitated, along withother UN agencies and donors, increased commitment to HIV/AIDS asa development issue in Southern Africa and Ethiopia. UNDP alsofollowed through on its commitment to support the HIV/AIDSprogrammes and activities that it said it would support. While it was toosoon to assess the effectiveness of the UNDP initiatives in a number ofareas, certain important contributions and outcomes were identified in allthe main outcome theme areas related to the HIV/AIDS response incase-study countries.

This is not intended to suggest that UNDP did enough or achievedenough. There were a number of missed opportunities, as cited in thechapters earlier. In addition, UNDP’s ability to monitor and evaluate itsactivities needs to be addressed and strengthened, especially asHIV/AIDS activities and programming continue to expand and mature.

In the face of the magnitude of this pandemic and its devastating impactson development, UNDP must find a renewed energy and impetus in itsHIV/AIDS actions and responses. Implementation of UNDP policies,strategies and projects are not keeping abreast with the growing toll thatHIV/AIDS is taking on countries, especially those that are already facingnumerous other developmental challenges. If UNDP is to assist countriesin halting the spread of this epidemic and meeting the MDG deadline of2015 for reversing and rolling back HIV/AIDS, it must invest itself morewholly in its commitment to the response, and it must also make thetransition from discussion to implementation, from talk to action.

This evaluation calls for new urgency and recommends actions to adjust UNDPHIV/AIDS programming and strategies, strengthen HIV/AIDS institu-tional capacity within UNDP, and learn from and build upon its experience.

4.1 SUMMARY OF FINDINGSOn the basis of the detailed country and international evidence gathered,the evaluation summarizes four major findings concerning UNDP’s roles 49


4

and contributions in the HIV/AIDS response in thecase-study countries in:

Finding 1. UNDP has made signal contributions tothe increasing recognition in Southern Africa andEthiopia of HIV/AIDS as a development issue andhas supported important changes to this end atthe country level.

The theme of HIV/AIDS as a development issue ranthroughout the AIDS-related work of UNDP in thecase-study countries, beyond the specific issue ofmainstreaming HIV/AIDS into other sectors.UNDP Resident Representatives, UN ResidentCoordinators, and UNDP CO personnel have madeimportant contributions to the progress in Africa inrecognition of HIV/AIDS as a development crisis.UNDP was at the forefront on mainstreaming, andinitiated change through its support to National AIDSCommissions and Councils, gender issues, and manylevels of government and society. When otherdevelopment partners were reluctant or unable toprovide support, UNDP continued supporting thecase-study countries in working on HIV/AIDS, bothas a current crisis and as a long-term development issue.

The evaluation demonstrated that UNDP has theability to engage effectively with country partners atfour main levels in its support for national responses.These are: political institutions and leaders; the mainsector ministries related to UNDP’s developmentmandate; sub-national levels of governmentincluding regions, districts and local government;and communities. At the national level, UNDP hasengaged in upstream work with central governmentagencies to strengthen macro-level responses. In thiswork, it had to compete for attention with better-funded partners, particularly in major sectors such ashealth, education, and agriculture. Evidence from thefield indicates that UNDP engagement with higherlevels of governance (including Parliament, Cabinet,President’s office, and powerful ministries such asFinance and Planning) has more often resulted in thegreatest influence in shaping policy and strategy. Thiswas seen in Botswana, Lesotho and Zimbabwe.Unfortunately, the attention paid to these levels,especially parliaments, was more limited in mostcase-study countries than would have been desirable.

Mid-stream interventions at decentralized, sub-national levels of government and civil society are anarea where UNDP has achieved some of its most

prominent successes in the case-study countries.Support for decentralized, participatory planning,and capacity development for district and localgovernment, as well as for strategically placed andumbrella HIV/AIDS CSOs, were among the areaswhere UNDP’s support has been highly valued acrossthe 10 case-study countries. UNDP has also pilotedinnovative projects downstream at community levels.

The evaluation team found substantial inter-countryvariations in contributions and outcomes and somemissed opportunities for UNDP to address HIV/AIDS as a development issue through projects anddialogue with political and opinion leaders at thecountry level. The achievements and roles played byUNDP in contributing to the recognition ofHIV/AIDS as a profound development issue inAfrica are at risk. The very success of the interna-tional community in mobilizing significant newfinancial resources for HIV/AIDS programmes, andespecially treatment, could revive the dominance ofthe previously prevailing medical paradigm.

Finding 2. Despite UNDP’s achievements in makingHIV/AIDS a development issue, important gaps existbetween UNDP’s statements and its performance.

Strong stances on HIV/AIDS in senior managementstatements and UNDP publications75 were not often matched at the country level by comparableperformance in the design, execution and measurableoutcomes of UNDP activities at the country level. This does not deny the dedication andeffectiveness of many staff and programmes in manycountries. Rather, it points to the limited scale anddepth of outcomes thus far, and to gaps in strategy andinstitutional capacity.

In particular, the evaluation identified limitedconsideration of how to scale up important outcomesand ensure sustainability, limited sense of urgency andimportance for HIV/AIDS in UNDP programmes,and limited information and communication—UNDP’s work on HIV/AIDS at the country levelwas often unknown by key stakeholders and someinformants tended to confuse UNDP and UNAIDS.

50

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIACHAPTER 4. SUMMARY OF FINDINGS AND RECOMMENDATIONS

75 See, for example, the UNDP Results-Oriented Annual Report for2001. It refers to “growing evidence of the impact of UNDP workon HIV/AIDS in Sub-Saharan Africa ….. as a major achievement,”and also refers to “clear indications” in many countries of SSA that“comprehensive UNDP interventions are contributing to signifi-cant country-level progress in government and grass-rootsmobilization to respond to HIV/AIDS.”

51


In the view of the evaluation team, this lack ofknowledge of UNDP’s HIV/AIDS work was due notonly to inadequate communication but also, onceagain, to inadequate strategy at the country level,especially with respect to how to maximize outcomes.

A second major gap is between policy and plan, andactual implementation in most areas of HIV/AIDSresponses—from NAC functioning to mainstreaming.Focus on upstream policy advocacy and analysis isnot giving room to a new priority for implementationof UNDP, client country, and external partner programs.In addition, UNDP projects and programmes are notreceiving enough support from COs and othersources to reduce delays in execution. This challengeis also influenced by the growing external financialresources being promised by donors.

Finding 3. In refining its roles and making futurecontributions to the HIV/AIDS response in the case-study countries, UNDP faces significant externalchallenges and needs for internal change.

The growing flow of external financial resources forHIV/AIDS programmes coming from outside theUN system implies a need for UN agencies to rethinktheir roles and activities. In financial terms, UNDP isalmost certain to become a much less important actoron the HIV/AIDS scene in the case-study countries.In contrast, the UNAIDS Secretariat is becoming anincreasing presence at the country level, with rapidlyrising financial resources and personnel in the field.

The rapid changes in the environment for the HIV/AIDS response of UNDP are affecting the case-study countries. The most significant manifestationof this lies in programmed external financialresources. The work of the Global Task Team, theunderstanding among key partners on the ThreeOnes principles, and other global policy initiativesmust be expected to have direct impact on UNDP’swork at the country level. Additional global initia-tives, currently unknown, must also be expected.

Finding 4. The central position of UNDP ResidentRepresentatives, UN Resident Coordinators andCOs in the international system of developmentsupport to the case-study countries was a keytheme in interlocutors’ comments.

UNDP’s role very frequently extended beyond UNagencies. This was reflected, for example, in country-

level Expanded Theme Groups on HIV/AIDS thatwere thought more effective than Theme Groupslimited to UN agencies. However, sometimes it wasnot clear whether UNDP’s comparative advantage in coordinating development at the country level was viewed as actual or only potential. The teamidentified cases, as in Lesotho, where the UNDPResident Representative seized opportunities toprovide forward-looking leadership. Too often, bothinternally and externally, UNDP country level leader-ship was seen as bureaucratic and diplomatic, ratherthan substantial and development-oriented. Skills,aptitudes, and budgets were all part of the problem.

4.2 UNDP COMPARATIVE ADVANTAGES IN ADDRESSING HIV/AIDS

The evaluation team offers several conclusions onUNDP’s comparative advantages in addressingHIV/AIDS at the country level.

The issue of comparative advantage must be seen inrelative rather than absolute terms, that is, UNDPmust be viewed in relation to other external develop-ment partners in the case-study countries. Thissuggests the importance of inter-country differencesand the uniqueness of each country case. Countrydifferences in epidemiology and social, political andeconomic conditions lead to different externalpresences in the country. Furthermore, in any givencountry there may be important differences betweenUNDP’s potential comparative advantages and itsactual advantages. For this reason, the evaluation iscautious on categorical statements about UNDP’scomparative advantages, and urges that UNDP’scountry-specific comparative advantages be discussedamong stakeholders at the country level.

Despite this cautionary note, the team identifiedseveral areas of comparative advantage. First, one keyUNDP comparative advantage is UNDP’s positionas coordinator and voice for the UN system and UNCountry Team. This was widely remarked upon bysources. It is a central theme throughout the work ofthe evaluation team in the case-study countries aswell as in its global policy interviews.76 One observerfrom outside the UN system commented that UNDP

76 See Annex 7 for a synthesis of the evaluation team’s global policy interviews.

can and should bring other donors to the dialogue atthe country level, even when those donors may beinclined not to participate and to operate outside it.UNDP comparative advantage as voice of theinternational aid system, even beyond the UN family,includes its closeness to country situations, itspresence on the ground, its contacts with political,parliamentary, and government leaders, and itscapacity to reach out to opinion leaders throughoutthe country.

Second, UNDP’s generally, but not universally strong,trusting relationship with government is another keycomparative advantage. This strengthens UNDP’srole as coordinator and facilitator in the dynamic ofgovernment-donor collaboration. It also enablesUNDP to work with government to achieve betterresults. The experience of the evaluation suggests thatthis comparative advantage has been under-used.

Third, ability to facilitate and promote mainstreamingand integration of HIV/AIDS issues into develop-ment strategy, including poverty reduction, should bea comparative advantage of UNDP. This includesmainstreaming HIV/AIDS issues into other sectors,and helping partners in host countries as well asamong bilateral donors to move in their thinking and action on HIV/AIDS beyond narrow, verticalor—as one key informant expressed the problem sovividly—’stovepipe’ approaches. UNDP demonstratedthis capacity in several case-study countries.However, given the importance of other external actors,especially the international financial institutions, in anumber of countries, as well as the challenges ofsupporting actual implementation of mainstreamingin sectors, the evaluation team concluded that UNDPwould need actively to prove this comparative advantagein mainstreaming case-by-case. Mainstreaming mustbe disaggregated to specific sub-issues at the level ofindividual countries.

Fourth, the team found a UNDP comparativeadvantage in addressing certain aspects of AIDS-related governance issues, especially decentralizedsupport to HIV/AIDS programmes and policies.This was seen in several of the case-study countries,including Botswana and Zambia. Whether UNDPwould have a comparative advantage in bringingdecentralized support to HIV/AIDS programmes toa national scale was, however, not clear to the studyteam because of the enormous demands this wouldbring for human, financial and organizational resources.

Fifth, UNDP has a comparative advantage in facili-tating the effective involvement of other donors,particularly the smaller UN agencies and donors withsome financial resources but little field presence orknowledge of country situations. Because of UNDP’suniversal field presence, this was thought to beespecially important in smaller countries, where someexternal partners would wish to engage but be unableto provide sufficient locally based staff support.Several global policy commentators saw the UNDProle in facilitating the engagement of other donors as particularly important in the future, with thegrowth in GFATM, PEPFAR, and World BankMAP resources, saying that UNDP should be able toassist countries to mobilize, disburse, and effectivelyutilize funds from these sources.

Sixth, UNDP should have a comparative advantage incapacity development, including particularly, as oneinterviewee put it, the “architecture of AIDS institu-tions” at the country level. AIDS impact on theworkforce and AIDS linkages to civil service issues werealso mentioned in the team’s global policy interviews,but the team observed little work in these areas in thecase-study countries. Beyond generic reference tocapacity development, one informant said thatUNDP needs to address the question of “capacity forwhat?” There is a particular need to strengthenUNDP training, especially planning and follow-up.

4.3 RECOMMENDATIONS

This evaluation has one overarching recommendation:In Southern Africa—where the HIV/AIDS epidemicis the most severe in the world—the COs in the case-study countries must demonstrate a much higherlevel of urgency in their work on HIV/AIDS.

Urgency should be measured, inter alia, by use ofresources, leadership, people, time and money. TotalUNDP spending on HIV/AIDS overall is not largeenough to have a significant impact on the epidemicat the country level. It is therefore particularlyimportant that it use HIV/AIDS resources, both humanand financial, in a strategic manner. It is critical todevelop coherent approaches to leveraging partnerresources in order to achieve the scale of outcomesrequired in countries with very severe epidemics.

With support of an agile team drawn from all concernedheadquarters units and the Regional Centre, each52


53


UNDP CO and each of the other units concernedshould develop, by September 2006, a monitorableaction plan through which to implement the specificrecommendations detailed in the evaluation report.These specific recommendations are:

4.3.1 COUNTRY OFFICES

Clarify strategic directionCOs should formulate or update UNDP countryHIV/AIDS strategies and integrate them intonational HIV/AIDS strategies and programmes.Strategies should:n

Include UNDP inputs from the Regional Centreand headquarters units, and promote mainstream-ing, especially the full integration of HIV/AIDSinto poverty reduction strategies.

n

Draw upon initiatives from the headquartersBureau for Development Policy (BDP) and theRegional Centre, where those initiatives arerelevant to the country’s situation.

n

Be based on country demand and need rather thanUNDP supply; take into account implementationof the ‘Three Ones’ principles; support donorharmonization; support integration of HIV/AIDSinto poverty reduction strategies; and associatedactions should feature prominently in UNDPcountry HIV/AIDS strategies and programmes.

n

Integrate all UNDP financial resources forHIV/AIDS, whether managed at country,regional or headquarters level, and whether coreresources or trust funds.

Shift programme focusn

Give central attention to supporting implemen-tation of country HIV/AIDS programmes,especially at decentralized levels.

n

With support from the Regional Centre, assistpartner countries in designing, financing, andexecuting programmes that take actions successfullypiloted by UNDP and other external partners toscale on a country-wide basis.

n

Assist partner countries with mobilization,disbursement and effective utilization of externalfinancial resources for HIV/AIDS, with supportfrom the Regional Centre.

Strengthen HIV/AIDS capacityCOs should strengthen their HIV/AIDS capacity,with support from the Regional Centre for SouthernAfrica and headquarters. CO HIV/AIDS capacityshould include budgets; staff skills, attitudes, and

deployment; staff incentives; organization for HIV/AIDS work; and internal and external leadership.Leadership by example rather than by mandateshould characterize UNDP cooperation with UNorganizations and other partners. In their HIV/AIDSwork, COs should go beyond UNDP projects andshould plan, draw upon and facilitate deployment ofthe entirety of the institutional resources available toUNDP through UNAIDS and the UN system.

Foster a culture of monitoring and evaluationSuch a culture should be fostered by strengtheningmonitoring, evaluation, exit strategies, and especiallylearning from experience, with an expectation ofmeasurable results from each UNDP HIV/AIDS projector intervention. Specific recommendations include:n

Review each ongoing UNDP HIV/AIDS projector activity for adequacy of its monitoring, evalua-tion and exit strategy. Projects should not simplyend, but should have a planned exit strategyinvolving evaluation and transfer of responsibility.

n

Establish successful work on monitoring andevaluation as a criterion for positive evaluation ofstaff performance.

n

Draw upon the monitoring and evaluation workof the Regional Centre for methodology tosynthesize monitoring and evaluation analysis informs usable by others, and to establish anddisseminate good practices and lessons learned.

4.3.2 REGIONAL BUREAU FOR AFRICA

Assume new HIV/AIDS leadership rolesn

Support stronger HIV/AIDS leadership on thepart of Resident Coordinators and ResidentRepresentatives. The Regional Bureau for Africa(RBA) should support and promote proactiveleadership on HIV/AIDS through job design,staff selection and performance appraisal, andthrough support with other UNDP units andexternal partners.

n

Review and revise SACI and ARMADA strategiesand mandates in close cooperation with theRegional Centre, to prioritize supportingcountry HIV/AIDS programmes with particularreference to monitoring and evaluation, anddisseminating good practices; support expansionof pilots evaluated as successful; design andsupport public management actions necessary for scaled-up HIV/AIDS programmes; andcontribute to formulating and executing COHIV/AIDS strategies and programmes.

n

Lead a task force for the independent assessmentof HIV/AIDS capacity in COs, the Regional Centreand RBA, with participation of BDP, the Bureauof Management, the Regional Centre, and COs.

4.3.3 BUREAU FOR DEVELOPMENT POLICY

Review corporate HIV/AIDS strategyReview the corporate HIV/AIDS strategy of UNDPin the light of the evaluation report to supportimplementation of country HIV/AIDS programmesand poverty reduction strategies.n

Focus on the two themes of: support toimplementation of country HIV/AIDS projectsand programmes, and support to integration ofHIV/AIDS into poverty reduction strategies.UNDP/BDP HIV/AIDS programmes outsidethe two central themes should gradually beconsolidated and transferred to other partners,except to the extent that they are directly responsiveto country demand and have been evaluated asbeing successful. The revised corporate strategyshould encompass a review of UNDP approachesto mainstreaming.

n

Assist the Regional Centre, and especially COs,with HIV/AIDS country strategy formulationand implementation.

n

Weigh the HIV/AIDS capacity of BDP, includingbudgets, staff skills, attitudes, incentives, andlinks with other UNDP units and partners,against the changing needs. BDP should giveparticular attention to capacity for monitoringand evaluation.

4.3.4 BUREAU OF MANAGEMENT

Accelerate implementation of a financial managementimprovement programme. The financial manage-ment strengthening programme should make itpossible for users in BDP, regional bureaux and COsto access and effectively use real-time, consistent,

comparable financial data on the full range of UNDPHIV/AIDS activities.

4.3.5 OFFICE OF THE ASSOCIATE ADMINISTRATOR

Clarify working relationshipsExamine and, where necessary, revise internalHIV/AIDS working and reporting relationships andexternal partnerships. The Office of the AssociateAdministrator should position UNDP for increasinglyeffective engagement on HIV/AIDS.n

Take the lead in defining CO standards andprocedures for resolving problems that arise inimplementing the division of HIV/AIDS-related labour among UN organizations that wasrecently agreed upon in follow-up to the work ofthe Global Task Team on Improving AIDSCoordination. Particular attention is needed toensure effective cooperation between UNDP andthe UNAIDS Secretariat.

n

Review collaboration and reporting relationshipsamong the concerned headquarters offices andbureaux, the Regional Centre and the COs.Establish the principle that the COs aresupported by the other units within theframework of agreed strategies.

n

Review UNDP’s role as principal recipient forthe GFATM for conflict of interest. If that role isretained, guidelines should be established to ensureits separation from UNDP advisory functions, andthere should be a concentrated focus on capacitydevelopment for early phase-out at the country level.

4.3.6 EXECUTIVE BOARD

Request a report on the implementation of therecommendations for the annual session in 2007.Monitor implementation of the recommendationsand commission a further evaluation at a convenientmid-point between 2006 and 2015.

54


ANNEXES

ANNEX 1. TERMS OF REFERENCE (SUMMARY)

Evaluation of UNDP's Role and Contributions in the HIV/AIDS Response in Southern Africa and Ethiopia

JUSTIFICATION FOR THE EVALUATION

Southern Africa is the most devastated sub-region in the world by theHIV/AIDS pandemic, and has the greatest danger to sustaining developmentachievements. Although rich in natural resources, it is a sub-regionsuffering from the triple effects of poverty, drought and famine, and theconsequent severe erosion of human capacities. In addition, movementsof people and soldiers across borders have had serious implications for thespread of HIV/AIDS. The impact of HIV/AIDS is also manifested inother ways. Due to shared economic interests, especially through the miningindustry, and reliance on one dominant economy in the sub-region, thereis much cross-border migration for work. This greatly increases theexposure of the general population to HIV/AIDS from high transmissionareas. Further, HIV/AIDS disproportionately affects women and adolescentgirls. Gender differences are at the root of a number of social, economicand political factors that drive the HIV/AIDS epidemic. Without anunderstanding of the complex relationship between gender and HIV/AIDS, strategies devised to tackle the epidemic are not likely to succeed.

The Evaluation Office is undertaking a strategic evaluation of UNDP’srole and support in addressing HIV/AIDS in Southern Africa, in particularin the following 10 countries: Angola, Botswana, Lesotho, Malawi,Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Ethiopia, inthe Horn of Africa, is also included in this evaluation since it is estimatedto have the second highest number of AIDS-infected people in Africaafter South Africa. It also suffers from chronic food shortage and famine,which has sharply increased its vulnerability to the HIV/AIDS epidemic,and like Angola, has recently emerged from conflict.

PURPOSE OF THE EVALUATION

The purpose of the evaluation is to assess, within the context of theMillennium Development Goals (MDGs) and the Declaration of 55


Commitment, UNDP’s role in achievng key outcomesat the country level. More specifically, the evaluationwill assess UNDP’s role in the context of thechallenges described above and the extent to which itused its resources to respond to the HIV/AIDSchallenge at the country level. Identification ofcountries for team visits will be made in consultationwith the concerned bureaus, based on a mix ofcriteria including the severity of the pandemic and itsimpact on capacities, size and complexity, implemen-tation of a Poverty Reduction Strategy (Paper)[PRS(P)], post-conflict situation, existence of goodpractice programmes, and successful and not-so-successful coordination mechanism in place.

In order to know if UNDP is doing the right thingand doing things right. policy and planning choicesbeing made by countries to address HIV/AIDS andUNDP’s role in advocacy, promoting a multi-sectoralresponse, and capacity development, will be assessed,including the extent to which UNDP’s support hashelped make progress towards the MDG on HIV/AIDS.Further, UNDP’s potential role to increase synergiesbetween activities to scale-up HIV/AIDS responsesfor society-wide impact will be identified and assessed.

The evaluation will also assess the outcomes of UNDP’sstrategy, programmes and projects in addressingHIV/AIDS at country level, including policy advice,knowledge management, and coordination issues. Itwill also assess UNDP’s partnership and fundingstrategies and role as a cosponsor of UNAIDS. Theevaluation will identify gaps if any, lessons learnedand propose future directions.

UNDP’s role as the Resident Coordinator and successin coordinating actions to address HIV/AIDS issuesneeds to be assessed, as does the role of the UN ExpandedTheme Group on HIV/AIDS within the country.The extent to which UNDP, with other partners, isassisting countries emerging from conflict, indeveloping realistic and achievable targets in nationaldevelopment plans, PRSs and PRSPs, to address theimpact of the AIDS crisis will also be assessed.

The findings of this evaluation are expected to assistthe selected UNDP country offices in positioningthemselves for a more effective role in the future inresponse to the crisis, with appropriate contributionsand meaningful and coordinated support fromcorporate units and the newly established regionalservice centre. The findings will also contribute tothe formulation of future UNDP strategies at thecountry level in combating HIV/AIDS.

SCOPE OF THE EVALUATION

The evaluation will be strategic in nature andforward looking. It will cover the period beginningfrom 1999 with the introduction of Strategic ResultsFrameworks (SRFs) and will include an outlook intobudgeted activities that are either ongoing or havenot yet begun. It will review evaluative evidenceprovided through available outcome evaluations atcountry/regional/sub-regional levels conducted byUNDP, including the Assessments of DevelopmentResults (ADRs) for Ethiopia.

PROCESS AND METHODOLOGY

The methodology for this evaluation requires theevaluators to obtain and analyze data to reachconclusions and build up empirical evidence to back up their conclusions. The empirical evidence on which the evaluation will be based will begathered through three major sources of information(according to the concept of “triangulation”): perception,validation and documentation.

The evaluation exercise will include country visits toselected countries, the preparation of country case studieson UNDP’s experience, good practices and lessonslearned in each of the 10 countries, and forwardlooking recommendations.Team visits by independentconsultants to the countries will validate issues andhold discussions with all key stakeholders. Nationalconsultants will prepare Country Assessment Reportsand will be part of the evaluation team in-country.

56

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 1. TERMS OF REFERENCE (SUMMARY)

57

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 2. BASIC DATA ON CASE-STUDY COUNTRIES

Notes: ICRG indicates Composite International Country Risk Guide risk rating (2003), which is an overall index, ranging from 0-100 (highest tolowest), based on 22 components of risk grouped into three main categories: political, financial and economic ratings less than 50 indicate very highrisk and those greater than 80 indicate very low risk. N/A indicates not available.

Sources:n UNAIDS Global Report 2004: HIV Prevalence (2003) - Adults (15-49 years) living with HIV at the end of 2003 divided by the adult population of 2003n UNAIDS Global Report 2002: HIV Prevalence (2001) - Adults (15-49 years) living with HIV at the end of 2001 divided by the adult population of 2001n World Bank 2004 Development Indicators: Health Expenditure per capita 2001,USD; Sub-Sahara Africa value for 1997-2000; ICRG Risk Rating - 2003n UNDP HDR 2002 and 2004: Population 2002, millions; Life Expectancy 2002, years; Infant Mortality Rate 2002, per 1,000 live births; Female

Literacy 2002, percentage ages 15 and above; GDP per capita - 2002, USD; HDI rank and value for 1998 and 2002

ANNEX 2. BASIC DATA ON CASE-STUDY COUNTRIES

SOCIO-ECONOMIC INDICATORS

Country Adult HIVPrevalence

(% ofpopulation15-49 years

of age)

Population(2002,

millions)

LifeExpectancy

at Birth(2002,years)

InfantMortality

Rate(2002, per1,000 live

births)

FemaleLiteracy(2002,

%)

GDPper

capita(2002,USD)

Human Development Index(HDI)

HealthExpenditure

per capita(2001, USD)

CompositeICRG Risk

Rating(2003)

2001 2003 HDIRank

(1998)

HDIValue(1998)

HDIRank

(2002)

HDIValue(2002)

Angola 3.9 5.5 13.1 40.1 154 N/A 857 160 0.405 166 0.381 31 53.3

Botswana 37.3 38.8 1.7 41.4 80 81.5 3,080 122 0.593 128 0.589 190 79.8

Ethiopia 4.4 6.4 67.2 45.5 114 33.8 90 171 0.309 170 0.359 3 59.3

Lesotho 28.9 31.0 1.8 36.3 91 90.3 402 127 0.569 145 0.493 23 N/A

Malawi 14.2 15.0 10.7 37.8 114 48.7 177 163 0.385 165 0.388 13 54.0

Namibia 21.3 22.5 2.0 45.3 55 82.8 1,463 115 0.632 126 0.607 110 76.5

SouthAfrica

21.5 20.1 45.3 48.8 52 85.3 2,299 103 0.697 119 0.666 222 68.8

Swaziland 38.8 33.4 1.1 35.7 106 80.0 1,091 112 0.655 137 0.519 41 N/A

Zambia 16.5 21.5 10.2 32.7 102 73.8 361 153 0.42 164 0.389 19 53.0

Zimbabwe 24.6 33.7 13.0 33.9 76 86.3 639 130 0.555 147 0.491 45 34.3

Sub-SaharanAfrica

7.5 9.0 641.0 46.3 108 55.9 469 N/A 0.464 N/A 0.465 29 N/A

58

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 3. UNDP COUNTRY COOPERATION FRAMEWORKS (CCFS) AND HIV/AIDS IN CASE-STUDY COUNTRIES

ANNEX 3. UNDP COUNTRY COOPERATION FRAMEWORKS (CCFs) AND HIV/AIDS IN CASE-STUDY COUNTRIES

Country

Angola

Botswana

Ethiopia

Objectives/Planned Outcomes

CCF 1997-2000n Support the reintegration and vocational training of

demobilized soldiersn Development of a national mine action capacityn Community rehabilitationn Administrative reform and capacity for

macroeconomic management

CCF 2001-2003n Poverty reduction strategy formulated and being

effectively implementedn Comprehensive strategies to prevent spread and

mitigate the impact of HIV/AIDSn National decentralization strategy formulated and

being implementedn Improved public-sector efficiency, accountability

and transparencyn Improved institutional capacity for planning and for

supporting community empowerment n Improved national capacity for aid coordinationn Increased public debate on sustainable

human developmentn Electoral process implemented

CCF 1997-2002n Develop comprehensive approaches to gender issuesn Prevent the spread of HIV and mitigate the impact of

HIV/AIDS at all levels of society

CP 2003-2007n Improve national capacity for leadership,

coordination, implementation, and monitoring andevaluation of the multisectoral response

n Build institutional capacity to plan and implementmultisectoral strategies to limit the spread of HIV/AIDS and mitigate its social and economic impact

CCF 1997-2001n Improve the quality of life of the rural population

through generation of higher incomes and reductionof poverty

n Provide comprehensive and integrated primaryhealthcare in health institutions at the communitylevel, with emphasis on disease prevention andhealth promotion

CCF 2002-2006n Strengthened capacity of key governance institutionsn An efficient and accountable public sectorn Human and income poverty addressed in national

policy frameworksn Expand and protect the asset base of the poor

(human, physical and financial)n Sustainable environment management to improve

livelihoods and security of the poor, and regional andglobal instruments for environmentally sustainabledevelopments that benefit the poor

Strategic Focus Areas (HIV/AIDS and Others)

CCF 1997-2000n Assistance to post-conflict activities such

as mine action and the integration of demobilized combatants

n Poverty reduction through the strengtheningof poverty monitoring systems and communityrehabilitation and empowerment

n Promotion of good governance throughimproved economic management, state modernization and institutional reforms

CCF 2001-2003n Poverty reduction and elimination of

extreme povertyn Promotion and strengthening of effective

participatory governancen Improved human security for

post-conflict recoveryn Promotion of gender equality

through mainstreaming

CCF 1997-2002n Poverty alleviation and job creationn Gender equityn HIV/AIDSn Environment

Country Programme (CP) 2003-2007n Povertyn HIV/AIDSn Environment

CCF 1997-2001n Agricultural development programmen Health sector development programmen Water resources development and utilizationn Education sector development programmen Capacity development for public policy

and management

CCF 2002-2006n Good governancen Special pro-poor initiativesn Sustainable environmental management and

water resources development

59


Country

Lesotho

Malawi

Namibia


CCF 1997-2000n Provide neutral mediation in a complex and unstable

political environmentn Strengthen the technical and institutional capacity

of the Ministries of Employment and Labour, Tradeand Industry

n Institutional strengthening of the NationalEnvironment Secretariat to oversee and coordinateenvironmental activities at local, regional and national level, within the framework of a revisedNational Environment Action Plan

CCF 2002-2004n Mainstream gender concernsn Transparent and accountable governancen Strengthen national capacities for peaceful

management and resolution of conflict, and nationalculture of tolerance and accommodation of otherpeople’s views

n Improve capacity of local authorities, communitiesand private sector in environmental management,conservation and sustainable utilization of natural resources

CCF 1997-2001n Formulation of multisectoral and results-oriented

national HIV/AIDS strategic frameworkn Preparation of guide on participatory

assessment, planning and implementation for sustainable livelihoods

n Develop systems for environmental and naturalresources utilization

CCF 2002-2006n Build capacity for the poverty reduction policy and

programming and promote interventions toempower vulnerable groups to enhance their livelihood base in a sustainable manner

n Capacity development for implementation and monitoring of the decentralization policy and theLocal Government Act

n Strengthen capacities related to development management in the public sector

n Strengthen institutional structures related to democratic governance

n Strengthen the capacity of national coordinating,implementation and monitoring institutions to effectively carry out their roles and functions in thenational response to HIV/AIDS

CCF 1997-2001n Provide shelter and training to street children and

to empower women in economic activities and decision making

n Provide better information about existing possibilities for potential entrepreneurs throughdevelopment of markets, improvement of access to credit

CCF 2002-2005n Support advocacy and upstream policy development

for strategic thinking and planning and to play a catalytic role for resource mobilization in the nationalpriorities issues of poverty reduction, HIV/AIDS andsustainable development


CCF 1997-2000n Enhanced governance and capacity

development for economic management andcivil service reform

n Human resources development and employment creation

n Rural development and environmental management

CCF 2002-2004n Poverty reductionn Good governancen Environment

CCF 1997-2001n Governance and democracyn HIV/AIDSn Sustainable livelihoodsn Gendern Environment and natural

resources management

CCF 2002-2006n Poverty Reduction Strategy

Support Programmen Poverty reduction through good governancen HIV/AIDS management

CCF 1997-2001n Capacity building for human developmentn Integrated community-based rural and urban

poverty reductionn Small and medium-scale enterprise and

entrepreneurship developmentn Water management

CCF 2002-2005n Poverty reductionn HIV/AIDS prevention and mitigationn Sustainable development through

environmental initiatives

60


Country

South Africa

Swaziland


CCF 1997-2001n Job creationn Promotion of women in role of developmentn Implementation of national gender

planning frameworkn Development of small to medium-sized enterprises

with emphasis on women and rural communitiesn Creation of capacity for provision of housing, safe

water, sanitation, health, education, sustainable energy and social services

n Enhanced transparency and accountability toencourage, individuals, groups and institutions totake initiative, save, invest, manage, and participate inthe development of their communities and country

n Enhanced status of women and men to ensure equalaccess to opportunities and resources as outlined inthe Reconstruction and Development Programme

n Strengthened capacity of government and otherpartners to monitor the impact of HIV/AIDS onreconstruction and development

CCF 2002-2006n Help the country translate some of its political, social,

and economic transformation policies and strategiesinto reality to benefit the majority of South Africans,particularly women who live in poverty-stricken conditions without benefits of public services orbasic governance systems

n Achieve upstream results through advocacy,policy dialogue, capacity enhancement at all levels,and development of systems, guidelines and best practices

CCF 1997-2000n Support codification of Swazi Law and Custom for

harmonization of the two systems towards a moreefficient and effective governance system

n Empower participants from the government and civilsociety with information, knowledge, new skills, andexposure to the critical role and responsibilities ofleadership in advancing the country’s political,economic and social development agenda

n Assist small and micro-enterprise development,looking particularly at the policy environment andimproving access by the poor to productive assets ofthe formal economy

n Strengthen capacity of the Gender Unit and havegender focal points in every ministry

CCF 2001-2005n Improve living conditions of the poor and reduction

of poverty levels from 66% to 50% by 2005n Reduce spread of HIV/AIDS as a result of an

integrated and coordinated response at nationallevel, reaching out to communities, and resourcesmobilized and effectively used

n Mainstream environmental concerns in developmentplanning and operational capacity to respond moreeffectively to environmental issues and disasters

n Synchronize relationships between traditional andWestminster systems of governance


CCF 1997-2001n Poverty reductionn Sustainable livelihoodsn Sound governancen Cross-cutting themesn South-south cooperation

CCF 2002-2006n Transformation for human developmentn Integrated sustainable rural developmentn Holistic response to HIV/AIDS and povertyn Environment and development

CCF 1997-2000n Capacity building for good governancen Promotion of sustainable livelihoodsn Poverty reductionn Gender

CCF 2001-2005n Poverty reduction through establishment of a

policy environment and planning frameworkfor sound economic development and management targeting human and incomepoverty and addressing HIV/AIDS epidemic

n Strengthening national capacity for policyanalysis, decentralized planning and goodleadership, in order to increase social cohesionbased on participatory governance

61


Country

Zambia

Zimbabwe


CCF 1997-2001n Preparation of national policies, plans, strategies

and programmes

CCF 2002-2006n Create an enabling environment for achievement of

Millennium Development Goal commitments, in particular, halving poverty by 2015

CCF 1997-1999n Support national efforts to integrate poverty

reduction strategies into the macro-policy framework through pro-poor advocacy

n Build capacity of communities to respond better and more effectively to the challenge of alleviating poverty

CCF 2000-2003n Sustain the high level of consciousness of poverty

issues in Parliament, the government and nationallyn Support leveraged delivery of resources to at least

12 districts through provision of staff to assist communities and rural district councils

n National allocation of financial resources to povertyprogrammes, HIV/AIDS programmes and other social programmes

n Establish mechanisms for greater participation of private sector and civil society in macro-policy formulation through the work of the NationalEconomic Consultative Forum

n Enhance the capability of Parliamentary Committeesto influence and comment on draft bills


CCF 1997-2001n Good governancen Sound environment managementn Agriculture, rural development and

food securityn Gender and HIV/AIDS

CCF 2002-2006n Multisectoral responses to HIV/AIDSn Governancen Environment and natural

resources managementn Information and communications technology

and advocacy

CCF 1997-1999n Development managementn Poverty reductionn Environment management and regeneration

CCF 2000-2003n Poverty reductionn Development managementn HIV/AIDSn Cross-cutting themes

62

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 4. UNDP HIV/AIDS PROGRAMMES IN CASE-STUDY COUNTRIES

ANNEX 4. UNDP HIV/AIDS PROGRAMMES IN CASE-STUDY COUNTRIES

Country

Angola

Botswana

Comments

In the 1997 CCF, HIV/AIDSwas not an area of focusfor Angola. However, oneof the lessons learnedfrom this CCF was theneed to move away fromimplementing stand-aloneprojects with no upstreamlinkages to broader devel-opment policies andstrategies. HIV/AIDS wasthen included as a cross-cutting theme in the CCF 2001-2003.

HIV/AIDS Programme Components

CCF 2001-2003n Joint United Nations Programme

on HIV/AIDSn Incorporation of HIV/AIDS

concerns in school curricula incollaboration with the UnitedNations Educational, Scientificand Cultural Organization(UNESCO)

CCF 1997-2002n Strengthen central and district

level government institutionalcapacity and non governmentalorganizations (NGOs), togetherreviewing the needs and preparedness of key institutionsto respond to the likely impact of HIV/AIDS

n Strengthen applied research capacity

n Support efforts to combat HIVwithin organized target groups

Country Programme (CP) 2003-2007n Support the development and

implementation of an effectivenational HIV/AIDS monitoringand evaluation system

n Support capacity development atthe National AIDS CoordinatingAgency (NACA), key ministriesand District Multi-SectoralHIV/AIDS Committees

n Improve water, waste and sanitation management by supporting public-private partnerships for the urban environment and supporting the development of integratedwater resources management

Planned Outcomes/Results

CCF 2001-2003n Comprehensive strategies to prevent

the spread and mitigate the impactof HIV/AIDS

n Incorporation of HIV/AIDS concernsinto school curricula

CCF 1997-2002n Arrest the spread of HIV/AIDS

epidemic and mitigate its consequences

CP 2003-2007n Strengthen national coordination

capacity within government, the private sector and civil society organizations, including networks of people living with HIV/AIDS;support leadership and institutionalarrangements to respond to the pandemic at all levels

n Reduce both the prevalence and incidence of HIV/AIDS and mitigateits impact

Note – Programmes and projects are not necessarily mentioned in Country Cooperation Frameworks (CCFs).For example, the Southern Africa Capacity Initiative (SACI) was launched in 2004 and provides additionalresources for support (as in Zambia) to all case-study countries except Angola and Ethiopia. In addition, theLeadership Development Programme (LDP) is being implemented in only a few countries, and is not reflectedin CCFs, as in Ethiopia, Lesotho and Swaziland.

63


Country

Ethiopia

Lesotho

Malawi


CCF 2002-2006n Support to parliament and

justice sector reformn Civil service reform and

decentralizationn Public/private sector

programmen National capacity

developmentn PRSP and sector

programmesn HIV/AIDSn Food security

and agriculturen Promotion of information

and communications technology

CCF 2002-2004n United Nations Partnership

Programme to Combat theTransmission of HIV/AIDS

CCF 1997-2001n Support to formulation of a

multi-sectoral and resultsoriented national strategicframework

CCF 2002-2006n Development of a national

HIV/AIDS policy and legalframework that is sensitiveto gender and humanrights to guide HIV/AIDSmanagement

n HIV/AIDS mainstreaming inpublic and private sectorpolicies programmes andprojects, especially military

n Capacity building for coordinating and advocacyinstitutions for people living with AIDS (PLWA)

n Access to services andtechnologies to overcomethe HIV/AIDS pandemic

Comments

HIV/AIDS was not a programmearea or area of focus in the CCF1997-2001. It is a cross-cuttingtheme in the second CCF (2002-2006) and is to be mainstreamedinto all programmes.

HIV/AIDS was not a programmearea in the first CCF. It wasincluded in the second CFF(2002-2004) under the thematicarea of Poverty Reduction throughthe United Nations Fund forInternational Partnerships (UNFIP)Programme. After the 2002 general election, which providedan opportunity to focus ondevelopment, and the UN SpecialEnvoy Report on the TripleThreat, UNDP undertook a mid-year review of its CCF refocusingits efforts on using HIV/AIDS as astrategic entry point.This resultedin adoption of the scaling upbook as a policy manual and anew country programme CPD2005–2007 with four thematicareas: HIV/AIDS; democratic governance; poverty reductionand food security; and energyand environment.


CCF 2002-2006n Formulation of comprehensive justice

sector reform programmen Improved service delivery, efficiency,

effectiveness and transparency in civil service

n Building of strategic alliance for private sector development.

n Strengthened national capacity focalpoints to establish and coordinate thedevelopment of a national capacity framework

n Development of a multisectoralresponse to limit the spread ofHIV/AIDS and mitigate its social andeconomic impact

CCF 2002-2004n Raising awareness, improving access

to health services and counseling,and generating employment opportunities

n Pilot country for the We CareProgramme

n Unplanned inclusion in theLeadership Development Initiative

n SACI

CCF 1997-2001n Building broad ownership and

consensus around policy concerns onthe national response to HIV/AIDS

CCF 2002-2006n Improved capacity of the National

AIDS Commission to plan, coordinateand monitor the national response asenshrined in the Malawi NationalHIV/AIDS Strategic Framework by 2003

n Strengthened capacity at district levelto implement district HIV/AIDS plansby 2004

n Strengthened capacity of civil society,especially PLWAs,and community-basedorganizations to carry out advocacywork aimed at improving managementand control of HIV/AIDS by 2003

n Formulation of HIV/AIDS policy andlegal framework and adoption ofHIV/AIDS work place strategy by 2003

n SACI

64


Country

Namibia

SouthAfrica

Swaziland

Comments

HIV/AIDS was a cross-cutting theme in the reconstruction anddevelopment programme.


CCF 1997-2001n Integrated community-based

rural and urban poverty-reductiondevelopment programme

CCF 2002-2005n Ohangwena Poverty

Reduction Programmen UNV Support Programmen Capacity Building for Economic

Management Programmen Public-Private Partnership for

Urban Environment Programme

CCF 1997-2001n Reconstruction and development

CCF 2002-2006n Support to developing poverty

reduction models for 4 poorestprovinces

CCF 1997-2000n Mobilization of local authorities,

churches, legal firms and youthclubs to focus on differentaspects of the response toHIV/AIDS to offer counseling and testing, legal aid, education,care and support

CCF 2001-2005n Implementation of the National

Strategic Plan for a multisectoralresponse

n Promote research and studies ontraditional medicines and policyaction as well as a comprehen-sive communications strategy insupport of the national response

n Capacity-building for pro-poorand gender sensitive policydevelopment and sound macro-economic management


CCF 1997-2001n Extend basic social services to the

poor especially those with HIV/AIDS

CCF 2002-2005n Provision of adequate human

resources needed for effective implementation of the NationalDevelopment Plan 2

n Strengthened capacity for nationaland regional governments and private sector to address increasingproblems of urbanization

n SACI

CCF 1997-2001n Strengthened capacity of government

and other national partners to monitor the impact of HIV/AIDS onreconstruction and development

CCF 2002-2006n Poverty reduction models developed

with HIV/AIDS fully mainstreamedn SACI

CCF 1997-2000n Create awareness of the need

for comprehensive action to fightagainst the pandemic at all levels

CCF 2001-2005n Reduced spread of HIV/AIDS

as a result of an integrated and coordinated response at nationallevel, reaching out to communities,and resources mobilized and effectively used

n Documentation of findings on traditional medicines including formal recognition of the potential oflocal medicines and other affordableoptions for positive living

n Availability of anti-poverty and gender sensitive policies and strategies, the existence of enhancedbusiness skills development structures,improved microfinance facilities anda gender policy

n SACI

65


Country

Zambia

Zimbabwe

Comments

In the first CCF, HIV/AIDSwas a cross-cutting themein Zambia and a NationalHIV/AIDS strategy was formulated.

In the first CCF, HIV/AIDSwas a cross-cutting themebut the Country ReviewReport suggested that itshould become a thematicarea in the CCF 2000-2003.


CCF 2002-2006n Formulation of the HIV/AIDS

decentralized multi-sectoral policy and legal framework

n Strengthened capacity for assessing and monitoring thesectoral impact of HIV/AIDS

n Support to NGOs and civil societyorganizations to replicate successful district-level HIV/AIDSinterventions on a national scale

CCF 2000-2003n Adoption of a strategy to combat

HIV/AIDS and coordinate thelocal–level efforts into a comprehensive programme


CCF 2002-2006n Enhance the capacity of district-level

structures to implement the nationalHIV/AIDS strategy, to monitor theincidence and the impact ofHIV/AIDS, and to replicate in ruralareas the strategies that have reducedurban HIV/AIDS infection rates

n SACI

CCF 2000-2003n A comprehensive economic impact

assessment of HIV/AIDS to facilitatenational policy formulation

n Information dissemination and edu-cation, provision of condoms, supportfor home based care, and incomeprojects for care of orphans

n SACI

66

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 5. HIV/AIDS FINANCIAL DATA ON CASE-STUDY COUNTRIES

ANNEX 5. HIV/AIDS FINANCIAL DATA ON CASE-STUDY COUNTRIES

ANNEX 5A. INDICATIVE LIST OF UNDP HIV/AIDS PROJECTS IN CASE-STUDY COUNTRIES, 1999-2004 1

1 This list was prepared by a researcher employed by the UNDP Evaluation Office, under supervision of a member of the international consultantteam. Prior efforts by the Evaluation Office to assemble background data for the international consultant team were not successful. Duringreport preparation, the team was aware of the discrepancies between Table 5A and Table 5B. These discrepancies are more substantial than can be explained by the differences between planned spending (Table 5A) and actual spending (Table 5B). During review of the draftevaluation study, UNDP financial staff recommended deletion of the table, and construction of a detailed table along the lines of Table 5B byeach case-study Country Office. This was not feasible in the time remaining. The team decided to leave the table in its final report as a purelyindicative expression of UN HIV/AIDS Projects in the case-study countries. The financial data in Table 5A should be read as lower bound figures, as indicated by the differences between the Lesotho data in Table 5A versus Table 5B.

Country Project Planned Spending (USD)

Project UNDP Cost Sharing Total Year Number Resources Resources

Angola

1999-2003 No Projects

1999-2003 Subtotal 0 0 0

2004 Strengthening the Education System in Angola 11109 702,437 72,616 775,053

2004 Subtotal 702,437 72,616 775,053

Angola Total 702,437 72,616 775,053

Botswana

1999-2003 HIV/AIDS Support to the National AIDS Programme BOT96B01 0 635,976 635,976

1999-2003 HIV/AIDS Support to the National AIDS Programme BOT96001 1,559,604 5,148,896 6,708,500

1999-2003 NKAIKELA Youth Support Group BOT0004 37,864 0 37,864

1999-2003 NKAIKELA Youth Support Group BOT00H04 0 37,864 37,864

1999-2003 Subtotal 1,597,468 5,822,736 7,420,204

2004 HIV/AIDS 11625 0 394,000 394,000

2004 Reproductive Health & Promotion of Safer Sex 11630 0 262,609 262,609

2004 HIV and AIDS 11633 400,000 785,663 1,185,663

2004 Subtotal 400,000 1,442,272 1,842,272

Botswana Total 1,997,468 7,265,008 9,262,476

Ethiopia

1999-2003 HIV/AIDS Diagnostic & Screening Services ETH94316 201,251 0 201,251

1999-2003 Subtotal 201,251 0 201,251

2004 HIV/AIDS & Gender & Development 12473 0 236,051 236,051

2004 HIV/AIDS and Development 12479 2,044,350 0 2,044,350

2004 Subtotal 2,044,350 236,051 2,280,401

Ethiopia Total 2,245,601 236,051 2,481,652

Lesotho


1999-2003 Subtotal 0 0 0

2004 Joint UN Partnership on HIV/AIDS 13404 0 181,920 181,920

2004 Subtotal 0 181,920 181,920

Lesotho Total 0 181,920 181,920

67




Malawi

1999-2003 Support to HIV/AIDS:UNV Support to People Living With HIV/AIDS MLW99V01 300,000 0 300,000

1999-2003 HIV and Development MLW97007 1,763,769 169,515 1,933,284

1999-2003 Subtotal 2,063,769 169,515 2,233,284

2004 HIV/AIDS Management 13618 937,479 162,504 1,099,983

2004 Subtotal 937,479 162,504 1,099,983

Malawi Total 3,001,248 332,019 3,333,267

Namibia


1999-2003 Subtotal 0 0 0

2004 Support to National HIV/AIDS Strategic Plan 13957 340,000 0 340,000

2004 Acceleration of the Multi-sectoral Implementation of MTPII: National Strategic Plan on HIV/AIDS in Namibia 25778 0 27,192 27,192

2004 Support to National Strategic Plan on HIV/AIDS 25779 0 5,711 5,711

2004 Study on HIV/AIDS in Farming Communities 25781 0 172,609 172,609

2004 Subtotal 340,000 205,512 545,512

Namibia Total 340,000 205,512 545,512

South Africa

1999-2003 GIPA: UN Support for the Greater Involvement of People Living with HIV/AIDS SAF97016 298,597 43,363 341,960

1999-2003 HIV/AIDS in the Workplace: Guidelines for the Code of Good Practice: HIV/AIDS in the Workplace SAF00015 49,482 0 49,482

1999-2003 SIRF: UN Support to Integrated Response Framework to HIV/AIDS SAF00013 60,000 0 60,000

1999-2003 Subtotal 408,079 43,363 451,442

2004 Involving Youth in HIV/AIDS Programmes in South Africa 14668 0 945,525 945,525

2004 Prevention of HIV/AIDS 14676 0 877,635 877,635

2004 National Database 14679 0 186,958 186,958

2004 Integrated Response to HIV/AIDS 14680 711,570 4,805,645 5,517,215

2004 Subtotal 711,570 6,815,763 7,527,333

South Africa Total 1,119,649 6,859,126 7,978,775

Swaziland

1999 Development of a Comprehensive HIV/AIDS Community/Home Based Care and Prevention Programme in Swaziland SWA95003 100,357 63,280 163,637

1999 Joint UN Support to Combat HIV/AIDS: Joint UN Support to Develop Regional Capacity in Swaziland to Combat HIV/AIDS Among Adolescents SWA01H01 52,500 0 52,500

1999 Programme Acceleration Funds HIV/AIDS:Support to accelerate the Implementation of the HIV/AIDS Strategic Plan SWA00003 0 110,000 110,000

1999 Multi-sectoral Response to HIV/AIDS: Capacity Building for a Multi-sectoral Response to HIV/AIDS SWA00001 0 225,000 225,000

1999 Subtotal 152,857 398,280 551,137

2004 Sustainable Livelihoods 14884 0 0 0

2004 Joint UN Support to Combat HIV 14886 0 127,919 127,919

2004 Scaling Up VCT in all Four Regions 14887 0 2,524 2,524

2004 Joint UN Support to Combat HIV 14888 0 100 100

68




Swaziland (cont-d)

2004 Poverty Reduction and HIV/AIDS 14890 244,949 201,320 446,269

2004 Programme Acceleration Funds- HIV/AIDS 25906 0 5,983 5,983

2004 Development of a Comprehensive HIV/AIDS Community 25907 0 461,400 461,400Home-Based Care and Prevention Programme

2004 Subtotal 244,949 799,246 1,044,195

Swaziland Total 397,806 1,197,526 1,595,332

Zambia

1999-2003 Community Oriented HIV/AIDS Care Prevention and Support Project ZAM98002 563,304 0 563,304

1999-2003 UNAIDS Support to AIDS Institution: Institutional Support to National Programme, Professional Associations and Vulnerable Groups ZAM00005 10,000 860,000 870,000

1999-2003 Subtotal 573,304 860,000 1,433,304

2004 UNAIDS Support to AIDS Institution 15678 0 5,113 5,113

2004 Local Community to Mitigate Impact of HIV 15691 0 0 0

2004 HIV/AIDS District Response in Zambia 15682 1,030,625 0 1,030,625

2004 HIV/AIDS District Response in Zambia 33500 150,000 0 150,000

2004 HIV/AIDS District Response Output 3 34253 38,515 0 38,515

2004 Subtotal 1,219,140 5,113 1,224,253

Zambia Total 1,792,444 865,113 2,657,557

Zimbabwe

1999-2003 HIV/AIDS District Response Initiatives: HIV/AIDS District Response Initiatives United Nations Country Team In Zimbabwe ZIM00H07 3,499,650 0 3,499,650

1999-2003 HIV/AIDS Youth Project: HIV/AIDS Adolescent Reproductive Health Project ZIM00H06 1,202,826 0 1,202,826

1999-2003 Support To the National AIDS Council: Support for the National AIDS Council National AIDS HIV/AIDS Programme Coordination ZIM00010 1,256,000 0 1,256,000

1999-2003 Supporting Sentinel Surveillance System: Supporting Sentinel Surveillance System for HIV/AIDS in Zimbabwe ZIM0009 0 96,857 96,857

1999-2003 HIV/AIDS District Response Initiative: HIV/AIDS DistrictResponse Initiative in Selected Districts in Zimbabwe ZIM00002 0 571,429 571,429

1999-2003 Subtotal 5,958,476 668,286 6,626,762

2004 HIV/AIDS District Response Initiative 15697 0 424,881 424,881

2004 Support to the National AIDS Council 15699 -452,727 0 -452,727

2004 HIV/AIDS District Response Initiative 15700 0 2,118,386 2,118,386

2004 HIV/AIDS Youth Project 15701 0 493,258 493,258

2004 District Response Monitoring and Evaluation 15707 0 235,050 235,050

2004 Management & Coordination Support 15708 0 266,070 266,070

2004 HIV/AIDS Mainstreaming and Integration 15716 117,000 0 117,000

2004 Advocacy and Mass Media Campaign for HIV/AIDS 25966 0 23,363 23,363

2004 Supporting Sentinel Surveillance System 25967 0 2,037 2,037

2004 Subtotal -335,727 3,563,045 3,227,318

Zimbabwe Total 5,622,749 4,231,331 9,854,080

Grand Total 17,219,402 21,446,222 38,665,624

Notes: All figures are in U.S. dollars. Figures for 1999-2003 are from the UNDP Gateway financial system. Figures from 2004 are from the UNDP Atlasfinancial system. In late 2003, UNDP transferred its financial accounting from Gateway to Atlas. Cost sharing is the amount of money provided byother donors or recipient governments. The list consists of all UNDP projects in the ten case-study countries that have HIV or AIDS in their title ordescription in the UNDP Headquarters financial databases.

69


ANNEX 5B. DISAGGREGATION OF UNDP COUNTRY PROGRAMME SPENDING ON HIV/AIDS IN LESOTHO

Programme 2002 2003 2004 2005(actual, USD) (actual, USD) (actual, USD) (planned, USD)

Combating the Spread of HIV/AIDS Among Adolescent Girls (UNF) 18,676 262,546 177,628 17,000

Environmental Management for Poverty Reduction 40 000

Workplace HIV/AIDS Programme ‘We Care’ 10,000 20,000

Core-streaming of HIV/AIDS in Trade Sector 32, 000

HIV/AIDS Leadership Development Programme (LDP) 168,000 50,000

Core Streaming HIV/AIDS (Regional Project) 10,000 70,000Core Streaming HIV/AIDS (SACI) 75,000Core Streaming HIV/AIDS in Education Sector 10,000

Empowering Communities in Development Planning 12, 000 101, 860 101,860

Capacity Enhancement (Irish-funded) 137, 000 137, 000

Fighting HIV/AIDS with Traditional Leaders (Canada-funded) 35,000Fighting HIV/AIDS with Traditional Leaders (British-funded) 45,000

Scaling up the National Response to HIV/AIDS 70,250

Scaling up the National Response to HIV/AIDS (DfID-funded) 766,283

Total HIV/AIDS programme spending 88,676 521,406 921,738 833,283

Total programme spending* 1,917,917 3,075,815 2,181,195 1,746,283

Total HIV/AIDS programme spending as percentage of total programme spending (%) 4.6 17.0 42.3 47.7

*This reflects the total allocation of programme funds for the years 2002–2005 and is inclusive of HIV/AIDS programmes.

Source: UNDP Lesotho Country Office, March 2005

Note: The Lesotho Country Office (CO) staff are concerned that in a difficult environment for resource mobilization, the above amounts do notreflect the extensive involvement of the CO in scaling up the national response to HIV/AIDS. For UNDP Lesotho, HIV/AIDS was used as a strategicentry point to work with government on more effectively using its capacity and resources as a governance issue. It is therefore difficult to separatefunding from programmes since the CO, in re-positioning itself, put HIV/AIDS at the core of its business, whether be it governance, environment orpoverty reduction. To this extent, the CO undertook a revision of the second CCF to better reflect HIV/AIDS as a governance issue, addressingpolicies, stakeholder involvement, delivery of services, systems, and transformational leadership. As the Chair of the Expanded Theme Group, theResident Representative spearheaded the preparation of an integrated strategy for all stakeholders, titled ‘Turning a Crisis into an Opportunity:Strategies for Scaling Up the National Response to HIV/AIDS in Lesotho.’This strategy has been adopted as a policy document by the government.Consultations in this process involved the core part of the work of the CO over two years, and yet the allocation for funding of the document isvalued at USD 120,000, in the CO administration budget. This does not reflect the total CO commitment in time and personnel. Through advocacywork and collaboration with WHO, the CO has spearheaded a complete change in the roll out of the 3x5 Initiative and the understanding ofHIV/AIDS as more than a health issue and representing a major development challenge.The CO work led further to the launch of the national ‘KnowYour Status’ campaign spearheaded by the Prime Minister, UNDP support to restructuring the public service to more effectively deliver in light ofthe triple threat, and UNDP support to generate social mobilization in one of the remote districts affected by the triple threat to generate socialmobilization. The CO work in 2005 and beyond will build on this, as it endeavors to support the change agenda within the public service andelsewhere, especially at district level.

ANNEX 5C. GLOBAL FUND GRANTS FOR HIV/AIDS IN CASE-STUDY COUNTRIES

70


Source: Global Fund website, data as of April 23, 2005

APPROVED PROPOSALS GRANT AGREEMENTS & DISBURSEMENTS

Country Disease Approved Total Lifetime Principal Recipient Grant Grant Grant Amount AmountCompo- Grant Amount Budgets Number Signature (USD) Disbursed tonent (USD) (USD) Date Date (USD)

Angola 4 HIV/AIDS CCM 27,670,810 91,966,080 Not signed yet

Botswana 2 HIV/AIDS CCM 18,580,414 18,580,414 The Ministry of Finance and BOT-202- 04-Dec-03 18,580,414 9,019,119Development Planning of G01-H-00the Government of Botswana

Ethiopia 2 HIV/AIDS CCM 55,383,811 139,403,241 The HIV/AIDS Prevention ETH-202- 09-Oct-03 55,383,811 40,444,917and Control Office G03-H-00

4 HIV/AIDS CCM 41,895,884 401,905,883 The HIV/AIDS Prevention ETH-405- 11-Feb-05 41,895,884 19,390,093and Control Office G04-H

Lesotho 2 HIV/AIDS CCM 10,557,000 29,312,000 The Ministry of Finance and LSO-202- 10-Oct-03 10,557,000 4,419,252Development Planning of G01-H-00the Government of theKingdom of Lesotho

Malawi 1 HIV/AIDS CCM 41,751,500 267,176,782 The Registered Trustees MLW-102- 10-Feb-03 41,751,500 36,253,844of the National AIDS G01-H-00Commission Trust of the Republic of Malawi

Namibia 2 HIV/AIDS CCM 26,082,802 105,319,841 The Ministry of Health NMB-202- 23-Nov-04 26,082,802 809,947and Social Services of the G01-H-00Government of Namibia

South 1 HIV/TB CCM 14,354,000 70,354,000 The National Treasury of the SAF-102- 08-Aug-03 2,354,000 2,354,000Africa Republic of South Africa G01-C-00

The National Treasury of the SAF-102- 08-Aug-03 12,000,000 12,000,000Republic of South Africa G02-C-00

1 HIV/TB Sub 26,741,529 71,968,018 The National Treasury of the SAF-102- 08-Aug-03 26,741,529 12,873,456CCM Republic of South Africa G03-C-00

2 HIV/TB CCM 8,414,000 25,110,000 Not signed yet

3 HIV/AIDS CCM 15,521,457 66,509,557 The Provincial Health SAF-304- 25-Aug-04 15,521,457 8,282,075Department of the Western G04-HCape, South Africa

Swaziland 2 HIV/AIDS CCM 29,633,300 54,872,400 The National Emergency SWZ-202- 18-Jun-03 29,633,300 15,991,853Response Council on G01-H-00HIV/AIDS (NERCHA) of the Government of the Kingdom of Swaziland

4 HIV/AIDS CCM 16,396,800 48,283,310 Not signed yet

Zambia 1 HIV/AIDS CCM 42,298,000 92,847,000 The Central Board of Health ZAM-102- 30-Mar-03 21,214,271 16,936,307of the Government of Zambia G01-H-00

4 HIV/AIDS CCM 26,770,776 253,608,070 Not signed yet

Zimbabwe 1 HIV/AIDS CCM 10,300,000 14,100,000 The United Nations ZIM-102- 14-Apr-05 10,300,000Development Programme G01-H-00

Total forCase-Study Countries 412,352,083 1,751,316,596 312,015,968 178,774,863

Total forSub-Saharan Africa 1,849,781,705 4,859,050,959 1,441,942,501 611,673,956

Grand Totalfor Global Fund 3,274,421,318 8,062,745,795 2,423,643,364 1,121,170,573

Ro

un

d

Sou

rce

71


ANNEX 5D. COMMITMENTS OF OFFICIAL DEVELOPMENT ASSISTANCE FOR HIV/AIDS IN CASE-STUDY COUNTRIES, 2000-2003 (USD, MILLION)

Country 2001 2002 2003 2004

Angola 1.8 1.8 9.5 N/A

Botswana 3.9 11.6 10.0 29.6

Ethiopia 73 24 30.0 86.8

Lesotho 2.6 1.5 2.2 11.6

Malawi 13.1 24.7 23.6 134.8

Namibia 4.1 5.4 10.3 17.3

South Africa 19.5 24.9 43.8 140.1

Swaziland <0.5 1.0 2.0 N/A

Zambia 20.3 25.4 82.6 134.3

Zimbabwe 31.4 17.9 31.8 24.6

Total 169 138 246 579

N/A indicates not available.

Source: OECD/DAC data base and World Bank Global HIV/AIDS Programme, May 2005

6.1 ANGOLA

6.1.1 MethodologyDue to delays in completion of work by the nationalconsultant and his subsequent withdrawal from the task, the Angola country report did not followthe methodology of the other country case-studyassessments. Because of the importance attached byUNDP to inclusion of Angola among the countrycase studies, a member of the international consultantteam visited the country in February 2005 withoutprior preparation by a national consultant. A nationalconsultant without specialized health expertisejoined him for a week in the field. The two collecteddocuments, interviewed actors and stakeholders, andheld a validation meeting on tentative findings at the end of the week. On the basis of this fieldwork,the national consultant prepared a draft report under the guidance of the international consultant, whocompleted the study.

6.1.2 ContextDuring the past three decades, Angola’s ongoing civilwar has destroyed much of the country’s physical andsocial infrastructure. Angola’s HDI rank in 2004 was164--the weakest HDI ranking of the 10 case-studycountries, despite a per capita income of more thanUSD 850. With a settlement of the civil conflict in2002, Angola finds itself in transition. Developmentissues are only beginning to gain greater attentionfrom policy makers. At the time of the field work, aPoverty Reduction Strategy Paper (PRSP) was nearcompletion and discussions were under way with theBretton Woods Institutions about the possibility oforganizing a Consultative Group meeting of thecountry’s development partners.

Estimates of adult HIV prevalence in Angola havefallen in recent years, from 5.5 percent in 2001 to 2.8 percent in 2004. The civil war and the low sero-positivity in Angola have resulted in little attentionand few resources being allocated to HIV/AIDS.However, the increasing awareness of the situationelsewhere presents and opportunity for early inter-vention. In 2002, the National AIDS Commissionwas created with a mandate to coordinate and overseethe fight against AIDS and other epidemics atnational level. In 2003, a new National Strategic Planwas adopted, and an AIDS law was adopted 2004. In2005, the National Programme to Fight AIDS became

the National AIDS Institute, giving HIV/AIDS amore prominent place in the Ministry of Health. AnHIV-in-the-workplace law has also been approved.HIV/AIDS NGOs have evolved but have limitedcapacity and few financial resources. In addition, therewas a generally strained relationship between NGOsand the government at the time of the field work.

The financial situation of Angola concerningHIV/AIDS changed dramatically in 2004. A grantof USD 90 million was awarded from the GlobalFund to Fight AIDS, Tuberculosis and Malaria(GFATM) under Round 4, after rejection of previousproposals. In addition, the World Bank committedUSD 21 million for HIV/AIDS, TB and malaria(HAMSET) in 2004.72

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 6. COUNTRY CASE-STUDY SUMMARIES

ANNEX 6. COUNTRY CASE-STUDY SUMMARIES

UNDP experience in Angola points to several strategic issues.

n The importance of defining and communicatingUNDP’s country strategy and roles on HIV/AIDS toall stakeholders.

n The successful identification of a new niche forUNDP as facilitator of access to external resourcesfor HIV/AIDS from external partners.

n The importance of moving beyond small-scale UNDPpilot projects and assisting in designing,establishing,and facilitating the financing of expanded programmes when the pilots are successful.

n The critical importance of Country Office capacityfor supporting HIV/AIDS projects and programmes.

n Making outcome-oriented monitoring and evalu-ation a central part of UNDP activity.

In the future, UNDP should:

n Build on opportunities to prevent HIV transmissionwhile HIV seroprevalence is still low through formation and communication of an updatedcountry HIV/AIDS strategy integrating all UNDPHIV/AIDS-related activities carried out in Angolaregardless of their sources of financing.

n Make capacity development of AIDS institutionsand effective use of new donor financial resourcescentral to its HIV/AIDS work in Angola.

n Expand its work on mainstreaming in the educationsector and with CSOs – they are key to future success.

n Strengthen the HIV/AIDS capacity of the UNDPCountry Office, including its capacity for outcome-oriented evaluation of projects and programmes –also a condition for UNDP success.

Strategic Issues and Key Implications ofMain Report for UNDP Action in Angola

73


During the evaluation period, four main changeswere observed: (a) Increased awareness of HIV amongAngolan leaders; (b) Limited increase in countrycapacity for addressing HIV/AIDS, in the public, privateand NGO sectors; (c) Creation of a framework ofpolicies and institutions for action on HIV/AIDS,which at the time of the evaluation still had not beengiven sufficient Angola-specific content and operationalcharacter; and (d) Commitment of significant newexternal financial resources for HIV/AIDS from theGlobal Fund and the World Bank.

6.1.3 UNDP responseDuring the civil war, the main United Nations familyactors in Angola were the UN Office of theCoordinator for Humanitarian Affairs (OCHA) andthe World Food Programme (WFP). UNDP wasrelatively inactive, and the Resident Coordinator and Theme Group leader was from WFP. Therewere discontinuities in staffing of the ResidentRepresentative position, and the 2001 UNDP staffre-profiling exercise was perceived to have weakenedCountry Office HIV/AIDS capacity. At the time ofthe evaluation, the Representative expressed a wish todeepen UNDP’s engagement on HIV/AIDS.

In 1999, UNDP supported the first socioeconomicimpact study of HIV/AIDS in Angola, and in 2001it sponsored a survey of the perceptions andknowledge of Angolans regarding HIV/AIDS. Thisled to a 2002 UNDP project, Strengthening theEducation System in Angola to Combat HIV/AIDS.Its aim is to reduce the impact of HIV on the Angolaneducation system, but the project has reached outbeyond the education sector. In 2002, UNDP facilitatedan AIDS study tour of an Angolan senior politicaldelegation to Uganda. UNDP provided technicalsupport in the formulation of the National StrategicPlan and in the preparation of the Angola proposal tothe Global Fund. UNDP was also involved indrafting the AIDS law and facilitated the integrationof HIV into the Interim PRSP. The UNDP CountryOffice has also made efforts to tackle HIV in theworkplace within UNDP itself. In January 2004,UNDP was selected as principal recipient (PR) forthe Global Fund grant. As PR, UNDP will beresponsible for funds management, monitoring andevaluation, and building government capacity to takeon the PR role within two to three years. At the timeof the evaluation, the UNDO CO was working toimplement a larger programme of HIV/AIDS activitieswith several other development partners.

6.1.3.1 Outcomes associated with UNDP responseGovernance: The UNDP Country Office focalperson is widely thought to have contributed greatlyin the work of the technical group preparing theNational Strategic Plan (NSP). Much of thebackground information contained in the NSP onprojections, impact, and attitudes came from UNDPstudies. The NSP has been translated into provincialplans in a process that also benefited from UNDPinput. At the time of the evaluation, there was still aneed to operationalize these provincial plans. UNDPassisted in the establishment of the National AIDSCommission (NAC). The NAC is led by thePresident of Angola and composed of ministers andvice-ministers from several ministries, as well asrepresentatives from the medical faculty of the publicuniversity and the armed forces. However, it was notoperational at the time of the field work for theevaluation and does not include NGOs, especiallypeople living with HIV/AIDS (PLWHA). Severalstakeholders saw an opportunity for UNDP tointervene in clarifying the relative roles and responsi-bilities of the NAC and other AIDS institutions,especially the Country Coordination Mechanism.

Leadership: While there were still reports of tensionbetween NGOs and public officials, there is agrowing space for NGOs and CSOs in the politicaland social fabric of Angola. UNDP’s ResidentRepresentative and Country Office staff havecontributed to this result through parliamentarycontacts, Country Office staff facilitation, and aprogramme to support national NGOs. UNDP hasassisted the embryonic AIDS umbrella organizationANASO. Discontinuities in leadership and staffingof the UNDP Country Office reduced the effectivenessof UNDP’s support in this area. The HIV/AIDSstudy tour of Angolan personnel to Uganda, whilehaving considerable potential, involved a lower leveldelegation than anticipated and had little follow-upand no apparent impact.

Capacity development: Public officials and otherstakeholders have increased their knowledge ofHIV/AIDS and associated issues. UNDP’s supportfor AIDS studies, and its associated advocacy activities,contributed to this result. There is also growingawareness of HIV among UNDP Country Office staff,and the “We Care” UNDP workplace programmeand the work of the human resources staff in theCountry Office have contributed to this. The CountryOffice has not drawn on other UNDP instruments

for capacity development support, such as L4R and UNV.

Mainstreaming: The UNDP-supported project with theMinistry of Education has initiated the integrationof AIDS into school curricula, with training of socialactors in two provinces. The project has facilitatedparticipation of local NGOs by integrating them intoprovincial units, expanding delivery capacity,promoting community involvement, and engagingPLWHA. The project has established a small,well-regarded pilot but not a practical, financableinvestment proposal for scaling-up the response.

Partnership coordination for country results: Relationsamong AIDS Theme Group partners were sound atthe time of the evaluation. However, opportunitiesfor synergy and outspoken leadership with thegovernment and within the donor communityseemed to have been missed—in part due to a failureadequately to define the UNDP Country Officestrategy and role in HIV/AIDS and to communicatethat information to UN agency partners and beyond.As a result, UNDP was perceived to have a dispersed,un-conceptualized, and often unknown programmeand strategy on AIDS in Angola. One strategy mightbe that of opportunity and of filling gaps left byothers, however, this did not seem to be the case atthe time of the evaluation. The advent of largeGFATM and WB funding commitments providesUNDP an opportunity to position itself as facilitatorof access to those and possibly other financialresources, but this would mean a willingness to takea less visible role. It would also require equipping theCountry Office, either directly or through regionalprojects, with capacity to assist in transitioning pilotprojects to large-scale programmes.

Monitoring and evaluation of the outcomes ofUNDP’s HIV/AIDS-related work in Angola hasreceived no attention. This has weakened UNDP’sability to recognize successes, disseminate informa-tion, learn from failures, and facilitate sustainableUNDP projects.

6.2. BOTSWANA

6.2.1 MethodologyThe Botswana country assessment was conducted bya national consultant with support from a designatedinternational consultant, although the internationalteam did not visit Botswana. The assessment

involved documentation review, interviews of keyinformants, and group discussions using standardinterview guides. Three districts were visited andfocus group sessions were held with communities. Astakeholders’ validation workshop was held to discussfindings and to provide feedback to persons andinstitutions who were engaged in the data collection.

74


UNDP experience in Botswana points to several strategic issues.

n UNDP has a comparative advantage as a strongpartner in catalyzing actions for district levelresponses to the epidemic, and related gover-nance and capacity development. This has earnedthe agency credibility. It has leveraged domesticresources in some districts, and the opportunity toscale up this experience is high.

n Support to civil society as a parallel track for a comprehensive national response has been initiated, but these efforts have apparently notbeen systematic enough to create the momentumrequired for civil society to enter into partnershipwith government for managing the nationalresponse. UNDP’s credibility among civil societyorganizations could be further exploited to boostsynergy between government and civil society.

n Interventions such as assisting ministries withmainstreaming HIV/AIDS into operational planshave not been harnessed to sufficiently meet programme requirements. A more rigorous planfor priority setting and increased support forcapacity development would appear to be a critical next step in support of national level institutions in their efforts to mainstream andimplement HIV/AIDS initiatives.

n Leveraging other funding resources from govern-ment and other donors can enhance the scale andoutcomes of UNDP support considerably.

In Botswana, UNDP should:

n Continue, strengthen, and expand existing inter-ventions, especially on capacity development,particularly, at the “mid-stream”decentralized level.

n Identify roles that build on comparative advantagesand complement the initiatives of other externalpartners, especially PEPFAR and GFATM, and external partners with less in-country presence.

n Updated its HIV/AIDS country strategy, to givegreater emphasis to priority-setting, CSO collabo-ration, mainstreaming HIV/AIDS into other UNDPprogrammes and activities, and initiating a UNDP-UN “We Care” workplace programme.

n Strengthen monitoring and evaluation andknowledge-sharing.

Strategic Issues and Key Implications ofMain Report for UNDP Action in Botswana

75


6.2.2 ContextBotswana is a large country, mostly desert, with apopulation of 1.7 million. The country is classified asmiddle income due to strong economic growth,based mainly on diamond mining. However, 37percent of the population still live below the povertyline. Botswana was ranked 126 in the HumanDevelopment Index of 2003.

The HIV/AIDS epidemic in Botswana is one of theworld’s most severe. Sentinel Surveillance resultsshowed a rise in the rate of HIV/AIDS infectionfrom 18.1 percent in 1992 to 35.7 percent in 1998.By 2003, 37.3 percent of people aged between 15-49years were believed to be infected with HIV. Anestimated 43,000 children have lost their parents toHIV/AIDS.

Botswana’s Short Term Plan of Action (1987-1989)focused on preventing infection through bloodtransfusion. The Medium Term Plan I (1989-1997)prioritized public awareness and prevention throughABC (Abstain, Be Faithful, and use Condoms)strategies. The Medium Term Plan II (1997-2002)and the National Strategic Framework (2003-2009)adopted a multi-sectoral and multi-level participa-tory approach, and strengthened systematic andstrategic coordination of interventions. In 1993, theNational HIV/AIDS Policy was launched. At thetime of this evaluation, this document was beingrevised to address current developments, includingantiretroviral therapy (ART).

Strong political leadership on HIV/AIDS has beenprominent since the late 1990s. The institutionalbase of the response has evolved from theHIV/AIDS/STD Unit in the Ministry of Health, tothe National AIDS Council (NAC) and the NationalAIDS Coordinating Agency (NACA). Provincialand district level structures have been created andthey are receiving support through the nationalbudget system.

The focus of national strategy includes prevention,care and support, and impact mitigation. TheBotswana national ART programme that was started in2001 was the first in Southern Africa. Approximately23,000 people were receiving ART by August 2004, butan estimated 110,000 people were still in need of ART.

6.2.3 UNDP responseUNDP Botswana was the first of the CountryOffices in the 10 case-study countries to develop

HIV/AIDS interventions. Between 1997 and 2003,UNDP focused on capacity development in policy,institutional strengthening and improving servicedelivery systems. Capacity development targetedcentral and district level institutions, disciplinedforces, civil society organizations (CSOs) and appliedresearch. In the late 1990s, UNDP began supportingthe HIV/AIDS/STD Unit in the Ministry ofHealth, which was responsible for coordinating thenational response to HIV/AIDS. It has subsequentlysupported NACA in its coordination of theimplementation of a multi-sectoral approach toHIV/AIDS. UN Volunteers (UNVs), technicalsupport, and training have been provided to theHIV/AIDS/STD Unit, NACA, NGOs, lineministries and District Multi-Sectoral AIDSCommittees (DMSACs) in support of the nationalresponse. UNDP has also had innovative approachesto use of Information Communication Technology,particularly an interactive Talkback programmefacilitating teacher-participant communication onHIV/AIDS.

Since October 2003, a new UNDP programme hasbeen implemented. It aims to strengthen capacity fora gender-sensitive multi-sectoral response to HIV/AIDS, focusing on four areas: community conversationdialogues, leadership training, mainstreaming HIV/AIDS, and gender and teacher capacity development.

6.2.3.1 Outcomes associated with UNDP responseGovernance: UNDP has had a key role in helping toredefine structures and develop a more participatory,decentralized approach to managing and implement-ing the national response to HIV/AIDS. Theseefforts have created stronger structures within localgovernment that are coordinating community-levelawareness and programmes for impact mitigation. Inparticular, UNDP’s support at the district level wascritical in the emergence of DMSACs and VillageAIDS Committees to facilitate, coordinate andimplement HIV/AIDS interventions. UNDPadvocacy also facilitated the appointment of DistrictCommissioners or Council Secretaries as the Co-Chairs of DMSAC. UNDP has provided UNVs,finance, training and other technical assistance foreach of the districts. Several districts have elaboratedsituation and response analyses, and developedstrategic plans with UNDP and SIDA support.District AIDS Coordinators have assumed previousUNVs’ roles in some districts.

At the national level, UNDP has influenced develop-ment of governance institutions since it begansupporting the HIV/AIDS/STD Unit. UNDPadvocacy and support are considered to have been animportant contribution to the formation of the NAC,NACA and Department Committees. Advocacy hasalso boosted the authority of HIV/AIDS structuresby situating NACA in the Office of the Presidentand elevating the NACA Coordinator’s post to thePermanent Secretary level. UNDP has also beenintegral to producing national HIV/AIDS strategicplanning frameworks by supporting processes thatdeveloped and refined the National Policy onHIV/AIDS and the National Strategic Frameworkand its Operational Plan. These have helped toclarify the roles of HIV/AIDS structures.

Effective functioning of many components of thegovernance system has been an ongoing challenge.However, overall, UNDP support is considered to haveimproved coordination and community mobilization,resulting in greater involvement of CSOs, localauthorities and private sector institutions in decisionsand policy making at all levels. UNDP assisted inclarifying the roles of CSOs and other key stakeholdersin the national response. Ownership of interventionswas reported to be moving to communities, andPLWHAs are increasingly assuming leadership rolesin programmes at national and local levels.

Another key role that UNDP played was to emphasizethe notion of HIV/AIDS as a development issue.This has been reinforced by support for improvedinformation generation and dissemination. TheBotswana UN Human Development Report 2002was the first to focus on HIV/AIDS. This report,impact studies and other publications have providedinformation that made significant contributions tomobilizing awareness and support for the HIV/AIDS response, particularly at the early stages of theresponse. They have influenced subsequent policy,planning and actions, including policy on roll out ofART and mainstreaming by the public service andother line ministries. However, it was difficult toassess how new forms of information are beingutilized, especially, the lessons learned in managingnew information and the knowledge generatedthrough UNDP support.

Botswana is a country where UNDP has promotedgender mainstreaming in conjunction with HIV/AIDS programmes. UNDP advocacy, research,

Human Development Reports, and training werespecifically noted to have contributed to bringinggender issues and involvement of women into thenational response. However, UNDP still missedopportunities to build on its gender-specificinterventions. Strengthening the Women’s AffairsDepartment and development of national genderframeworks had little follow-up support forimplementation, and were not linked withHIV/AIDS programmes to enhance mainstreamingin both directions.

Leadership: UNDP has facilitated stronger leadershipin the HIV/AIDS response at the national, district,and community levels through advocacy, training,study tours and exposure to best practices. UNDPadvocacy also seems to have contributed to strongpolitical leadership by the President, who chairs theNAC, other political leaders and officials, andPLWHAs. At the operational level, programmemanagers have increasingly provided sound leadershipto improve collaboration among key stakeholders.

The scale of outcomes of leadership development inBotswana was reported to have been greatly increasedby supplementary funding from the government—animportant indication of growing national ownershipfor the coordinated response to HIV/AIDS. One ofthe challenges, however, was the limited scale-up ofleadership development instruments and techniquesintroduced by UNDP. While increased resourceswere found to be available for programming at thedistrict level, they were not necessarily beingdeployed to fund the issues, such as leadership fordevelopment, which have a high potential for impacton HIV/AIDS planning and management.

Capacity development: UNDP played a critical role indeveloping the capacity of the HIV/AIDS and STDUnit in the Ministry of Health, and subsequentlyNACA, through training, deployment of UNVs, andother technical assistance. This has contributedsubstantially towards the ability of these institutionsto carry out their responsibilities, including thesupport to ART roll-out. In addition, capacityenhancement through training, planning exercisesand technical assistance to various ministries waswidely considered to have improved planning relatedto HIV/AIDS.

UNDP played a groundbreaking role in developingDMSACs early in the period under review. A76


77


number of DMSACs have proved to be sustainableand have played effective roles in the HIV/AIDSresponse. DMSACs and Village AIDS Committeeshave enhanced community capacity to prevent andmitigate the impact of HIV/AIDS.

UNDP support is also considered to have enhancedthe capacity of CSOs. It supported the establishmentof network organizations such as BONELO,BONEPWA and BONASO at a time when civilsociety’s role in the response was minimal or absent.However, an overall weakness of UNDP’s efforts tostrengthen civil society was lack of appropriate exitstrategies to ensure sustainability of organizationsonce UNDP withdrew support.

A feature of UNDP involvement has been thestrengthened involvement of PLWHAs at thenational and lower levels, through support to NGOs,promoting PLWHA involvement, and support forthe formation of PLWHA support groups. This hasbeen instrumental in achieving greater representation,involvement, destigmatization, care and support.

Mainstreaming: UNDP has had a substantial role inincreasing acceptance of the multi-sectoral nature ofHIV/AIDS and mainstreaming in Botswana, one ofthe earliest outcomes in this area in Southern Africa.Advocacy, planning, research and other processessupported by UNDP have facilitated mainstreamingof AIDS into the health sector, public servicemanagement, labour, education, agriculture andfinance. UNDP was instrumental in advocating forthe appointment of ministry HIV/AIDS focalpersons, development of sector plans, and HIV/AIDS workplace programmes. Nearly all publicsector institutions are now implementing HIV/AIDSworkplace programmes. However, there has been norigorous evaluation of these interventions to determinetheir impact. There are concerns that policies, plansand programmes may achieve limited impact.

UNDP has also enhanced mainstreaming and multi-sectoral involvement at district and local levels.DMSAC initiatives have been a catalyst forenhanced understanding, planning and action at thedistrict level, although results vary and obstacles toeffective multi-sectoral action still exist at this level.

It is important to note that UNDP Botswana—despite its focus on mainstreaming in governmentand other sectors–is not mainstreaming HIV/AIDS

into its own programmes, such as in the povertyreduction and environment programme, In fact, theevaluation found no UNDP-UN HIV/AIDSworkplace programme.

Partnership coordination for country results: UNDPhas played an important role in building inter-agencysynergy. UNDP, to a large extent through theresident coordinator, has played a key role in the UNTheme Group and was instrumental in forming thePartnership Forum. This forum includes donors, theprivate sector, and CSOs and is reported to haveimproved information sharing and collaboration,including several joint projects. The important rolesplayed by other partners in this connection must,however, be acknowledged. The environment forfinancing in Botswana, as in other countries, wasfound to be complex and sometimes competitive,even among UN agencies.

An important aspect of UNDP work in Botswanahas been helping to mobilize resources from externalpartners. UNDP has been part of joint UN initiativeswith the government to develop Global Fundproposals, access funds and implement projects fromPEPFAR, and to mobilize funding from foundationsand bilateral donors.

6.3 ETHIOPIA

6.3.1 MethodologyThe country assessment was undertaken in late 2004by a national consultant who was joined by aninternational consultant for a week to conclude datacollection. It was based on documentary evidence,extensive interviews using interview guides, groupdiscussions, a visit to Leadership DevelopmentProgramme (LDP) training and CommunityConversation (CC) sites, and a validation workshopto complete the triangulation.

6.3.2 ContextEthiopia is a large country with more than 70 millionpeople. Of these, 87 percent live in rural areas and arelargely dependent on subsistence agriculture.Ethiopia’s 2004 HDI rank was 170, the lowest amongthe study countries, despite gains since the mid 1980s.In addition to addressing chronic developmentchallenges such as food insecurity, the country is stillrebuilding from the civil war. The per capita GDPwas USD 90 in 2002, and around 45 percent of thepopulation lives below the absolute poverty line.

78


HIV prevalence among pregnant women reached12.6 percent in urban areas in the 1990s and seems tohave been level for the last seven years. In rural areas,it has risen slowly to approximately 2.6 percent andmay be reaching a plateau. By 2003, there were anestimated 2.2 million Ethiopians living with HIV/AIDS and 1.2 million HIV/AIDS-related orphans.

In 1985, the Ethiopian government established aNational Task Force on HIV/AIDS. The Ministry ofHealth (MOH) developed and implemented the firstMedium Term Plan (1987-1990) and then thesecond Medium Term Plan (1992-1996). Thegovernment approved a comprehensive HIV/AIDSpolicy in 1998 that created an environment for amulti-sectoral response. In recent years, efforts havebeen made by the government, NGOs, the privatesector and development partners to put in placepolicies, strategies, systems and institutions neededfor the national response. A National AIDSPrevention and Control Council, chaired by the

President and involving civil society, was establishedin 2000. The HIV/AIDS Prevention and ControlOffice (HAPCO), which serves as its Secretariat,had moved from the Prime Minister’s Office to theMOH at the time of the evaluation. RegionalHAPCOs have also been formed. The HIV/AIDSStrategic Plan (2000-2004) was formulated withvarious stakeholders’ input, and the National AIDSPriority Strategies (2001-2005) were also identified.Some 170 local and international NGOs are involvedin HIV/AIDS.

During the past five years, awareness of HIV/AIDShas reached high levels. Capacity development forgovernment and civil society has been progressing, ashave efforts to increase access to care and support,including antiretroviral therapy (ART). Institutions,policy and strategic frameworks have been put inplace to combat HIV/AIDS. Ability to coordinateand drive the national response has been limited, butestablishment and recent clarification of mandates

At the time of the international consultant visit, many UNDP EthiopiaHIV/AIDS initiatives had only recentlybeen implemented. There were indications of changes due to UNDPprogrammes in targeted communities,civil society and government, but theoutcomes remain to be seen.However,UNDP experience in Ethiopia pointsto several strategic issues:

n UNDP’s good relationship with thegovernment was an importantcomparative advantage.

n The Resident Representative andother UNDP staff have a markedinfluence on UNDP’s potential toachieve significant outcomes inHIV/AIDS.

n UNDP showed ability to developinnovative methods to tackle HIV/AIDS. Community conversationmethods were particularly pow-erful at integrating HIV/AIDS anddevelopment issues.

n UNDP Ethiopia was developingways to scale up and consolidateinterventions at the time of theevaluation. However, the size ofEthiopia and its resource con-straints highlight the need forfocused consideration of exit

strategies, duration of funding,sustainability and scaling up withgovernment and other partners.

n The future of some civil society andcommunity initiatives stimulatedby UNDP was uncertain at thetime. Stronger monitoring andevaluation of interventions wouldhelp to substantiate their efficiencyand outcomes, refine them, andcreate a firmer foundation forscaling up and sustainability.

n Enhancing capacity and resourcesfor Country Offices, includingtheir ability to access support, isan important determinant of theirability to achieve and ensure sustainability of results. Inter-ventions such as the LeadershipDevelopment Programme andCommunity Conversations, whichmay be taken over by other donorsor local actors, raise questionsabout potential UNDP roles(such as technical support andquality assurance) in the followup and scale-up phase of pilotedinterventions.

n Overall, increased urgency needsto be given to HIV/AIDS through-out UNDP work in Ethiopia.


n Learn from Ethiopia’s experience inscaling up innovations, promot-ing sustainability, and facilitatingeffective use of partners’increasedfunding for HIV/AIDS.

n Increase emphasis on programmerather than project support,within the framework of anupdated UNDP country HIV/AIDSstrategy integrating all UNDPHIV/AIDS activities and funding.

n Prioritize support to provincialand local authority levels.

n Strengthen and expand capacitydevelopment, based on priorexperience of country-level and piloted activities, and givegreater attention to mainstream-ing HIV/AIDS.

n Review the roles and capacitiesof the Resident Representative,Resident Coordinator, and CountryOffice for dealing with HIV/AIDS,and adopt a more assertive public policy posture with thehost country authorities.

n Strengthen monitoring and evaluation of HIV/AIDS activities.

Strategic Issues and Key Implications of Main Report for UNDP Action in Ethiopia

79


around the HAPCO system should enhance abilityto act.

A large number of development partners are involvedin HIV/AIDS in Ethiopia, including virtually all UNagencies and a number of bilateral agencies.Substantial external resources have been available tosupport action on HIV/AIDS, with significant newfinancial support from the World Bank, GFTAMand PEPFAR. The major financial contributorsthrough HAPCO (total in 2004 USD 50 million)were the Global Fund (43 percent) and the WorldBank Ethiopian Multi-Sectoral AIDS Project(EMSAP) (42 percent). Other partners have notalways funded through HAPCO but may use thischannel more now that HAPCO’s position is clearer.

6.3.3 UNDP responsePrior to 2002, UNDP had no specific HIV/AIDSprogramme in Ethiopia and focused on povertyreduction, reconstruction and institutional development.In 2001-2002, the Support Services for Policy andProgramme Development on HIV/AIDS andDevelopment assessed possible areas for HIV/AIDSsupport and informed the follow-up programme.Since UNDP’s commitments to HIV/AIDS wererecent at the time of the evaluation, it was difficultfor the team to discern outcomes. More results couldbe expected in the future.

UNDP’s HIV/AIDS and Development Projectfocused on governance issues and developing leader-ship in the government and civil society for responsesto HIV/AIDS. The project has several components:1) Strengthening development planning. Capacity

development, research and informationgathering have been used to enhance planningand mainstreaming HIV/AIDS into the draftPoverty Reduction Strategy Papers (PRSP) andother initiatives, including the EthiopianStrategic Plan for Intensifying Multi-SectoralHIV/AIDS Response (2004-2008).

2) Leadership and capacity development for socialmobilization. The LDP has cultivated new skillsamong leaders in government, AIDS councils,civil society and the private sector. TheCommunity Capacity Enhancement Approachhas used CCs to stimulate open discussion andempower communities to address stigma, preventionand support, initially in two woredas (districts)where HIV risk was assessed as being high.

3) Human rights. This includes support for legislative

and policy change, along with empoweringPLWHA and organizations promoting humanrights, women’s rights and PLWHA issues.

4) Communication and advocacy. This aims to buildan enabling environment through the action andexample of new leaders. Training and workshops,including an Arts and Media Workshop havebeen held. Future 500, an innovative mediacampaign using role models, has been launched.

5) Mainstreaming HIV/AIDS. This has begun tointegrate HIV/AIDS in UNDP-supportedprogrammes under Country CooperationFramework II including regional planning,decentralization and workplace interventions.The intention has been to develop capacity of thegovernment, civil society, the private sector andUNDP programme managers to mainstreamHIV/AIDS into their plans.

Other governance components (such as the CivilService Reform Programme) and pro-poor componentsof the UNDP country programme have potential fordirect or indirect contributions to combat HIV/AIDS.

6.3.3.1 Outcomes associated with UNDP responseGovernance: UNDP involvement helped increaseinclusiveness and thus broad-based nationalownership of recent HIV/AIDS policy, strategy andprogrammes, although there is still room forimprovement. There are strong indications thatparticipatory approaches at the community level andsome LDP breakthrough initiatives such as MothersAgainst AIDS have helped to empower communitiesand vulnerable groups such as women and PLWHA.

UNDP has also contributed to recognizing the rightsof PLWHA and reducing stigma. At the pilotcommunity level, PLWHA reported that CCs hadcreated a more supportive and less stigmatizedenvironment. The Media and Arts initiative isthought to have led to more advocacy for an HIV/AIDS response, as well as more open and sensitivereporting on HIV/AIDS issues. UNDP involvementin revision of the penal code has helped to make itmore sensitive to gender, sexual health and harmfultraditional practices.

Empowerment of women appears to be a prominentfeature of changes related to certain projects. This hasmanifested itself most notably in the recentformation of a National Coalition of WomenAgainst AIDS (NCWA), as well as in empowerment

of women and reported changes in traditionalpractices such as female genital mutilation incommunities involved in CCs.

There were also indications that involvement ofregional HAPCOs and other leadership in LDP hashelped to strengthen decentralized systems forHIV/AIDS responses, particularly in the SouthernNations Nationalities and Peoples Region (SNNPR).

Leadership: UNDP has enhanced leadership onHIV/AIDS in several spheres, particularly throughthe LDP. This has reached approximately 750trainees from diverse levels and areas of work. Anumber of testimonies show that the programme has led to substantial changes in the attitudes andleadership approach of some trainees. Requests toincorporate LDP methodology into routine civilservice training also suggest that it is seen aseffective, and UNDP was working to institutionalizeLDP in 2005. Several sources commented that LDPhad contributed to clearer understanding amongleaders of roles in the HIV/AIDS response.

At the national level, a number of parliamentariansand government officials have been reached by LDP.National and regional presidents were present atevents such as launching of CCs. Initiatives such asthe NCWA and Ethiopian Volunteer MediaProfessionals against AIDS (EVMPA) have not beenestablished for long, but seemed to be providingleadership. Initiatives to engage influential religiousleaders have won commitment of various denomina-tions to new projects to mainstream HIV/AIDS intheir development and spiritual work.

Limited regional and community level leadership onHIV/AIDS is a particular challenge. LDP appears tobe important in building leaders’ commitment andskills, and clarifying their roles, particularly inSNNPR. At the community level, CCs alsoenhanced leadership for HIV/AIDS responses in thepilot communities.

It was noted that the UNDP Resident Representative(RR) had previously provided strong leadership onHIV/AIDS issues within the donor community andin interactions with government.

Questions remained about whether UNDP hasmanaged to establish a critical mass of effectiveleadership on HIV/AIDS. Steps have been taken to

form an LDP alumni group, but uncertainty remainsabout the longer term effectiveness and sustainabilityof key changes.

Capacity development: UNDP has had a role indeveloping more widely applicable knowledge,methodologies, tools and capacity for use in relationto LDP and CC. A cadre of LDP trainers hasemerged with skills to take LDP forward, the NGOKembata Women Self Help Organization has anemerging role in supporting implementation of CCby other projects, and other donors were starting touse CC methodologies, with potential support froma CC Implementation Guide that was beingdeveloped at the time of the evaluation.

The most widely cited outcomes were in relation toCC communities, where there was substantialqualitative evidence of changes in individual andcollective knowledge, attitudes and, in some cases,practices. Beyond this level, UNDP initiatives haveincreased awareness and knowledge of HIV/AIDSamong targeted leadership cadres at national,regional and civil society levels. There has been someprogress in rolling out CCs, which were beingadopted by other partners and government at thetime of the evaluation, but achieving results on therequired, less localized scale remained a challenge.

Other human and organizational capacity to respondto HIV/AIDS has been developed through initiativessuch as Media and Arts, EVMPA and the Women’sCoalition. However at the time of the evaluation,there was not much indication of how effective andsustainable these initiatives will be. Several CSOsand NGOs indicated that UNDP funding andsupport for initiatives were not always reliable, whichcan threaten their effectiveness and sustainability.

Informants reported that UNDP had reinforcedHIV/AIDS responses by providing and leveragingcapacity on HIV/AIDS issues that were in relativelyshort supply in Ethiopia at earlier points in theperiod under review. No clear outcomes from otherUNDP knowledge generation, such as studies onHIV/AIDS impact on food security and genderissues, were reported.

Potential roles of UNDP in developing regional andlower level capacity and leadership were highlighted.Some positive impact on leadership and capacity at these levels was noted from the Country80


81


Cooperation Framework and LDP, and DevelopmentAssistance Forum (DAF) members felt it was animportant gap that UNDP could address.

Mainstreaming: Prior to 2003, mainstreaming rarelyaddressed in Ethiopia. UNDP’s mainstreaminginitiative has helped raise awareness of the need forHIV/AIDS mainstreaming and to place HIV on theagenda of donors, government and sectors. This hasled to formation of a Mainstreaming Task Force,with multi-sectoral representation, that is developinga manual on gender and HIV/AIDS mainstreaming.

Nevertheless, there has been limited progress onmainstreaming in planning and implementation.This was described as being at “embryonic stage,”especially at regional level, although the SNNP Regionhas started some initiatives. Some mainstreaming ofHIV/AIDS into the PRSP and the MillenniumDevelopment Goal (MDG) review process hasoccurred. UNDP had a key position in chairing adonor task force and providing technical support tointegrate HIV/AIDS in the PRSP. However someinformants felt that UNDP could have providedstronger leadership for mainstreaming in the PRSPand MDG processes and achieved stronger results.

UNDP has developed a strong workplace response toHIV/AIDS, but has not assumed a leadership roleamong the UN agencies. Workplace responses werealso reported by a number of government ministries,but the evaluation could ascertain how effective theywere and to what extent this could be attributed to UNDP.

LDP and CC were notable for showing ways to useHIV/AIDS initiatives to address broader develop-ment challenges in areas such as civil service reformand community empowerment and development.

Partnership coordination for country results: UNDPEthiopia made a substantial contribution to coordination among donors and the government,particularly under the previous RR. However, UNDPcould have been more assertive in relations with thegovernment, and at the time of the evaluation,UNDP had a low profile on HIV/AIDS issuesoutside the UN. Development partners indicatedthat they would be receptive to stronger UNDPleadership in partnership coordination and indefining strategic direction for partners. Strong RRleadership was seen as a critical success factor.

However, whether UNDP was the most appropriatepartner to lead coordination depended on circum-stances, such as the availability and ability of the RRor other appropriate UNDP staff, as well as availabil-ity of strong alternative leaders from other agencies.

UNDP was relatively weak in mobilizing resourcesfor the HIV/AIDS response in Ethiopia. However, itshould be noted that it had begun to have success inmobilizing government and other donors to adoptCC methodologies and extend interventions to more communities.

UNDP created a strong internal HIV/AIDS capacitythat has benefited partners and its own programmes.However, UNDP capacity may be too low for it toplay a significant role.

6.4 LESOTHO

6.4.1 Methodology The Lesotho study follows the pattern of other casestudies. A national consultant reviewed availableliterature and other documents, talked with UNDPCountry Office staff, and interviewed of key informants.Research guides were used to obtain information,and focus group discussions were held with membersof the District AIDS Task Force in four LesothoDistricts. The consultant worked closely with theUNDP Country Office focal person for HIV/AIDSand benefited from the visit of the internationalconsultant assigned to support the Lesotho case study.

6.4.2 ContextLesotho is a small, mountainous country of 2.2million people, landlocked within South Africa andlargely dependent on subsistence agriculture andremittances from South Africa. With a per capitaincome of USD 423 in 2001, Lesotho is one of theworld’s least developed countries. Nearly two thirdsof the population lives below the poverty line.Following turmoil in the late 1990s, reasonablepolitical stability has been re-established, withelections facilitated by UNDP in 2002.

The country works closely with its internationalpartners. Since 2001, the government’s economicprogramme has been supported by the InternationalMonetary Fund and the World Bank. A PovertyReduction Strategy Paper (PRSP) was prepared overa period of four years, with continuous UNDPinvolvement. HIV/AIDS is a central issue in the PRSP.

According to UNAIDS, Lesotho is Southern Africa’s third worst affected country by HIV/AIDS.Adult prevalence of HIV was estimated at 31 percentin 2000. Life expectancy has declined to 48.7 yearsfor men, and 56.3 for women. HIV/AIDS hasdrastically cut household income and constitutes amajor impediment to the achievement of thecountry’s MDGs.

In the year 2000, Lesotho adopted a NationalStrategic Plan and policy framework to addressHIV/AIDS. The policy framework recognized theimportance of partners such as NGOs and externaldonors. The Government of Lesotho (GOL)adopted a publication of the Expanded ThemeGroup, “Turning a Crisis into an Opportunity,” as aworking document for scaling up the nationalresponse. The National AIDS ProgrammeCoordinating Authority (LAPCA) was establishedunder the Prime Minister’s office in 2001. Inter-ministerial task forces were created, but LAPCA wasnot effective in coordinating the response. Thereforethe Cabinet decided to replace it with a broad-basedautonomous National AIDS Commission (NAC),modeled after the Independent ElectoralCommission that helped to reduce political conflictduring the elections. The Ministry of Labor hasprepared policy guidelines on AIDS in theworkplace, but at the time of the evaluation had notyet published them, and employers have established aBusiness Coalition against HIV/AIDS.

6.4.3 UNDP responseUNDP engagement in HIV/AIDS in Lesotho came late. In July 2002, that the new ResidentRepresentative (RR) initiated a consultative processwith the GOL that led to a significant shift in UNDPstrategy and to substantive growth in its engagementon HIV/AIDS. UNDP led a multi-disciplinary,multi-sectoral diagnostic mission that resulted in theUN Theme Group publication, “Turning a Crisisinto an Opportunity.”

The We Care Programme on HIV/AIDS in theUNDP workplace started as early as 2001, and the Country Office took advantage of the staffreprofiling exercise to realign its staff with therequirements for an expanded HIV/AIDSprogramme. UNDP used the approach of transfor-mational leadership to pilot new initiatives withmany key groups in the country. Parliamentary,church, public service and community leaders wereall reached. The Lesotho 2003 MDG reportprepared by the GOL and UNDP, “The War againstHIV/AIDS,” established HIV/AIDS as a priorityarea for achievement of all eight MDGs.

HIV/AIDS has grown remarkably as a share of totalUNDP programme spending in Lesotho: In 2002,HIV was 5 percent; in 2003, 17 percent; in 2004, 42percent; and in 2005 plans called for 47 percent of82


UNDP has had many sound initiatives, yet it has notsuccessfully expanded its initiatives, or facilitated theexpansion of others’ activities, to a national scale.

n UNDP has succeeded in bringing a rights-basedapproach to HIV/AIDS issues and in integratingHIV/AIDS into its entire country programme.

n UNDP needs to ensure that the learning experiencefrom initiatives is practical and applicable. Forexample, participants in leadership training workshops were unsure how to use their trainingand the District AIDS Task Forces supported byUNDP were unsure of their coordination role,including what to coordinate, their mandate, andwhat to implement.

n The capacity to design arrangements—includingtechnical support, management, financing, andmonitoring and evaluation—and to move frompilot projects to national programmes needs to bebuilt into UNDP programmes. This could be a rolefor regional projects.

n UNDP engagement in HIV/AIDS in Lesotho was personally associated with one ResidentRepresentative (RR). It is not clear to what extentthe progress made under the outgoing RR hasbeen fully institutionalized into the attitudes andwork of the entire Country Office, and whether thesame approach will continue under the new RR.This is an issue that should concern not only theCountry Office but UNDP Headquarters as well.


n Sustain the urgency given to HIV/AIDS in theUNDP programme in Lesotho.

n Within theContry Office, give greater attention toinstitutionalizing the attention given to HIV/AIDSissues by the former RR with a revised and updatedUNDP country HIV/AIDS strategy.

n Strengthen Country Office follow-through andaddress implementation gaps, continuing the closecooperation with donor partners establishedunder the the previous RR.

n Focus on expansion and scaling-up proven initia-tives, to national programmes, and enhance monitoring and evaluation.

Strategic Issues and Key Implications ofMain Report for UNDP Action in Lesotho

83


total UNDP country programme spending to bedevoted to HIV/AIDS.

6.4.3.1 Outcomes associated with UNDP responseGovernance: UNDP successfully advocated for a rights-based approach to HIV, focusing on the disease as agovernance issue. Its RR bears a high level ofpersonal responsibility for shifting AIDS from amedical to a development paradigm in Lesotho.UNDP played a central role in facilitating dialoguefor progress towards an AIDS-competent society,with decentralized HIV and health services andincreasing the perception of HIV/AIDS as a cross-cutting issue with implications for all the MDGs.The Prime Minister declared AIDS to be the“biggest threat to humanity,” and stigma appears to have been reduced during the period of thisevaluation. Nonetheless, superstition and denialremain critical issues.

UNDP played a central role in the decision to shiftfrom LAPCA to the NAC, and at the time of theevaluation, the legislative process had started to enactthe policy to establish the NAC. Some stakeholdersremain concerned about the risks that the NACwould also be ineffective. A network of PLWHAacknowledged UNDP assistance in its formation, butthe NGO response remained largely uncoordinated,unfocussed and without vigor. Aside from its impacton the overall environment for AIDS-relateddecisions, UNDP advocacy might have influencedthe GOL decision to allocate 2 percent of eachministry’s budget for HIV/AIDS. UNDP has notbeen engaged in budget monitoring for HIV/AIDS.In cooperation with WHO, UNDP played a key rolein the GOL decision to adopt the 3 x 5 Initiative forthe expansion of antiretroviral therapy (ART).

Leadership: The UNDP RR and the UNDP CountryOffice effectively exercised leadership on HIV/AIDSissues at many levels. HIV/AIDS is now widely seenas a development issue and this is the result of the RRactivity and UNDP’s programme of transformationalleadership. Leadership visits by many senior UNofficials to the country have helped to boost localconfidence and keep HIV/AIDS on local agendas.UNDP successfully promoted public commitment of political leaders to voluntary counselling andtesting (VCT) through a public Know Your Status(KYS) campaign. Some stakeholders, however, feltinadequately included in the KYS launch. Questionshave been raised about the extent to which participants

in UNDP-sponsored events have felt empowered tocounsel others on VCT, and fear of testing is said toprevail widely. Interventions with parliamentarianshelped to facilitate adoption of laws and to harnesstraditional leaders on HIV/AIDS. Nonetheless, therewas some feeling that UNDP’s activity with manyleaders consisted of meetings and organizingcommittees, with little follow-up action.

Capacity development: UNDP increased the capacityof many national stakeholders and a limited numberof CSOs, particularly through the VCT-KYScampaign. However, UNDP has had little contactwith the National Council of NGOs--the umbrellabody of CSOs in the country. UNDP Lesothopublications and training helped to build confidence,particularly at the district level. While the LeadershipDevelopment Programme has helped, the govern-ment has identified a need to improve senior officials’utilization of capacity for placing HIV/AIDS at thecenter of policies and plans.

Mainstreaming: UNDP contributed to the decisionof the business community to launch policyguidelines on HIV/AIDS in the workplace. Theextent of UNDP’s engagement in the PRSP processhas not been documented, but it is clear that UNDPhas integrated HIV/AIDS into its entire CountryOffice programme. The national consultant reportedthat UNDP has contributed significantly to a shift inthe public service environment from burnout toopenness and readiness to admit the need forassistance. Deepening and sustaining this shift willbe a continuing challenge. For mainstreaming tosucceed, UNDP must also overcome tensionsbetween the Ministry of Finance and EconomicDevelopment and UNDP senior staff.

Partnership coordination for country results: TheUNDP RR successfully mobilized the entireUNCT—indeed, the entire UN community inLesotho—on HIV/AIDS. Resource mobilizationwas so successful that bilateral donor funding ofUNDP Lesotho on HIV/AIDS exceeded UNDPcore resources. A rotating scheme of ResidentCoordinator leadership appears to have worked well.UNDP was perceived as a trusted and neutralpartner. Yet, UNDP in Lesotho seems to havesuffered from one widely perceived weakness in thecountry—the difficulty of moving from policies andplans to implementation. The national consultant, forexample, observed that operational follow-through is

required to ensure utilization of a guidance manualprepared by UNDP. Another observer commentedthat UNDP needs to strengthen its relations with thedonor community in Lesotho.

6.5 MALAWI

6.5.1 MethodologyThe Malawi country assessment followed the modelof other country assessments for this evaluation with the team leader participating in the evaluationin-country. A two-day workshop was held inJohannesburg, south Africa for training nationalconsultants from participating countries to refineevaluation tools. Guidance questionnaires were usedfor interviews at the national and district levels, andtopics for focus group discussions at the communitylevel we predetermined. Available documents werealso reviewed by the national consultant. An interna-tional consultant team member joined final discus-sions and selected interviews. Towards the end of thenational consultant’s work there was a validationworkshop to review preliminary findings.

6.5.2 ContextAIDS was first diagnosed in Malawi in 1985. By2003, 14.4 percent of the population was estimatedto have HIV/AIDS. Life expectancy, which hadbeen projected to rise from 48 years in 1992 to 57years in 2000, actually declined to 40 years in the year2000. The Human Development Index has fallen inrecent years. Poverty, estimated at 65 percent of thepopulation in 1998, has risen. GDP per capita wasestimated to be less than USD 200 in 2002. Of thetotal country population of 11 million, more than800,000 were orphans in 2003 – nearly 50 percentattributable to AIDS.

Following the implementation of two successiveAIDS Medium Term Plans, in 2001 the governmentcreated the National AIDS Commission (NAC) toreplace the National AIDS Control Programme.While the NAC has a broader mandate than theNACP, it remained under the Ministry of Healthuntil 2002, when it was transferred to the Presidency.An HIV/AIDS policy was launched in 2004.

6.5.3 UNDP responseFrom 1998 to 2000, UNDP helped increase opendiscussion of HIV/AIDS through communitymobilization and capacity development. This workculminated in the National Strategic Framework for

2002-2004. UNDP provided financial and technicalassistance to prepare and manage the HIV/AIDSResource Mobilization Round Table. UNDPsupported HIV/AIDS impact studies in the publicservice, assisted with the participation of Malawiansin international AIDS conferences, and supportedthe NAC, district-level coordination, and civil societyorganizations. It also facilitated integration ofHIV/AIDS issues into the military. The HIV/AIDSTheme Group supported by UNDP won a grant ofUSD 3.4 million from the UN Foundation.

6.5.3.1 Outcomes associated with UNDP responseGovernance: HIV/AIDS is increasingly beingrecognized as a national concern and developmentchallenge in Malawi. UNDP’s support for impactstudies and other advocacy work contributed to thisresult. UNDP contributed to the AIDS policy. Inrecent years, there has been important growth incommunity support groups and local non-governmental84


UNDP experience in Malawi points to several important issues:

n UNDP had important accomplishments in areassuch as the AIDS Round Table, supporting NGOs,and mainstreaming for uniformed personnel.

n However, there were missed opportunities inareas such as the central/district dichotomy, thecapacity gaps of CSOs, the poverty reductionstrategy, and the leadership and convening roleamong donors.

n Moving beyond upstream activities to follow-through by UNDP and its partners is critical, and itis important to address the risks of early exit fromactivities that have been successfully launchedbut not fully institutionalized.


n Strengthen UNDP’s HIV/AIDS engagement, with agrowing urgency to the issue, under an updatedUNDP country HIV/AIDS strategy moving fromproject to programme support for the country’sHIV/AIDS SWAp.

n Review and strengthen CO HIV/AIDS capacity.

n Give greater attention to capacity building,particularly with the NAC and CSOs.

n Facilitate integration of UNDP and partner inter-ventions into national processes, including thePRSP, the national budget, and for CSOs.

n Ensure greater attention to monitoring, evaluation,and institutionalization of initiatives.

Strategic Issues and Key Implications ofMain Report for UNDP Action in Malawi

85


organization (NGO) engagement; UNDP supportwas a key factor in this change. However, UNDP hasnot adequately supported the conversion ofcommunity groups to full NGOs. UNDP supportfor the NAC was critical to its effective establishmentand operation, though there are concerns about itssustainability and future operation at the districtlevel. UNDP has facilitated AIDS programmedecentralization, although this remains to beadequately operationalized. UNDP is widely seenamong Malawi’s development partners to have takenthe lead in mobilizing the national response to HIV/AIDS. UNDP’s work is reported to have contributedto the reduction of stigma and discrimination againstpeople living with HIV/AIDS.

Leadership: UNDP has contributed to the emergenceof leaders and opinion makers who have strength-ened the Malawi response to HIV/AIDS. Advocacyand commitment by UNDP Resident Representativeand Resident Coordinator personnel at the highestlevels of Malawian institutions are reported to havecontributed significantly to the recognition of HIV/AIDS as a development challenge. The failure tosupport this at lower levels in the political arenarepresents a missed opportunity. Thanks to UNDPengagement, the public sector response has beenconverted to a multi-sectoral one, especially throughUNDP support to the Department of Human Resourcesand Development in the Presidency. A task forcesponsored by the Presidency with UNDP support hascontributed greatly to engaging public institutions.

Capacity development: In recent years, thanks toUNDP support, Malawi has developed enhancedcapacity among people living with HIV/AIDS andcommunity support groups, such as the MalawiNetwork of AIDS Services Organizations. UNDPimpact studies have contributed to enhancedknowledge on HIV/AIDS. In addition, capacity forHIV/AIDS-related planning has increased at thelocal level, thanks to UNDP’s decentralizationprogramme. UNDP support was essential for manyaspects of the early development of the nationalstrategic framework and the NAC, as a multi-sectoral body staffed with local nationals. Furtherprogress is needed on integration of AIDS issues intoMalawi’s poverty reduction strategy and annualbudgeting process.

Mainstreaming: UNDP support to NGOs has beencritical to mainstreaming HIV/AIDS into their

work. However, NGOs expressed concern that theycontinue to need UNDP support in accessing otherdonor’s resources. With the poverty reductionstrategy of Malawi up for review, UNDP’s pastinvolvement in this work has positioned it well tofacilitate integration of HIV/AIDS into the PovertyReduction Strategy Paper, a missed opportunity inthe past. UNDP advocacy for a multi-sectoralapproach and its facilitation of the transfer ofHIV/AIDS responsibilities from the Ministry ofHealth to the Presidency have contributed to theshift from a biomedical paradigm to a developmentorientation to HIV/AIDS issues. UNDP is alsocredited with the successful mainstreaming ofHIV/AIDS into the Malawi Army and Police.UNDP support contributed to integration ofHIV/AIDS issues into public sector workplaces, butthis integration has not carried over to private sectorworkplaces. Even among public sector institutions,there still remains much to do—a survey of 40institutions revealed that less than 40 percent hadstarted preparing workplace HIV/AIDS plans as ofJanuary 2003. The survey shows the magnitude ofthe task ahead.

Partnership coordination for country results: UNDP’srelatively early engagement and constant supportwere critical to the AIDS Round Table, which led tocreation of donor basket funding for the AIDSSector Wide Approach (SWAp), with pledgesamounting to approximately USD 400 million.Since then, UNDP seems to have taken a back seatto Department for International Development andthe World Bank in support of the NAC. Thanks toUNDP support, local level partnerships have beenenhanced. Continuing support is needed to leverageadditional resources to scale up efforts, especially atthe local level. A forum is needed to bring all actorstogether to discuss partnership issues in the NGOsector. The UNDP Country Office has committeditself to invigorated HIV/AIDS programming throughinternal change, but little evidence of cultural changehad emerged at the time of the evaluation.

6.6 NAMIBIA

6.6.1 MethodologyThe country assessment for Namibia was conductedby a national consultant without a direct field visit bythe international team. The approach followed themodel of other country assessments for this evaluation,using data collection instruments prepared collectively

to guide interviews at the policy, institutional andcommunity levels. The country assessment forNamibia also benefited from an assessment ofnational development documents and those preparedby UNDP.

6.6.2 ContextNamibia is classified as a lower middle-income country,with an annual per capital income of approximatelyUS$1,800. In terms of income alone, Namibiaperforms quite well on the global scale, ranked 65 out of 175. However, when using the HumanDevelopment Index, combining income with othercapability measures such as health and education,Namibia drops to a rank of 124. More than half ofNamibia’s population survives on approximately 10percent of the average income, suggesting profoundpoverty levels. With a national unemployment rate of35 percent, and particularly high unemploymentamong women and youth, diseases such as HIV/AIDS

have found fertile grounds for alarming escalation.As of 2004, Namibia was ranked among the topseven countries hardest hit by the HIV/AIDSepidemic in the world. From the first diagnosis in1985, Namibia has recorded a cumulative total ofmore than 136,000 cases of HIV/AIDS, nowstanding at a national prevalence rate of 22 percent(based on the 2002 National HIV Sentinel Survey).With a population of 1.8 million people, HIVinfection among women accounts for 50 percent ofall reported cases. Current estimates put the numberof orphans at 82,000, and this number is expected torise to 120,000 by 2006.1

Responding early to the HIV/AIDS challenge,Namibia established an AIDS Advisory Committeein 1987 and developed the National AIDS ControlProgramme (NACP), with a mandate to coordinateand manage HIV/AIDS patient care and preventionactivities. Since 1992, Namibia has had threeMedium Term Plans. The first was from 1992-1997,the second from 1999-2004, and the third covers2004-2009. Under the second Medium Term Plan,the National AIDS Co-ordination Programmereplaced NACP, with a comprehensive set ofobjectives that specifically related to a shiftingemphasis from a bio-medical to a multi-sectoraleffort. The third Medium Term Plan truncated thesecond plan to realign development priorities andinstitutional arrangements towards an HIV/AIDS-conscious national development planning approach.

6.6.3 UNDP responseUNDP’s support for HIV/AIDS in Namibia did notbegin until the 2002-2005 Country CooperationFramework. This made it difficult for the evaluationto document specific results associated with UNDPsupport. UNDP support was entirely governmentexecuted; limited government execution capacity andlimited UNDP Country Office HIV/AIDS staffhampered UNDP programme execution. However,the Regional Project provided support that was well-received. UNDP support targeted institutionalreform to invigorate the NAC, support for decentral-ized management aligned with UNDP support fordecentralization in Namibia, integration of HIV/AIDS responses into the Poverty Reduction StrategyPaper, and issues of human rights and gender equity.With the establishment of an HIV/AIDS Unit in

86


Namibia demonstrates both the promise and thebottlenecks associated with UNDP’s role in supportingthe national response to HIV/AIDS. UNDP experiencein Namibia points to two important issues:

n At the level of promise, Namibia appears to havean institutional framework that consistently produces national development strategies. Thesehave been influenced to emphasize HIV/AIDS andto anticipate a more focused implementation.

n However, the absence of strategically-placedcapacity development to move from policy toimplementation continues to be a major issue forUNDP, especially in the context of increasingresources available to Namibia, through theGlobal Fund and other facilities.

In future, the UNDP should:

n Increase the urgency given to HIV/AIDS in thework of UNDP through an updated UNDP countryHIV/AIDS strategy that integrates projects into alarger programme drawing upon the wide varietyof instruments available, including UNVs forcapacity development.

n Focus on the implementation gap, movingbeyond policy and beyond generating a responseto facilitating impact on the ground by UNDP andits partners.

n Move beyond the national level to mid-stream action.

n Give greater attention to monitoring and evaluation,and particularly to use of available information forincreasing effectiveness.

Strategic Issues and Key Implications ofMain Report for UNDP Action in Namibia

1 UNAIDS Country Report Summary, available online athttp://www.unaids.org as of 5/15/2005.

87


the UNDP Country Office in 2002, UNDP was ableto assist the government in reviewing the secondMedium Term Plan and to truncate it by introducingthe third Medium Term Plan. This third plansubstantially restructured the institutions formanaging HIV/AIDS, giving them a more multi-sectoral focus and aligning them better with overallpolicies and programmes elaborated in the Plan.UNDP has also been instrumental in assistingNamibia with resource mobilization. The governmentwas successful in its proposal to the Global Fund andreceived approval in 2003 for a total of USD 113million, of which more than USD 105 million is for HIV/AIDS.

6.6.3.1 Outcomes associated with UNDP responseGovernance: Three key contributions are associatedwith UNDP’s role as it relates to governance of theHIV/AIDS response: 1) supporting the integrationof HIV/AIDS into the Poverty Reduction Strategyby assisting the National Planning Commission tofocus on the connection between youth (un)employmentand HIV/AIDS; 2) supporting the development ofdecentralized institutions for managing HIV/AIDSbeyond the national level; 3) emphasizing genderissues, in the context of support for rights of margin-alized populations and of people living with HIV/AIDS. However, while UDNP’s contributions areappreciated at the policy level, there have beenmissed opportunities in transforming the policy-levelsupports to implementation arrangements on theground. Since UNDP successfully assisted thegovernment in reviewing and refining its MediumTerm Plan, this led to a perception of UNDP asprimarily a policy player. To date, the implementationgap looms large in Namibia.

Leadership: Advocacy and corresponding training forwomen leaders has been instrumental in ensuringthat most Regional Coordinators of HIV/AIDSprogrammes are women. Business leaders have beensupported to be advocates at the national levelthrough grants and capacity development providedby UNDP to NABCOA–a national association withHIV/AIDS programmes that are often cited in thenational media. While the efforts in leadershipdevelopment have been described by UNDP as partof its transformation efforts, the emphasis appears tobe at the national level, primarily with governmentofficials and business leaders. UNDP has assisted inmobilizing faith-based organizations and othercommunity organizations for active engagement in

HIV/AIDS, but other donors have been more instru-mental to such community-level organizations byproviding resources to fund projects and activities.Capacity development: Capacity development hasbeen one of UNDP’s strongest contributions. Somesignificant outcomes and substantial missed opportu-nities were noted in this area. Starting with consis-tent efforts in building capacity with the NationalPlanning Commission for the understanding of thehuman development dimensions of HIV/AIDS,Namibia has consistently produced HumanDevelopment Reports for 1997, 1998, 1999, 2000/1and 2002/3. Increasingly, this capacity is beingdeployed to enrich planning processes at the nationallevel, with the latest revision to the Medium TermPlan III reflecting a strong correlation betweennational targets and Millennium Development Goals,within the context of the Human DevelopmentIndex. However, while these capacities are beingdeveloped at the policy level, their implementation isbeing constrained by the inability of staff at NPC tofollow through and their limited capacity to usefunds set aside by UNDP and other donors. One ofthe capacity development instruments that heldpromise for assisting Namibia to fill vital humanresource gaps is the deployment of UN Volunteers(UNVs). More than 1,000 UNVs (both national andinternational) were expected to be deployed inNamibia. At the time of the evaluation only 18 hadbeen mobilized. Inadequate funding has hamperedthis programme, which resulted in fewer opportunitiesfor national and international UNV recruitment.

Mainstreaming: UNDP has contributed to main-streaming in Namibia through strong advocacy forHIV/AIDS workplace coordinators in the public andprivate sector and the production of toolkits for useby promoters of workplace HIV/AIDS programmes,both among the private sector (through NABCOA)and municipalities (through AMICAL). This is aunique UNDP niche, which it has been sharing withUNAIDS. NABCOA claims that they would not beable to do the work they are currently doing withoutthe support received from UNDP and UNAIDS,such as the AIDSBRIEF—a quarterly publicationwith a wide circulation among business leaders.However, concerns have been expressed about missedopportunities for assisting the NPC in operationalizingits plans for mainstreaming, which have beensupported by UNDP. In particular, the PlanningCommission has developed several good ideas aboutmainstreaming HIV/AIDS into policies, workplaces,

and national life, but there has been no monitoring orevaluation of how they are progressing. UNDP alsoexperienced some setbacks in its effort to mainstreamHIV/AIDS in the educational system. UNDPsupported a pilot initiative to train university teacherson HIV/AIDS in the hope of launching a corecourse within the curriculum focusing onHIV/AIDS. After the one-off training, there waslittle substantive follow-up. The expectation oflaunching a course at university-level fizzled, until amuch delayed renewal with the expected signature ofa Memorandum of Understanding with theUniversity of Namibia to co-sponsor a series oftraining sessions on HIV/AIDS.

Partnership coordination for country results: UNDP’srole in coordination of HIV/AIDS activities at thecountry level has focused primarily on the UNTheme Group, which UNDP chairs. The UNDPCountry Office has made effective use of PAF fundsfrom UNAIDS. The Country Office also successfullynegotiated for a two-year HIV/AIDS advisor fromSIDA. However, UNDP has been characterized asrather insular--focusing on the specific HIV/AIDSprojects that it is implementing, yet encouraging thegovernment to broaden policies. Opportunities toleverage funding (which the government has beensuccessful in mobilizing) and to use its conveningcapacity to generate consensus about improvedcapacity for implementation at the national and sub-national levels merit greater attention.

6.7 SOUTH AFRICA

6.7.1 MethodologyThe country assessment for South Africa occurred ata time when the Country Office had commissionedone of its first evaluations of a major HIV/AIDS and Poverty Reduction Project, using a methodologyfor evaluation that focused on traditional projectevaluation. This presented an opportunity to obtaininformation on project-level operations and tocompare the project evaluation methodology withthe outcome evaluation approach in order to assesschanges in development conditions across a broaderspectrum of programme interventions in support of HIV/AIDS action in South Africa. The nationalconsultant applied the tools designed for data collection and, with the support of three members of the international team, complemented this datawith selected strategic interviews with government,private sector, civil society and donor partners in

South Africa. A validation session, although sparselyattended, provided an opportunity to refine the findings.

6.7.2 ContextSouth Africa has the unenviable record of having thelargest number of people living with HIV/AIDS ina single country. Out of a population of 44.8 million,88


Although UNDP currently has a limited role in SouthAfrica, there are several areas of comparative advantagethat UNDP should emphasize as it positions itself forfuture support of South Africa’s national response to HIV/AIDS:

n UNDP is recognized by the government at thenational, provincial and local levels as an impartialresource that does not feed into party politicalagendas, that is driven by international norms andconventions, and that is focused on the poor andmarginalized, regardless of race, gender, creed orpolitical orientation.

n Members of government and civil society alsoanticipate UNDP capacity to import global bestpractices through the UN system. One of the areasof knowledge and value-added development thatthe government appears anxious learn fromUNDP is the focus on sub-national, community-driven processes for empowerment, targeting thepoor and the vulnerable.With mounting pressuresfor solutions at the local, community levels,UNDP-supported pilot projects in Leadership forDevelopment and Community Conversations areseen as potential contributions to national policyand strategy on HIV/AIDS.


n Review and update UNDP country HIV/AIDS strategyto give increased urgency to the issue of HIV/AIDSas a development, and not just a medical,challenge; particular attention should be paid toactions at the provincial level and to adopting amore assertive posture with public authorities,even if that posture must be “behind the scenes.”

n Give greater attention to UNDP’s role as an AIDSinnovator, including the expansion and scaling-upof pilot projects with support from other partners,and facilitating access by South Africans belowthe national level to knowledge and experienceon HIV/AIDS issues around the world.

n Move beyond projects into an integrated countryprogramme of HIV/AIDS support, drawing uponrelevant UNDP instruments that are available atthe national, regional and global levels.

n Facilitate the effective use of others’ resources forHIV/AIDS,including the resources of public authorities.

Strategic Issues and Key Implications of Main Report for UNDP Action in South Africa

89


an estimated 5.3 million people have HIV/AIDS.The national HIV infection rate among pregnant womenattending antenatal clinics in 2003 was 27.9 percent,with variations among the country’s nine provinces,from as high as 37.5 percent in Kwazulu-Natal to13.11 percent in the Province of Western Cape.2

In contrast to other parts of Sub-Saharan Africa,however, South Africa experiences relatively high percapita income of approximately USD 2,300. Thereare wide variations in income distribution and a hugediscrepancy in the standard of living between theraces, reflecting a legacy of decades of apartheidpolicies. Development infrastructure, includingeducation and health care delivery are relatively highin South Africa, making it one of the countries inSub-Sahara Africa with higher capacity to managethe substantial quantity of care required for its largeHIV/AIDS patients.

South Africa’s national response to HIV/AIDS isshaped by the national strategic framework for 2000-2005, following the approval of a comprehensivenational plan for HIV/AIDS care, management andtreatment in 2003. The plan aims to providetreatment to more than 1.4 million South Africansby 2008. The government has a strong commitmentto tackling the epidemic, backed by increaseddomestic financial resources. In 2003, the governmentallocated approximately USD 1.7 billion from thenational treasury to fight the epidemic over a three-year period. Another measure of national commitmentis the plurality and vigor with which organizations of civil society engage with the state in discussions(and sometimes strong disagreements) on strategyand priorities. This has promoted a great degree ofaccountability for public policy to various interestgroups, including a large and vocal civil society ofpeople living with HIV/AIDS.

6.7.3 UNDP responseUNDP support to the national response has beenguided by the United Nations DevelopmetnAssistance Framework (UNDAF) 2002-2006, the1999 Common Country Assessment that informedthe priorities of UNDAF 2002-2006, and the twoCountry Cooperation Frameworks (CDFs) of 1997-2001 and 2002-2006—all of which recognized thenegative impacts of HIV/AIDS on development and

transformation in South Africa. UNDP has beenpart of the HIV/AIDS Theme Group and throughthe Resident Coordinator system participated inagency collaboration efforts in the fight againstHIV/AIDS. The CCF 2002-2006 defined keyprogrammatic interventions at the national, provincialand local levels that include Enhancing an IntegratedResponse to HIV, AIDS and Poverty, InvolvingYouth in HIV/AIDS Responses, Greater Involvementof People Living with HIV/AIDS (GIPA), and aNational Database of philanthropic investments andactivities aimed at prevention and mitigation of theimpacts of HIV/AIDS in the country. UNDP’sprimary interventions target three provinces in thecountry, including KwaZulu Natal (with the highestinfection rate—more than 35 percent), Limpopo andthe Eastern Cape. The need for greater attention tomonitoring and evluation was recognized as aweakness in the UNDP programme.

6.7.3.1 Outcomes associated with UNDP responseGovernance: Government leadership for policy andprogramming in HIV/AIDS is strong–it currentlyhas a comprehensive plan funded substantially fromgovernment budget allocations. As a result, UNDPhas had a less visible and discernable influence ongovernment policies and programme priorities.3

At the time of the evaluation, the coordination of theshift to a multi-sectoral response to HIV/AIDS (versusa bio-medial response) remained a critical challengeto the government and represented a key missedopportunity for UNDP. While key institutionsparticipating in programme formulation andimplementation had internalized this paradigm shift,the coordination efforts were still in transition.UNDP was not at the forefront in the developmentand finalization of the HIV/AIDS/STD Strategic Planfor South Africa 2000-2005 and the concomitantshifts that informed the plan such as the need for amulti-sectoral response have been largely driven bydomestic considerations rather than externalinfluence. Government departments that are moreaccustomed to dealing with HIV/AIDS as adevelopmental issue, such as the Department ofSocial Services, have not been the ones at the centerof the partnership with UNDP.

While UNDP does not target civil society in itsprogramme interventions (as its priority and prime

2 UNAIDS Country Update on HIV/AIDS available online athttp://www.unaids.org as of 5/5/2005.

3 This poses frustrations for donors, such as UNDP, who have beenaccustomed to exerting considerable influence in public policy,elsewhere in the developing world.

partner is the government), it faces the danger ofbeing perceived as uncritical of government inaction.A strong and vibrant civil society advocates for andengages the government in shaping and sometimeschanging policy directions in the national response.However, UNDP has not played any noticeable rolein the debates associated with government and civilsociety and has not been visible in supporting orhelping to drive civil society responses to governmentinaction and delays.

UNDP has been successful in helping mainstreamHIV/AIDS into the development plans of localcouncils in priority provinces, as indicated by theincreased demand for the development of HIV/AIDS components for local and provincial plans. Theemerging HIV/AIDS responses by municipalities areindicative of the efforts of the UNDP in laying thefoundation for more concerted and formalizedresponses to the epidemic at the local levels. Inaddition, communities have been linking HIV/AIDSto wider issues of community governance, access topublic services and accountability of government forservice delivery, especially at the local governmentlevel. UNDP-facilitated conversations at the localcommunity level galvanized energy and raised theconfidence of communities to declare their needs andaspirations and to take responsibility for their owndevelopment challenges. UNDP community conver-sations brought government closer to the people andreinforced communities’ involvement and leadershipin handling their own development priorities.

Leadership: At the time of the evaluation, leaders inboth the public and private sector were taking a morecomprehensive view of addressing HIV/AIDS. TheLeadership for Development process, which hadchampions from all sectors, sensitized leaders toHIV/AIDS--its dimensions, linkages with poverty,and personal impacts. However, missed opportunitiesin leadership development arose from UNDP’sinability to demonstrate how the efforts at theprovincial and district levels could be scaled-up toother equally vulnerable areas of the country.

UNDP has played an exemplary role in a number ofpilot initiatives in that help people living withHIV/AIDS influence private firms’ HIV/AIDSpolicies. The deployment of fieldworkers intocorporate environments in private business,parastatal organizations and government depart-ments has successfully reinforced the imperative that

PLWHA should lead their own endeavors inresponding to the HIV/AIDS epidemic.

Capacity development: Because UNDP is limited in itsinput at the national level, there is little measure ofcapacity development at this stage. However, UNDPcapacity development through community conversa-tions at the local level showed evidence of changes inknowledge, attitudes and practices of communityleaders in the fight against HIV/AIDS and poverty.By building grassroots capacity for social action,UNDP is helping put in place the building blocks ofa more effective national response to HIV/AIDS.

Mainstreaming: Despite efforts by the UNDP (albeitlimited at the national level) and other stakeholdersin the country, the mainstreaming of HIV/AIDS ingovernment had yet to be realized. While there hasbeen a shift from a bio-medical approach to addressingHIV/AIDS to a multi-sectoral response, mainstreamingof HIV/AIDS was not pervasive at the national levelas key institutions continued to undertake discreteyet profound programming and interventions.

At the sub-national levels, there was an increasedunderstanding of the need to mainstream HIV/AIDS by key development planners at the provincialand local levels, with a few councils beginning tomainstream HIV/AIDS into their IntegratedDevelopment Plans. The development change wasassociated in part UNDP support at the sub-nationallevels, combining different programming instrumentsand thematic programmes with an effort inmainstreaming in the three priority provinces.

UNDP’s programming has resulted in innovations,for example, workplace HIV/AIDS support of peopleliving with HIV/AIDS. Yet, at the time of theevaluation these innovations, which seemed to workwell in the HIV/AIDS programmes, were not beingshared with other programmes within UNDP itself.Also, innovations and capacities in the other programmeswere not embraced or shared by the HIV/AIDSinterventions. This weakness in synergy amongUNDP’s programmes limited UNDP’s impact ondevelopmental conditions relating to HIV/AIDS inthe provinces where UNDP provided support.

Partnership coordination for country results: TheGovernment of South Africa’s strong role indetermining HIV/AIDS policy and programming,allocating substantial domestic resources, and directing90


91


donors to areas commensurate with their comparativeadvantages has had the following impact on UNDPSouth Africa: limited convening role in coordinatingdonor activities to address HIV/AIDS in thecountry; and reduced leadership for providingintellectual content for HIV/AIDS programming andpriority setting, compared to other case-study countries.

At the time of the evaluation, the Department ofHealth was central to the national response toHIV/AIDS, both as host of a nominal NationalAIDS Council and as the institution responsible formobilizing and allocating resources for the nationalresponse. The UNDP Country Office worked closelywith the department, but greater engagement of otherdepartments was needed. The apparent diplomatichiatus of UNDP vis-à-vis the Government of SouthAfrica created a general paralysis at the CountryOffice and an inability to act in the role normallyoccupied by UNDP as convener, partnership broker andfacilitator for development assistance. Mechanismsof interface between community demand andgovernment resource allocation were still in theirinfancy, and resources earmarked for accelerateddevelopment, including some for HIV/AIDS weretherefore not being disbursed fast enough to meet thehuge needs. Greater potential seemed to exist forharmonization at the provincial, local governmentand community levels, but this needed an “honestand neutral broker” such as UNDP.

6.8 SWAZILAND

6.8.1 MethodologyThe assessment was performed by a national consultantwho reviewed available documentation and used semi-structured interview guides to conduct key informantinterviews and group discussions. Informantsincluded UNDP staff and other participants andstakeholders in UNDP activities at community andhigher levels. An international consultant assigned tothe study gave feedback on drafts and specific queries.

6.8.2 ContextSwaziland is a small country with a population of approximately 930,000 in the late 1990s. It isclassified as a middle income country but has beenchallenged by slowing economic growth and largebudget deficits that severely constrain the govern-ment’s ability to increase spending. Approximatelytwo-thirds of the population live below the povertyline. The country’s 2004 Human Development Index

rank was 137—a decrease from the early 1990sranking due to HIV/AIDS and economic stagnation.Approximately 75 percent of the population lives inrural areas and recent droughts have necessitatedlarge scale food aid. Controversial national governanceand limited human resources in key sectors are othermajor challenges.

Swaziland has the highest rate of HIV/AIDSprevalence in the world. Levels among pregnant

UNDP can be particularly influential in achieving out-comes in countries such as Swaziland that are smalland have limited capacity and limited developmentpartner support. UNDP experience in Swazilandpoints to several important issues:

n UNDP has comparative advantages of strong relationships with the government and closeinvolvement with national planning processes.

n There is a need to develop stronger strategies toensure consolidation of various interventions,increase national ownership and deal with otherrequirements for sustainability and scaling up ofinterventions and outcomes.

n Support for high-level planning without follow-upat the implementation and operational level canlimit potential for outcomes and impact.

n UNDP Swaziland may have been responsive toimmediate priorities and country context, but thewide spread of UNDP activities raises questions ofwhether, in the longer term, all the interventionsbuild on UNDP’s main comparative advantagesand allow for strategic consolidation and optimaluse of resources.

n Limited UNDP capacity and resources along withCountry Office staff turnover were significant constraints on results, particularly in an environ-ment where few other donor and governmentresources can be leveraged.


n Formulate and communicate an updated UNDPcountry HIV/AIDS strategy giving greater urgencyto the issue and drawing upon the relatively largeUN presence in the country.

n Consolidate and integrate activities and interven-tions, and give greater attention to moving fromideas to action and consistent follow-through and implementation.

n Review and strengthen Country Office capacity tosupport HIV/AIDS actions.

n Give increasing attention to mobilizing and facili-tating use of funds from other external partners.

Strategic Issues and Key Implications of Main Report for UNDP Action in Swaziland

women were higher than 42 percent in 2004, andmore than 220,000 Swazis were living withHIV/AIDS. The number of orphans was approxi-mately 60,000, and was projected to rise to about120,000 by 2010. Effects of HIV/AIDS are beingfelt throughout society.

Government responses to HIV/AIDS started in the1980s. Major changes have occurred since KingMswati III declared HIV/AIDS a national disasterin 1999. The National Emergency ResponseCommittee on HIV/AIDS (NERCHA) was formedin 2000 to coordinate all HIV/AIDS activities andresource mobilization for a multi-sectoral response.The National Strategic Plan 2000-2005 covers arange of prevention, care and impact mitigationcomponents. Swaziland has begun to roll outantiretroviral therapy (ART). About 6,000 peoplewere on free ART in late 2004. Governmentexpenditure on education and health has increaseddramatically since 2004, in large part to cater toorphans and people living with HIV/AIDS(PLWHA). HIV/AIDS workplace programmeshave been started in all government ministries, andsectors are required to mainstream HIV/AIDS intheir programmes and budgets.The Poverty ReductionStrategy was expected to mainstream HIV/AIDS in various components. Non-governmental organiza-tions (NGOs) have also been prominent in thenational response.

Development partner support to Swaziland has beenlimited by the country’s size, middle income statusand concerns about its governance record. Thelimited number of bilateral agencies that are involvedtend to have regional rather than country programmes.UN agencies therefore have a relatively large profile.The UNCT Theme Group on HIV/AIDS supportaimed at capacity development and institutionalstrengthening of government, local authorities,NGOs, community based organizations, privatesector and organizations for PLWHA. Currentfunding sources include the Global Fund, WorldBank, UK Department for International Development,EU, Italy, USA, Germany and China.

6.8.3 UNDP responseUNDP assistance has transitioned from traditionaldevelopment issues to focusing on HIV/AIDS sinceit was declared a national disaster. UNDP HIV/AIDS activities had a budget of USD 370,000 for theperiod 2003-2004.

UNDP has provided support in a range of areasduring the period under review. A major focus hasbeen synergistic initiatives under the Leadership forResults Programme since 2003. This has includedleadership development programmes (LDPs) fornational and lower levels of government and civilsociety partners, as well as community capacityenhancement through community conversations todevelop participatory mechanisms to decentralize theresponse to HIV/AIDS.

Building on its relationship with governmentplanners and policy makers, UNDP has promotedHIV/AIDS-responsive policy dialogue in relation tonational development planning and in specificsectors. Other related initiatives have included threesectoral HIV/AIDS impact studies, and establishmentof an inclusive Human Development Forum for policydialogue around governance and poverty reduction.The government has also been assisted throughtechnical and other support to strengthen institutionalcapacity to plan and implement multi-sectoral strategieson HIV/AIDS and strengthen skills at national andlocal level for mainstreaming HIV/AIDS.

UNDP has promoted sound perspectives on humanrights, discrimination against PLWHA and genderin all aspects of the national response includinglegislation, policy, research and community initiatives.UNDP interventions have supported a range of NGOsand community based organizations including women’sgroups, churches, youth NGOs and organizations of PLWHA, as well as specific local and nationalgovernment partners.

UNDP activities around HIV/AIDS have included:resource mobilization through organization of ThematicRound Tables; joint projects with other UN agenciesincluding a joint UN/UNIFIP project targetingadolescents and strengthening voluntary counsellingand testing; contributions to development of a nationalcommunication strategy on HIV/AIDS; piloting useof digital villages for access to information onHIV/AIDS; facilitating access to “e-pap” (fortifiedmaize meal); and income generation through amushroom growing project initiated with governmentin 2000.

More recent UNDP initiatives have included supportto NERCHA to develop multi-sectoral policy andstrategy on HIV/AIDS, and the 2004 SwazilandCapacity Initiative to assist the government and its92


93


key partners to respond to human and institutionalcapacity erosion.

6.8.3.1 Outcomes associated with UNDP responseGovernance: UNDP advocacy, policy and planninginputs, and policy dialogue were seen as important toa more receptive environment for multi-sectoralpolicy development and planning in response to theepidemic. In national planning processes, includingthe National Development Plan and PovertyReduction Strategy, UNDP markedly improvedintegration of HIV/AIDS, Millennium DevelopmentGoals and United Nations General Assembly SpecialSession. However, at the time of the evaluation, itwas uncertain how efficiently the plans wouldtranslate into action on HIV/AIDS. UNDP seemedto have missed opportunities to translate strategiesinto actionable operational plans, particularly in theNational Strategic Plan on HIV/AIDS.

Information provided by impact studies and theHuman Development Report were reported to havestrengthened awareness of the policy, planning andmanagerial implications of HIV/AIDS, and supportfor sound responses. Some of the studies havecontributed to subsequent specific actions includingmainstreaming by the public service and otherministries. However, there was some difficulty inimplementing responses to such awareness.

UNDP advocacy, research, policy support andtraining, and the 2003 report on culture andHIV/AIDS were specifically noted to have resultedin greater prominence of gender issues in HIV/AIDS responses. Involvement and empowerment ofwomen (and men, who had previously not engagedHIV/AIDS) was also seen as an important outcomein communities targeted by community conversations.

Support to the Swaziland organizations of PLWHAand other support groups, along with interventionsaround workplace policies, the private sector and thecommunity level, have helped reduce stigma, andincrease recognition of rights and involvement ofPLWHA. Engagement with journalists and editorshas also improved media involvement. UNDPassistance has also helped to enhance NERCHA’scredibility and ability to coordinate the nationalmulti-sectoral response, although limitations still toexist, including a need to strengthen coordinationwith the Ministry of Health and Social Welfare.

Leadership: The LDP has led to changes and actionby trainees from the government, traditional leadership,civil society and the private sector. A number ofstriking initiatives by individuals have arisen from theLDP and the potential “reach” of the interventionswas substantial. More than 70 percent of local chiefshave been reached by the intervention, for example.Nevertheless, it was difficult to assess whetherleadership breakthroughs have added up to a signifi-cant scale or depth of impact, or how sustainableleadership outcomes tend to be.

The Human Development Forum convened byUNDP also seems to have enhanced leadership forinfluencing critical policies and responses withingovernment, organizations, the private sector andcommunities. While there was an indication ofUNDP facilitation of stronger leadership by nationallevel politicians and officials in Swaziland, asevidenced by several policies and politicalpronouncements, further details about UNDP rolesin this were not provided.

Capacity development: Capacity for Swaziland’s HIV/AIDS response has been strengthened substantiallythrough UNDP programmes. At the national level,LDP has developed individuals’ leadership skills andattitudes and initiated institutional changes that haveenhanced HIV/AIDS responses within nationalministries. UNDP also had a role in strengtheningNERCHA’s organizational development and capacityfor coordination, mobilization of resources and policy development.

At more decentralized levels, LDP has led tosubstantial development of capacity in targeteddistricts and communities. There are many reports of changes in capacity, competencies and actions inorganizations, traditional leadership and communitiestargeted by the programme. However, the proportionof LDP trainees who have gone on to use their skills,and the scale of outcomes could not be established.

Community conversations have proven to be anotherpowerful method for generating capacity at the locallevel. They have stimulated youth involvement andled to formation of youth groups and greateropenness. There were also reports of increased uptakeof voluntary counseling and testing, treatment forsexually transmitted disease, and condom use,although data to establish scale and association withUNDP were not available.

UNDP also achieved results in building capacity ofcivil society organizations. Involvement in LDP andcommunity conversations, as well as other support,has helped to stimulate NGO and other civil societyactivity on HIV/AIDS, as well as enhance organizations’leadership and delivery capacity. A more strategic,holistic response to HIV/AIDS has been facilitatedthrough UNDP support to a well-placed network ofNGOs, as well as through direct support and specificengagements to enhance activities and networking ofrole players at national and other levels.

A notable feature of UNDP inventions has beenstrengthening organization and involvement ofPLWHA both at national level and at the local level,where community conversations have built PLWHAinvolvement and strengthened support.

However, UNDP missed opportunities to supporthuman resources planning, management anddevelopment in follow up to impact studies whichhighlighted human resource challenges presented byHIV/AIDS in Swaziland.

Mainstreaming: UNDP supported planning, researchand other processes that have facilitated more focusedmainstreaming of HIV/AIDS by governmentministries. Leadership training helped clarify roles ofdifferent sectors and reports of individual initiativesto address AIDS within sectors were given. UNDProles in development of the NDS, Poverty ReductionStrategy, and other poverty and planning have helpedmainstream HIV/AIDS into development planning.However, it was not yet clear, at the time of theevaluation, whether HIV/AIDS had been integratedadequately and how far plans would be translatedinto effective mainstreaming.

UNDP has also facilitated establishment ofworkplace responses in government sectors, throughits impact studies, support for development of policyand manuals, and through initiatives of leadershiptrainees. Although focal points have been appointedin Ministries, progress in implementation has beenslow. Further support might be necessary to ensureoutcomes. It was also noted that LDP had helped tostimulate private sector initiatives to addressHIV/AIDS, both in the workplace and as part ofbroader corporate social responsibility. However,resource constraints had undermined effectiveness ofthe UN’s We Care workplace programme, and thearts and media response.

Imaginative efforts to mainstream HIV/AIDS intoInformation and Communication Technologyprogrammes have occurred, but there was nosubstantial indication that these had been effective.

Partnership coordination for country results: UNDPleadership through the Round Table, the UNCountry Team, and the UN Theme Group onHIV/AIDS made a difference to inter-agencysynergy, especially with bilateral donors. In addition,UNDP collaborated with other agencies on anumber of other projects that have benefited fromUNDP input and have achieved some successes.However, it could not be ascertained whether theserepresented the most strategic use of UNDP resources.

The Human Development Forum has also contributedto better coordination and networking of stakeholdersfrom government, civil society, the private sector and other constituencies. At local level, there werefurther examples of UNDP initiatives leading toeffective partnerships.

6.9 ZAMBIA

6.9.1 MethodologyThe Zambian assessment was undertaken by anational consultant who was joined for five days inNovember 2004 by international consultants toconsolidate data collection and validation. Datacollection used document review and interviews ofbeneficiaries, donors and government officials, usingprepared schedules, as well as field visits to theSouthern and North-West provinces. A validationworkshop helped with triangulation.

6.9.2 ContextZambia confronts HIV/AIDS in a context of seriousdevelopment challenges, including limited economicgrowth and weak institutions. Poverty levels are atapproximately 80 percent in rural areas and 53 percentin urban areas. The country’s Human DevelopmentIndex ranking in 2004 was 164, having declined sincethe mid 1980s due to economic stagnation and theeffects of HIV/AIDS on life expectancy.

Zambia has a mature HIV/AIDS epidemic. Adultpopulation HIV/AIDS prevalence was estimated at16 percent by the 2001-2002 demographic andhealth survey (DHS). Infection rates may havestabilized and even begun to decline. Levels aresubstantially higher in women than in men, and urbanadult prevalence was estimated at 22 percent compared94


95


11 percent in rural areas. An estimated 700,000Zambian children have lost parents to AIDS.

Zambia established an HIV/AIDS Programme inthe Ministry of Health in 1986 and produced a seriesof Medium Term Plans for HIV/AIDS. TheNational HIV/AIDS Council (NAC) and aSecretariat were established in 2000 outside theMinistry of Health. The NAC, the draft HIV/AIDSNational Policy, and the National HIV/AIDS/STI/TBIntervention Strategic Plan 2002-2005 reflect anincreasingly multi-sectoral approach to HIV/AIDS.Antiretroviral therapy (ART) has become a highprofile component of the response since 2003.Increasing government commitment was shown byactive, high-level political leadership, national budgetallocations for ART, development of workplaceprogrammes, and other responses in ministries since2003. The NAC has had very limited effectiveness.At the time of the evaluation, more attention wasbeing given to strengthening coordination, monitoringand evaluation, and to the decentralized HIV/AIDSstructures formed in 2002. Civil society has been an

important role player in the HIV/AIDS response.Prominence is being given to strengthening theprivate sector response.

A large number of bilateral and multilateral developmentpartners have devoted high levels of resources to HIV/AIDS in Zambia. Large scale resources have beenmade available in recent years by the Global Fund,World Bank and PEPFAR.Many donors have supportedvertical programmes, and the government has tried todiscourage this to improve coordination and equity.UNDP has been a notable exception due to its emphasison responding to priorities defined by the government.UNDAF strategies on HIV/AIDS include a focus onsupporting development of a national multi-sectoralHIV/AIDS coordinating mechanism; mainstreamingand capacity development in line ministries; a nationalresponse that covers youth, stigma and discrimination,rights for women and orphans; and information,education, and counseling and support for care.

6.9.3 UNDP responsePrior to 2000, UNDP supported home based care

The Zambian case study suggestsseveral strategic issues of broad relevance:

n UNDP has the advantage of strongrelationships with government,but opportunities have beenmissed to use these relationshipsto enhance HIV/AIDS responsesand to mainstream HIV/AIDS.

n Zambian experience shows thatUNDP can play an important rolethrough its ability strategicallyand rapidly target key gaps incountry responses, such as theneed to strengthen the decen-tralized response to HIV/AIDS, anarea which often remains under-supported by other partners.

n Coordination with the WorldBank and other partners canenable UNDP to leverage itsresources and interventions toenhance overall impact at country level.

n Strategic use of national UNVolunteers (UNVs) is a particularcomparative advantage of UNDP.In the Zambian experience there

are opportunities to strengthenoutcomes and sustainability bydeveloping more holistic, betterresourced approaches to UNVprogrammes.

n UNDP has an advantage of flexibility to provide resourcesand support in response to arange of needs, but this can create risks of thinly spreadresources and apparent or reallack of strategy. It also risks limiting consolidation and sustain-ability of particular initiatives.

n UNDP’s ability to be an efficient,reliable funder of civil societyorganizations (CSOs) needs to be reviewed and strengthened if CSO support is to be a majorfeature of future programmes.

n UNDP’s partnership coordinationand leadership role needs to be clarified at the country level,considering country context andemerging roles of UNAIDS. UNDPcan also benefit from improvedcommunication.

In the future, in Zambia UNDP should:

n Consolidate and build on pastsuccesses, especially at the district level, in an updatedUNDP country HIV/AIDS strategythat gives greater urgency to HIV/AIDS and draws uponUNDP’s strong relations with thegovernment for greater impact.

n Increase focus on capacity devel-opment for the National HIV/AIDS Council and other coreagencies, and review UNDPCountry Office capacity for HIV/AIDS activities.

n Give greater attention to part-nerships, especially with UNAIDSand the World Bank, to facilitateeffective use of the significantincreases in external resourcesflowing from other partners.

n Support more effort on prioriti-zation, monitoring, evaluation,sustainability, and knowledge-sharing.

n Consider increasing Country Officesupport to achieve optimal results,as its capacity for HIV/AIDS workhas often been stretched.

Strategic Issues and Key Implications of Main Report for UNDP Action in Zambia

and sex worker interventions. Since then, UNDP’sHIV/AIDS programme has targeted key structuresand organizations with a set of catalytic interventions.It has emphasized approaches that are participatory,“bottom–up”, rights-based, and recognize the roles ofgender and poverty. UNDP has supported:n Developing capacity of coordinating institutions

at provincial and district leveln Strengthening community based structures at

village leveln Developing the capacity of the national coordi-

nating mechanism, the NACn Strengthening responses of the private sector and

civil society, including people living with HIV/AIDS (PLWHA) organizations, advocates fororphans and faith based organizations

n Strengthening ministries through the provisionof expert UNVs to assist focal point persons

n Support for advocacy and research related toBehavior Change Communication, care and support,voluntary counseling and testing, rights-basedapproaches, and strengthening political supportfor the national response.

The share of the UNDP Country Office budget forHIV/AIDS has increased from 4 percent to 35percent since 2000, with funds largely diverted froman agriculture programme where UNDP’s role hadbecome redundant. Nevertheless, UNDP resourcesremain small compared to those of many other donorprogrammes. UNDP has tried to focus on gaps thathave been neglected by others and that have potentialto leverage other resources. UNDP has played acentral role in the UN system workplace programme.The Regional Center has been very actively engagedin Zambia.

6.9.3.1 Outcomes associated with UNDP responseGovernance: UNDP support has been influential inhelping NAC function and develop a clearer idea of its role in the multi-sectoral response. UNDP has also played a key role in a strategic shift inunderstanding of benefits of decentralized HIV/AIDS programme planning and management andhow to achieve it. Its support to decentralizedplanning processes and capacity development havebeen central to developing and strengthening newinstitutional arrangements at district and provinciallevels, including mechanisms for community involvement. Citizen demands for services and rightsrelated to HIV/AIDS are increasingly represented in district workplans. Nevertheless, action has been

hampered by limited linkages of HIV/AIDSstructures and processes to the local governmentsystem, including formalization of accountability andauthority. This may be an emerging opportunity forUNDP to use its governance expertise for increasingresults at district level.

Support to the National Network of Zambian People Living with HIV/AIDS (NZP+) and strong involvement of PLWHA’s in district AIDS planningtask forces (DATFs) have helped to enhancePLWHA rights, visibility and influence in planningand programmes. Support for other NGOs has alsoenhanced recognition of rights of other vulnerablegroups such as workers and orphans. UNDP alsohad a role in creating greater awareness of multi-sectoral HIV/AIDS issues, and role clarity in relationto Millennium Development Goals (MDG),through advocacy and support of the MDG reviewand Demographic and Health Surveys DHS.

Leadership: UNDP has had a key role in mobilizingleadership, including traditional leaders, at decentral-ized levels though training, community mobilization,advocacy campaigns and other support. Results arereported mainly in the pilot North West province,but at the time of the evaluation, it appeared thatlearning could be leveraged to other provinces anddistricts. NGOs supported by UNDP such as NZP+and KKCF have also provided leadership in advocacyand representation of vulnerable groups, although thedegree to which this was directly associated withUNDP support could not be ascertained.

Capacity development: UNDP supported NACcapacity development at a stage when the NAC wasnew and support from other donors was limited.UNDP contributed a major proportion of NAC corefunding and supported key running costs, projectfunding, and technical assistance. Although NACfunctionality has remained severely limited, otherdonors have increased support to it. The NAC mighthave collapsed completely without UNDP support inthe interim.

Positive outcomes are widely reported in relation toUNDP capacity development at the district level,primarily through contributing national UNVs andthrough training, assistance in planning, andresources for information communication andtechnology and transport. There have been increasesin action at decentralized levels, existence of plans,96


97


increased funding flows to HIV/AIDS projects at thecommunity level and government requests for roll-out to all districts. UNDP’s role is central to thesesuccesses, and its support has strong potential forachieving results at scale due to recent roll-out ofUNV support to 69 of Zambia’s 72 districts, andsynergy with the World Bank’s CRAIDS and DCIsupport at provincial level.

Questions were raised about the sustainability ofUNV-dependent capacity development initiatives,and the need for a more holistic approach to supportingthem if they are to be effective. However, theimmediate benefits of the UNVs were substantialand, while these concerns are real, they should nothold up deployment of UNVs.

UNDP also added to capacity development in civilsociety, with support to organizations and particularactivities such as training that have strengthenedorganizations such as NZP+. However, there were perceptions that UNDP can be an unreliableand inefficient funder of civil society organizations,with negative implications for effectiveness andsustainability of its efforts.

UNDP also contributed to strategic information relatedto the MDG evaluation and Poverty ReductionStrategy Paper (PRSP) that has been used in policy.However, it was uncertain how effective the HumanDevelopment Report had been at country level.

Mainstreaming: UNDP helped to facilitate a shift inperception towards seeing HIV/AIDS as a developmentand multi-sectoral issue at national and district level.This has, to varying extents, been translated intoplans and actions. UNDP support in the PRSP,Transitional National Development Plan and economicgovernance facilitated inclusion of HIV/AIDS in these plans. However, while HIV/AIDS ismentioned in plans as a cross cutting issue, there islittle integration into all relevant components ofplans, and a medical bias was noted in PRSPHIV/AIDS sections.

Extensive Regional Programme support has beengiven to mainstreaming training in ministries andlower levels of government. UNDP also facilitateddecisions to allocate national budgets to HIV/AIDS and promote responses within ministries.Mainstreaming initiatives have also occurred inseveral Ministries, but the impact of these changes

and how much progress could be attributed to UNDPcould not be determined at the time of the evaluation.

UNDP was widely considered to have enhancedmainstreaming and multi-sectoral involvement inHIV/AIDS at the district and local level throughtraining, tools and other support. At the time of theevaluation there was a need to consolidate this.

UNDP support for NZP+ and the Zambian BusinessCoalition had positive outcomes in raising and sustainingawareness of workplace HIV/AIDS issues, includinginfected workers’ rights. However it could not beascertained that UNDP support had led to other,effective action in workplace programme development.

No significant mainstreaming of HIV/AIDS intoother UNDP programmes in governance, environ-ment and economy was noted. However, district leveloutcomes seemed to be attributable at least in part toleveraging experience of UNDP’s decentralizationsupport programme.

Partnership coordination for country results: A prominentoutcome of UNDP programmes at the district level has been effective mobilization and leveragingof other donor resources, particularly through coordi-nation with CRAIDS and DCI. However a numberof important potential partners knew little aboutUNDP initiatives, and opportunities for strongercoordination have been missed through limitedcommunication. UNDP was well engaged in thedonor harmonization dialogue but was unable to joinin pooling funds.

The UNDP Resident Coordinator, AssistantResident Representative and Programme Advisorhave played technical and other leadership andcoordination roles within the UN family, as well asthrough participation and coordination roles withinthe Expanded Theme Group and its technicalcommittees. Smaller UN agencies, in particular,appreciated UNDP coordination, facilitation andsupport roles and highlighted the benefits of atechnically strong programme advisor. However, itwas not possible to form an opinion of how strongUNDP coordination and leadership roles had beenoverall. UNAIDS appeared to be assuming anincreasing role in coordination, and some felt thatUNDP had missed opportunities to assist thegovernment and donors in defining HIV/AIDSstrategic priorities more clearly.

6.10 ZIMBABWE

6.10.1 MethodologyThe Zimbabwe country assessment was undertakenby a national consultant in late 2004. It was based ondocumentary evidence, extensive interviews usingspecially designed interview guides, one focus groupdiscussion, a case study of a health district, and avalidation workshop to complete the triangulation.No member of the international consultant team visitedZimbabwe in connection with the country assessment.

6.10.2 ContextDuring this evaluation period, the macroeconomicenvironment in Zimbabwe continuously deteriorated,causing the fastest-ever decline in the economy. Anestimated 60 percent of the population lives belowthe poverty line. A worsening budget deficit, growingat 9 percent per year, has triggered an inflationaryspiral. Capacity to provide social services declined atall levels, and socio-political tensions have risen.Bilateral development partners and the BrettonWoods Institutions ceased new commitments, butUN agencies continued to operate in the country.

Patriarchy and gerontocracy characterize Zimbabwe’spopulation of 11 million. Poverty and the dynamicsof cultural change have contributed to a weakening oftraditional community structures, especially in urbanareas. The HIV/AIDS epidemic has put them underfurther strain. Adult HIV prevalence was estimatedat 24.6 percent in 2003; it was previously estimated at34 percent in 2002 based on different methodology. Thenumber of annual AIDS deaths rose from approxi-mately 12,000 in 1988 to a staggering 177,000 in 2003.

The Zimbabwean leadership has shown somecommitment to addressing HIV/AIDS, as reflectedin adoption of a National AIDS Policy; enactment ofan AIDS levy; selecting Millennium DevelopmentGoal (MDG) six, on disease reduction, as an area offocus; endorsement of international instruments anddeclarations such as the UNGASS Declaration ofCommitment; and support to projects with peopleliving with HIV/AIDS (PLWHA). HIV/AIDS isnow reported to be on the agendas of many leaders,including government officials, civil servicemanagers, religious leaders, and political parties. Thegovernment has declared the epidemic a nationaldisaster. Nonetheless, the government’s response has notmatched its statements. Despite public pronounce-ments, a lack of openness about leaders who die of

AIDS indicates continuing denial and stigma.Advocacy was reported to be minimal.

The National AIDS Council (NAC) operates underthe Ministry of Health and Child Welfare (MOHCW)98


The Zimbabwe case study suggests several strategicissues of broad relevance:

n Capacity retention, where capacity has beendeveloped, is a major problem. UNDP, like otherpartners, has had great difficulty, at least inZimbabwe, in effecting change in the environ-ment that is such a critical factor in capacity retention. It was not clear whether UNDP has triedto stimulate such change.

n UNDP merits strong recognition for sustaining itscooperation in Zimbabwe in extremely difficultconditions. Yet, the Zimbabwe case poses afundamental strategic issue for UNDP, namely the

extent to which it can and should devote scarcehuman and financial resources to a country, oreven to an issue within the country, that is criticalto any concept of its long-term future, such asHIV/AIDS, when capacity utilization and retentionare so negatively affected by the social and economic environment.

n The sustainability of the accomplishments ofUNDP on HIV/AIDS in Zimbabwe is a serious issue.At its most extreme, the Zimbabwe situation illus-trates a conflict between UNDP’s humanitarianand development missions.

n Relations between UNAIDS and UNDP were foundto merit senior management attention.Zimbabwe wasnot the only country where this issue has surfaced.


n Formulate and communicate an updated UNDPcountry HIV/AIDS strategy with greater emphasison the issue in the work of UNDP; this should helpthe government to move increasingly from wordsto action and implementation.

n Encourage the government to give greater attentionto HIV/AIDS as a development issue and adopt amore assertive posture with the public authoritieswith greater attention to civil society organizationsand to capacity retention.

n Clarify roles and resolve misunderstandings withUNAIDS, with support from UNDP Headquartersas needed.

n Focus more on the UNDP integrating and leadership roles, and on the monitoring, evalua-tion and sustainability of interventions in a difficult environment.

Strategic Issues and Key Implications of Main Report for UNDP Action in Zimbabwe

99


and is considered to be stuck largely in a biomedicalmodel. Its location under the MOHCW reduces its autonomy and the effectiveness of its work ofcoordinating the response of many entities. Staffdepartures for better opportunities elsewhere havealso weakened the NAC. The NAC manages theHIV/AIDS levy resources. Upward, participatoryannual planning takes place at district and provinciallevels, and increasing protection of PLWHA wasreported at local levels, with PLWHA members oflocal multisectoral district AIDS action committees.Civil society organizations play a crucial and increasingrole in fighting AIDS, both nationally, throughparliamentary action, and locally. Nonetheless, theyhave weak leadership and often to face difficultiesmainstreaming AIDS into their work.

6.10.3 UNDP responseUNDP has been heavily engaged in HIV/AIDS inZimbabwe, though perhaps somewhat belatedly.Stand-alone intervention began in 2000. UNDPsupported strategy development and advocacy atboth the national and local levels. UNDPmainstreamed HIV/AIDS into its projects outsidethe health sector and in the UNDP workplace. Itproduced a draft HIV/AIDS policy for the publicservice, assisted with the establishment of an HIV/AIDS Coordination Unit to oversee implementa-tion, and carried out training workshops to developaction plans and workplace programmes for eachmajor agency. It also supported integration ofHIV/AIDS into macroeconomic models used by theMinistry of Finance. The UNDP South AfricanCapacity Initiative (SACI) project has supported theMOHCW in training of a new primary carecounseling cadre and mapping of the health systemcapacity for scaling up antiretroviral therapy (ART).It assisted the Zimbabwe Business Council on HIV/AIDS to develop competencies to assess HIV/AIDSimpact on business performance. With UNDPsupport, the Zimbabwe Human DevelopmentReport 2003 focused on HIV/AIDS, under the title“Towards Reducing Vulnerability – the UltimateWar for Survival.”

During the period of this evaluation, UNDP annualspending on HIV/AIDS in Zimbabwe has fluctuatedgreatly– from as low as USD 41,000 and 2 percent ofthe total programme in the year 2000, to USD1,387,000 and 31 percent of the programme in 2001.In 2004, spending was USD 2,227,000 and 22percent of the programme. While Country Office

capacity was limited, the UNDP Country Office inZimbabwe was unique among those in case-studycountries to have initiated outcome evaluation.

6.10.3.1 Outcomes associated with UNDP responseGovernance: UNDP project support has directlycontributed to the strengthening of nationalgovernance institutions concerned with HIV/AIDSthrough adoption of appropriate laws and policies,including the National AIDS Policy, NationalGender Policy, Legal Age of Majority Act, acceptanceof the UNGASS Declaration, and the choice of thegovernment to focus on the MDG goals of poverty,gender and HIV/AIDS. UNDP support to parlia-mentary information centers, including training ofMembers of Parliament (MP), is thought to havehelped inform MPs and help civil society hold themaccountable. However, there is an inherent tension inthis area in Zimbabwe, as UNDP has promoted civilsociety partnership but new NGO legislation haspolarized government-civil society relations. WhileUNDP supported the NAC, it appeared not to haveintervened in the issue of the location of the NAC inthe MOHCW – a source of weakness in UNDP’swork and of tensions among government stakehold-ers concerned. This represents a missed opportunityto reflect Government of Zimbabwe acceptance thatHIV/AIDS is not only a health issue but also amulti-sectoral development issue. Increasing protec-tion of the rights of PLWHA prevails at the districtlevel, thanks to UNDP project support. PLWHAwere reported to participate in district and wardAIDS committees. Successful decentralization of theNAC is directly attributable to UNDP projectsupport. Government capacity to budget forHIV/AIDS remains low. The establishment of thePartnerships Forum in 2003 to promote scaling upART was an important accomplishment, but theweak leadership of most civil society organizations/NGOs led to difficulty in mainstreaming HIV/AIDS in their work.

Leadership: There is increased commitment byZimbabwean leaders at all levels to an effectiveHIV/AIDS response. How firm this commitment isremains to be determined, through much-neededsurveys, as a result of the lack of openness about thecauses of death of AIDS patients, particularly thoseof low social status. The gradual engagement of MPsin HIV/AIDS issues is an important accomplishmentof UNDP leadership.

Capacity development: UNDP has made importantcontributions to the greater awareness of HIV/AIDSin Zimbabwe. Its Zimbabwe Human DevelopmentReport (ZHDR) was particularly important in thisrespect, and has been widely praised, thoughirresponsible reporting in the media--mentioned inthe ZHDR--has contributed to, rather than reduced,HIV/AIDS stigmatization. Further training ofjournalists to report on HIV/AIDS in Zimbabwe isneeded. A positive capacity development by-productof the contracts concluded by UNDP with localresearchers for the ZHDR and macroeconomicanalyses with the Ministry of Finance has been theirengagement in work in other countries. District-levelresponses were strengthened, but the extent of thestrengthening was not clear, particularly sinceconfusion and duplication of roles were reportedbetween district and ward AIDS committees. UNDPconcentrated its support in the public sector and paidrelatively little attention to NGOs at a time whenthey were assuming increasing importance asproviders of social services.

Mainstreaming: UNDP supported mainstreaming inministries, UNDP projects, and in the UNDPworkplace. The We Care Programme encouragedaction on HIV/AIDS in the UNDP workplace, butneeds scaling-up and encouragement of staff toreveal their HIV status. Increased private sectorinvolvement in HIV/AIDS was reported, withUNDP financing of business leader training in aworkshop. UNDP has also initiated some limitedpartnerships with civil society organizations in theZimbabwe AIDS Network (ZAN), in connectionwith the ZHDR. UNDP support to macroeconomicmodeling produced a government economic policy

package for 2005-2006 integrating HIV/AIDS as afactor. UNDP’s work in this area is widely hailed as asuccess, and with the withdrawal of the BrettonWoods Institutions, it would have been difficult tofind a donor to fund macro work if UNDP had notdone so. Despite the progress, there are significantgaps between government pronouncements onmainstreaming and other HIV/AIDS issues and thereality of daily life in the country, and betweenHIV/AIDS awareness and knowledge of specificprevention techniques and the provision of supportand treatment. Such gaps represent formidablechallenges to all stakeholders.

Partnership coordination for country results: UNDPZimbabwe has given greater attention to implemen-tation than to UNDP’s coordination role. Howevermonitoring and evaluation has been weak; theCountry Office staff should be trained on outcomeindicators and monitoring and evaluation.Misunderstandings reaching the level of reported”animosity” between UNAIDS and UNDP aredisturbing. UNAIDS was reported to criticize thework of UNDP in Zimbabwe and to allege that thelevel of UNDP funding shows that UNDP is not amajor player in AIDS work. UNAIDS has takenexception to an approach in the ZHDR described as“scaring people.” There is a need to resolve theseissues before they damage the image of the UNfamily. Coordination was strengthened when theUNDP Resident Representative assumed the chair of the HIV/AIDS Theme Group. UNDP had animportant resource mobilization success in Zimbabwe,with its role as Principal Recipient after the long-delayed signature of the Global Fund Round Onegrant to Zimbabwe.

100


101

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 7. SYNTHESIS OF GLOBAL POLICY INTERVIEWS

As part of the evaluation, the international consultantteam undertook semi-structured, confidential andoff-the-record global policy interviews with a panelof 22 key informants. All interviewees were asked to express personal, professional views, rather thaninstitutional perspectives. Most of the interviews wereconducted in person; some were conducted by phone.Notes were taken during the interviews, written up andthereafter distributed to members of the internationalconsultant team. The interview results were takeninto account in the main text of the report. Thisannex provides information on the interviewees andcontains an overall synthesis of their observations.

POPULATION OF KEY INFORMANTS AT THE GLOBAL POLICY LEVEL

Nine of the interviewees were UNDP staff; 13 werefrom outside UNDP. Fifteen were from UN agencies;seven were from outside the UN system. UNDP’smajor partner institutions in UNAIDS were representedamong the interviewees including UNAIDS, WHO(Headquarters and WHO/AFRO), UNICEF, UNFPAand the World Bank. Even those interviewees fromoutside the UN system were deeply engaged in HIV/AIDS work through work with the Global Fund toFight AIDS, TB, and Malaria; the World Bank;1

and bilateral donors. Several of the interviewees hadobserved UNDP’s HIV/AIDS activities from theperspective of working on HIV/AIDS in] differentorganizations. The major 3 HIV/AIDS financiers in the 10 case-study countries—the Global Fund,PEPFAR and the World Bank—all had key informantsamong the panel of interviewees. No non govern-mental organization (NGO) or foundation personnelwere included among the global interviewees, on thegrounds of limited familiarity with UNDP’s work onHIV/AIDS at the country level. The interviewees arelisted in Annex 8.

AWARENESS OF UNDP’S WORK ON HIV/AIDS

Aside from its overall role at the country level withinthe UN system, UNDP and its work on HIV/AIDSwere poorly known. As one interviewee commented,

UNDP “has been invisible” on HIV/AIDS. Externalinformants, and sometimes even UNDP staff, foundit difficult to identify specific positive, or negative,AIDS-related outcomes in the case-study countrieswith which UNDP has been associated. While manyinformants responded thoughtfully, it was only withdifficulty that they addressed a question about thecounterfactual of no UNDP engagement onHIV/AIDS—a manifestation of limited knowledgeof UNDP’s work on HIV/AIDS. It also suggests aproblem of defining and communicating UNDP’srole(s) on HIV/AIDS in the case-study countries. Inaddition, several observers interpreted the sameinformation on country situations in dramaticallydifferent ways, which hints at the problem of ade-quately defining UNDP’s roles and goals in relationto HIV/AIDS, particularly at the country level.

UNDP’s comparative advantages on HIV/AIDSObservers commented at length on UNDP’s comparative advantages in addressing HIV/AIDS inthe case-study countries. However, they sometimesfailed to distinguish what they thought UNDP’scomparative advantages actually are and what theyconsidered UNDP’s comparative advantages shouldbe. There were some references to poor use by UNDPof its comparative advantages, particularly in relationto other UN agencies. Informants tended to thinkthat UNDP’s comparative advantages in addressingHIV/AIDS issues had changed over time and couldbe expected to change further in the future.

The main conceptions of UNDP’s current comparativeadvantages on HIV/AIDS, listed in order of frequencyand importance attached by the informants, were:

1. Service as coordinator and voice for the UNsystem and Country Team—This was the mostwidely remarked comparative advantage and acentral theme throughout the interviews.One observer from outside the UN systemcommented that UNDP can and should bringother donors to the dialogue at the country level,even when those donors may be inclined not toparticipate and to operate outside it.

2. Ability to facilitate the effective involvement ofother donors, particularly smaller UN agenciesand those with financial resources but little fieldpresence or knowledge of country situations—

ANNEX 7. SYNTHESIS OF GLOBAL POLICY INTERVIEWS

1 Formally, the World Bank is a UN specialized agency. It is also asponsor of UNAIDS. However, for the purposes of the evaluationit is considered to be outside the UN system because its work,working methods, and country representation differ greatly fromthose of other UN agencies.

Several commentators saw this role as particu-larly important in the future, with the growth inthe Global Fund, PEPFAR, and World BankMAP resources, where UNDP could assistcountries to draw down their funds.

3. Service in building country capacity, particularly,as one interviewee put it, the ‘architecture ofAIDS institutions’ at the country level and, asanother interviewee observed, the capacity tomanage external resources; AIDS impact on theworkforce, and AIDS-linkages to civil serviceissues were also mentioned—Capacity buildingfor implementation was a theme in severalcommentators’ views, and reference was made toan ‘implementation gap’ in UNDP AIDS work.However, the observations tended to be genericrather than linked specifically to HIV/AIDS andto the specific situations of individual case-studycountries. Beyond generic reference to capacitybuilding, one informant said that UNDP needsto address the question of ‘capacity for what?’

4. Ability to address and communicate AIDS as adevelopment issue—This included mainstreamingHIV/AIDS issues into other sectors and helpingpartners in host countries as well as amongbilateral donors move beyond narrow or—as onekey informant expressed the problem so vividly‘stovepipe’—approaches. UNDP support fornational human development reports (NHDRs)and its work on the Millennium DevelopmentGoals (MDGs) were cited in this connection.

5. Closeness to country situations and contact withpolitical, parliamentary and government leaders—This included references to UNDP’s ‘neutrality,’its ‘objectivity,’ its work on policy and the policyenvironment, and (more generally but notuniversally) to trust in UNDP by host countryleaders. UNDP’s capacity to convene andmobilize decision makers was cited.

6. Community action and capacity to work with thecivil society—These were frequently evoked,including UNDP’s work with and for decentralizedHIV/AIDS responses. Several commentators,however, suggested that UNDP was at a compar-ative disadvantage, relative to other partners, inworking with the civil society and NGOs, andshould focus on the public policy dimensions andthe public sector response.

UNDP AND ITS DYNAMIC ENVIRONMENT

Most observers thought that UNDP must adapt tothe changing institutional and financial landscapeand environment for AIDS programmes in developingcountries. A small number, in contrast, thoughtUNDP should not change in the face of a rapidlychanging external environment. It was also observedby several commentators that it is extremely easy tobe critical of UNDP on HIV/AIDS, as in otherareas, because of the breadth of its areas of concern.2

Several informants commented that the ‘Three Ones’ initiative of UNAIDS—for one nationalstrategic framework, one national coordination institution for HIV/AIDS, and one single monitoringand evaluation framework—poses both threats as wellas opportunities for UNDP. Those who commentedon the matter found that the increasing tendency forUNAIDS to become operational posed role problemissues for UNDP.

A number of informants commented that UNDPwas becoming financially much smaller, relative toother development partners. Giving greater emphasisin the work of country offices to the resource mobilization function was not necessarily thought to bean appropriate response to this problem. Partnerships,it was said, had been too loosely conceived, and UNDPneeds to explain the concept and define expectedpartnership-specific results. Several observers consid-ered UNDP a difficult partner, possibly because ofthe breadth of its concerns, and one spoke of UNDPhaving a ‘big mouth’ with more words than action.

STRATEGIC OUTCOMES OF UNDP’S ENGAGEMENT ON HIV/AIDS IN THE CASE-STUDY COUNTRIES

There was a fairly wide consensus among the inter-viewees that, in the absence of UNDP engagementon HIV/AIDS over the period of the evaluation andpreviously, there would be less awareness of the diseaseand less attention to it as a development issue to bemainstreamed into all development activity, bothglobally and at the level of individual developingcountries. Similarly, it was thought that, withoutUNDP involvement, there would have been lessattention to governance dimensions of HIV/AIDS.However, there were also a number of comments that

102


2 This is also a common external complaint about the World Bank—an institution much more richly endowed with human and financial resources.

103


UNDP had been late engaging on HIV/AIDS at adeeper level. This may be a reflection of failure of theinternational community more generally. Manyinformants responded with difficulty to the questionabout the counterfactual of no UNDP engagementand found it hard to identify specific changes in relation to HIV/AIDS, globally or at the countrylevel, with which UNDP could be said to have beenassociated. This is a manifestation of the phenomenonof poor knowledge and understanding of UNDP’swork on HIV/AIDS.

Opportunities thought to have been well exploited byUNDP included: work with the Global Fund and(with somewhat less emphasis) other donors; work onawareness, advocacy and mainstreaming; and ‘upstream’activities. Concerns were, however, expressed regardingUNDP exit strategies in its cooperation with otherdonors, and reference was made to a reputational riskto UNDP in its assumption of the role of PrincipalRecipient of the Global Fund. There were several references to the critical importance of building sustainable local capacity to manage and effectivelyand efficiently use external resources for HIV/AIDS programmes.

Opportunities thought to have been missed by UNDPincluded: delays in making the SACI project operationaland, more generally, bureaucratic weaknesses and delayswithin UNDP itself; competition and tensions withother agencies, especially UNAIDS; and failure toscale-up success, as in the community conversationsprogramme in Ethiopia, when other partners’ fundswere available.

Success factors thought to have contributed positively toUNDP’s AIDS work cited by interviewees included:the central place of UNDP within the UN system atthe country level; quality of the ResidentRepresentative (RR)/Deputy RR; opening up theTheme Group beyond UN agencies; innovation,brainstorming, and addressing the underlying causesof HIV; confidence of client governments in theirown their policies and programmes and in UNDP;taking a demand-based approach to HIV/AIDSservices in response to the country situation; focusingon concrete, practical activities, such as costing ofHIV/AIDS activities and programmes; and absenceof donor competition.

Obstacles to effective UNDP AIDS engagement cited byinterviewees included: use of jargon and a tendency

towards rhetoric and overstatement, as in ‘transfor-mational leadership’ and ‘breakthrough initiatives’;difficulty in moving from concept to implementation;lack of focus;—one informant spoke of “drift” ascharacteristic of the UNDP AIDS response; poorinternal coordination among UNDP bureaus,especially between the Country Offices andHeadquarters, and weak regional presence—onespeaker referred to an ‘insularity’ of Country Officesas leading to a risk of loss of relevance; the challengeof maintaining appropriate balance between capacitybuilding and programme implementation, especiallyunder Global Fund grants; limited political courageand willingness to take risks, particularly amongcountry offices--it was said that UNDP should bemore willing to challenge host governments; concen-tration on delivery of workshops more than results,and ‘paper engagement’ more than substantialinvolvement; and the difficulty of getting beyondawareness raising and generating a response toanswering the question, ‘What next?’

STRATEGIC ISSUES EMERGING FROM THE GLOBAL INTERVIEWS

Strategic issues that emerged from the interviewsalso reflect many matters raised by the country casestudies. These include:

1) Timing and character of the evaluation. A numberof informants strongly welcomed the evaluation,and several UN agency personnel expressed awish that similar confidential, off-the-recordfeedback on the work of their agencies could beorganized. However, many interviewees observedthat UNDP’s AIDS evaluation may have beenlaunched too soon and that meaningfuloutcomes from UNDP’s interventions could notbe expected by 2005. It was also noted thatretrospective evaluation was extremely difficult toconduct in an environment of extremely rapidchange (such as the one prevailing in HIV/AIDS),since the goals themselves change frequently.

2) Changing nature of the needs of the internationalcommunity and UNDP’s clients and UNDP’sconsequential comparative advantages in relation toclient needs. Nearly all members of the panel ofkey informants considered that UNDP mustchange as the epidemic changes and the environ-ment for its work on HIV/AIDS changes. Thefact that the major HIV/AIDS donors in the

case-study countries fall outside the UnitedNations Country Team system was thought topose challenges for UNDP. One logical responsefollowed in some of the case-study countries is toconcentrate UNDP energies on an expanded UNTheme Group on HIV/AIDS that consciouslybrings in non-UN partners. Several intervieweeslinked their observations on UNDP’s AIDS-related work more broadly to the theme of UNReform, and expressed the hope that the currentUN Reform discussions would be taken as anopportunity to strengthen the UN ResidentCoordinator system with UNDP in the lead.

3) Limited documentation of experience. Theinterviewees frequently observed that UNDP’sexperience in HIV/AIDS had been poorlydocumented—a point confirmed in the countrycase studies—making it difficult to transfer thisexperience across countries, despite the centralrole of UNDP in knowledge sharing.This situationmakes outcomes evaluation hazardous, despite all efforts at triangulation, and excessivelydependent on interviews. UNDP and its partnersmust insist on stronger monitoring and evaluations,which implies the need for more careful planningat the design stage of UNDP interventions. Theweakness of existing monitoring and evaluationand other outcome data made it extremelydifficult for the evaluation team to assess thedepth and sustainability of outcomes associatedwith UNDP intervention.

4) The exceptionality of HIV/AIDS. Informants wereunclear on the exceptionality of HIV/AIDS. Asan organization concerned with the entire range

of development issues in the case-study countries,UNDP is well positioned to define and explain thenature of and reasons for AIDS exceptionality.

5) Institutional crowding and its implications forUNDP. Several commentators observed that thegrowth of PEPFAR, the World Bank’s MAPoperations, and the Global Fund threatenUNDP’s relevance and central position on HIV/AIDS at the country level. Similarly, the growingfield presence of UNAIDS was thought to poserole definition issues for UNDP. UNDP’s lack ofclarity on its own role in UNAIDS contributed,in the view of some observers, to a perceived lackof relevance among the UNAIDS co-sponsors.

6) Sustainability of UNDP interventions. Someinformants considered that UNDP interventionson HIV/AIDS lacked sustainability, in partbecause they were inadequately framed incountry-specific context. It was said that UNDPhad created many pilot programmes that had notbeen pursued.

7) Redefining and communicating UNDP’s HIV/AIDS roles. The limited knowledge of UNDP’sHIV/AIDS roles, and the changing environment,including appointment of a new UNDPAdministrator, give the organization an opportu-nity to reconceive and communicate its AIDSstrategy and roles. They permit internal reflectionon how to go beyond ‘building awareness’ andbeyond ‘generating a response.’ The interviewssuggest that perhaps the next stage of UNDPAIDS work could be summarized under a themeof ‘facilitating impact.’

104


105

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 8. REFERENCES

Angola Ministry of Finance, “Orçamento Geral doEstado, Proposta Orçamental, Exercício Económicode 2005,” Versão Preliminar, Angola, 2005.

Angola Ministry of Health, “Plano EstratégicoNacional Para as Infecções de Transmissão Sexual,VIH/SIDA, Angola 2003/2008,” Angola, nd.

Angola Ministry of Health, “Programa Anual doSector,” Angola, January 2005.

Angola Ministry of Planning, “Estratégia deCombate a Pobreza,” Angola, 11 September 2003.

Angola Ministry of Planning and UN System,“Relatório de Progresso MDG/NEPAD, Objectivosde Desenvolvimento do Milénio,” Angola, 2003.

Annan J et al, “Final Report: HIV/AIDS Surf Missionto Angola,” JSA Consultants and UNDP Bureau ofDevelopment Policy, Pretoria, 26 February 2002.

Annan K, “Remarks at the General Assembly High-Level Meeting on HIV/AIDS,” New York, 2 June 2005.

Bonnel R et al, “Poverty Reduction Strategy Papers:Do They Matter for Children and Young Peoplemade Vulnerable by HIV/AIDS?” Results of a JointUNICEF and World Bank Review, December 2004.

Caplan G, “Towards a UNDP Country Office of the Future—Lessons from Lesotho, 2002-2004,”November 10, 2004 (processed).

Center for Global Development, “HIV/AIDS:Money, Bottlenecks and the Future; Survey ofPerceptions of HIV/AIDS Bottlenecks – Summaryof Key Findings,” April 2005.

Centers for Disease Prevention and Control et al,“Seroprevalencia do VIH em Mulheres Grávidas emConsulta Prenatal, Relatório Geral,” PPT slides,Angola, 2004.

Chamber of Commerce of Angola (CCIA), “ActionPlan for the Fight Against AIDS in the Companiesof CCIA and Potential Members,” Angola, nd.

Commission for Africa, ‘“Our Common Interest,’”report commissioned by UK Prime Minister Blair,March 2005.

Delion J, Peeters P, Klofkorn Bloome A, “Experiencein Scaling Up Support to Local Response in Multi-Country AIDS ProgramsProgrammes (MAP) inAfrica,” Africa Region Working Paper Series, No.79, World Bank, December 2004.

Development Works, “Documenting the LDP inLesotho – Draft Report: 3,” UNDP Lesotho andUNDP BDP HIV and AIDS Group, February 2005.

Diário da Républica, “Decreto nº 43/03 Aprova oRegulamento sobre o HIV/SIDA,” Emprego eFormação Profissional, Angola, 2003.

Gaillard E, “Epidemiological Projections of HIV/AIDS Methodology, Parameters and hypothesis,”draft, email, 23 October 2002.

Gaillard E, “HIV/AIDS in Angola: EpidemiologicalProjections of HIV/AIDS in Angola, Methodology,Parameters, Sources and Hypothesis,” draft, TheFutures Group International with UNICEF andUNDP, nd.

Government of Lesotho, “National AIDS StrategicPlan, 2001/2001-2003/2004: A Three Year RollingPlan for the National Response to the HIV/AIDSEpidemic for Lesotho,” Lesotho.

Global Fund to Fight Aids, TB and Malaria, “FourthRound Proposal from Angola,” 2004.

High Level Forum, “Paris Declaration on AidEffectiveness: Ownership, Harmonization, Alignment,Results and Mutual Accountability,” 2 March 2005.

Kaufmann D, Kraay A, Mastruzzi M, “GovernanceMatters IV: New Data, New Challenges,” WorldBank, 2005.

Kirmaryo S, Okpaku J, Githuku-Shongwe A,“Turning a Crisis into an Opportunity: Strategies forScaling UP the National Response to theHIV/AIDS Pandemic in Lesotho,” Third PressPublishers, New Rochelle, NY, 2004.

Lewis M, “Addressing the Challenge of HIV/AIDS:Macroeconomic, Fiscal and Institutional Issues,”Working Paper No. 58, Center for GlobalDevelopment, May 2005.

ANNEX 8. REFERENCES

Millennium Project, “Investing in Development – A Practical Plan to Achieve the MillenniumDevelopment Goals,” United Nations, March 2005.

Mogedal S, “Oversight and Accountability for theOverall AIDS Response,” April 2004.

Mosse R, Sontheimer L, “Performance MonitoringIndicators Handbook,” World Bank TechnicalWorking Papers #334, 1996.

Mullen P, “Review of National HIV/AIDSStrategies for Countries Participating in the WorldBank’s Africa Multi-Country AIDS Programme(MAP),” Background Paper for the OperationalEvaluation Department Evaluation of World BankAIDS Assistance, September 2003.

O’Rourke N et al, UNDP “Outcome Evaluation onHIV and AIDS in Zimbabwe,” draft, 3 December 2004.

Piot P, “Statement at the General Assembly High-Level Meeting on HIV/AIDS,” New York, 2 June 2005.

Programa Nacional de Luta Contra SIDA, “Visita deEstudo Sobre o VIH/SIDA ao Uganda: Síntese daVisita de Estudo Sobre VIH/SIDA ao Uganda,”Angola, 2002.

Putzel J, “The Global Fight against AIDS: Howadequate are the National Commissions?” Journal ofInternational Development, #16, 2004.

Rossi L, Jorge F, “Estudo da Resposta dasOrganizções Não Governamentais (ONG)Angolanas no Combate a Epidemia do VIH/SIDA,”Ministério da Educação, Angola, 2004.

Sachs J, “The End of Poverty: Economic Possibilitiesfor Our Time,” Penguin Press, 2005.

Serrano-PNLS, Brito-PNUD and Oliveira-PNUD,“Guia para Elaboração dos Planos OperacionaisProvinciais (POPs),” Ministério da Saúde/ProgramaNacional de Luta contra o SIDA, Angola, 2004.

Sonke Consulting, “Documenting L4R Results,”final report, prepared by Jacques Pretorius and BarryPoppleton for UNDP BDP Unit, 28 October 2004.

Southern Africa Capacity Initiative (SACI), “FirstAnnual Report, March 2004 – March 2005,” UNDP.

UNAIDS, “2004 Report on the Global AIDSEpidemic,” Joint United Nations Programme onHIV/AIDS, June 2004.

UNAIDS, “Final Report of the Global Task Team onImproving AIDS Coordination among Multilateraland International Donors,” 14 June 2005.

UNAIDS, “The ‘Three Ones’ in Action: Where weare and where we go from here?,” 2005.

UNAIDS, UNICEF and WHO, “EpidemiologicalFact Sheets on HIV/AIDS and Sexually TransmittedInfections: 2002 update,” Angola, 2002.

UNDP, “UNDP Response to HIV/AIDS,” HIV/AIDS Group,Bureau for Development Policy, July 2004.

UNDP, “Corporate Strategy on HIV/AIDS,” HIV/AIDS Group, Bureau for Development Policy, nd.

UNDP, “2nd Regional Cooperation Framework forAfrica (2002-2006),” UN document DP/RCP/RBA/2,21 November 2001.

UNDP, “Results-oriented Annual Report 2000,” UNdocument DP/2001/14/Add.1, 4 May 2001.

UNDP, “Results-oriented Annual Report 2001,”UNDP, 2002.

UNDP, “Annual Report 2003,” UNDP, 2004.

UNDP, “Annual Report for 2004,” UNDP, 2005.

UNDP, “UNDP’s Work in Africa—Fast Facts,”Regional Bureau for Africa, May 2003.

UNDP, “Mid-Term Evaluation Report, on RAF/99/022—Building Capacities for Reducing HIV Spreadand Consequences on Development,” December 2003.

UNDP, “Building Capacity for Reducing HIVConsequences on Development,” UNDP RegionalProject on HIV and Development, Concept Note, nd.

UNDP, “Breakthrough: UNDP’s Response to AIDS,”Bureau for Development Policy, HIV/AIDS Group,June 2004.

UNDP, “Results: HIV/AIDS,” nd.106


107


UNDP, “Advancing Resource Mobilization andDelivery for Africa (ARMADA),” ProjectDocument, Project No. 0038975, 9 November 2004.

UNDP, “Cultural Liberty in Today’s Diverse World,”Human Development Report, 2004.

UNDP, “Supporting National HIV/AIDS Responses:An Implementation Approach—The Answer LiesWithin,” Bureau for Development Policy, June 2004.

UNDP, “Second Regional Cooperation Frameworkfor Africa (2002-2006),” UN Document DP(RCF/RBA/2), 21 November, 2001.

UNDP, “Terminal Evaluation Report of ZAM198/002 and ZAM 196/003,an Evaluation commissionedby the United Nations Development Programme,”Lusaka, Zambia, 2004.

UNDP, “Evaluation of the Second GlobalCooperation Framework of UNDP,” final editeddraft, 19/08/24, 2004.

UNDP, “Gender Equality—Practice Note,”November 2002.

UNDP, “From Making the Case for HIV/AIDS andDevelopment to Generating a Response,” Powerpointpresentation, HIV/AIDS Practice Area, nd.

UNDP—Angola, “Second Country CooperationFramework for Angola (2001-2003),” DocumentDP/CCF/ANG/2, 2002.

UNDP—Angola, “Quadro de Implementação doPrograma de Cooperação entre o Governo de Angolae o PNUD 2005-2008,” Draft CPAP, nd.

UNDP—Angola, “HIV/AIDS Interventions 2002/2004,” nd.

UNDP—Angola, “Angola Economic Developments2002-2004,” nd.

UNDP—Angola and Government of Angola,“Project Document: Strengthening the EducationSystem in Angola to Combat HIV/AIDS,” 2002.

UNDP—Angola, “HIV/AIDS Thematic TrustFund, Annual Project Report: Strengthening theEducation System in Angola to Combat HIV/AIDS,” nd.

UNDP—Angola, UNAIDS, and Government ofAngola, “Extensão do Projecto de Prevenção doVIH/SIDA com as FAA e a Polícia para a Provínciade Cunuene e Namibe”dentro do Projecto existente0011109, nd.

UNDP—Botswana, “First Country CooperationFramework for Botswana (1997-2002),” DocumentDP/CCF/BOT/1, 1997.

UNDP—Botswana, “Country Programme Outlinefor Botswana (2003-2007),” Document DP/CPO/BOT/1, 2002.

UNDP Bureau for Development Policy (BDP),HIV/AIDS Group, “Responding to HIV/AIDSMeasuring Results,” 2005.

UNDP—Ethiopia, “Second Country CooperationFramework for the Federal Democratic Republic ofEthiopia (2002-2006),” nd.

UNDP—Ethiopia, “Summaries of CountryCooperation Frameworks/CCF1—Programmes forthe Federal Democratic Republic of Ethiopia (1997-2001),” nd.

UNDP—Ethiopia, “Transforming the Response toHI/AIDS: An Ethiopian Experience,” nd.

UNDP—Ethiopia, “Up-Scaling CommunityConversations in Ethiopia: Unleashing Capacities ofCommunities for the HIV Response,” 2004.

UNDP—Evaluation Office, “Handbook onMonitoring and Evaluating for Results,” 2002.

UNDP—Evaluation Office, “Guidelines forOutcome Evaluators: Monitoring and EvaluationCompanion Series #1,” 2002.

UNDP and UNFPA, “Second Country CooperationFramework for Angola 2001-2003,” DP/CCF/ANG2, Angola, 2002.

UNDP Headquarters, “HIV/AIDS and PovertyReduction Strategies: The Answer Lies Within,”Policy Note, August 2002.

UNDP Headquarters, “Supporting NationalHIV/AIDS Responses, An ImplementationApproach,” UNDP, 2004.

UNDP Headquarters, “Results: HIV/AIDS,” nd.

UNDP—Lesotho, “Second Country CooperationFramework for Lesotho (2002-2004),” DocumentDP/CCF/LES/2, 2001.

UNDP—Lesotho, “Country Review Report forLesotho,” Document DP/CRR/LES/1, 2001.

UNDP—Malawi, “Second Country CooperationFramework for Malawi (2002-2006),” DocumentDP/CCF/MLW/2, 2001.

UNDP—Namibia, “Extension of First CountryCooperation Framework for Namibia (1997-2000),”Document DP/CCF/NAM/EXTENSION/1, 2001.

UNDP—Namibia, “Second Country CooperationFramework for Namibia (2002-2005),” DocumentDP/CCF/NAM/2, 2002.

UNDP—South Africa, “First Country CooperationFramework for South Africa (1997-2001),”Document DP/CCF/SAF/1, 1997.

UNDP—South Africa, “Second CountryCooperation Framework for South Africa (2002-2006),” Document DP/CCF/SAF/2, 2002.

UNDP, Southern Africa Development Communityand Southern African Political Economy SeriesTrust, “SADC Regional Human DevelopmentReport 2002—Challenges and Opportunities forRegional Integration,” Sapes Books, 2000.

UNDP—Swaziland, “Second Country CooperationFramework for Swaziland (2001-2005),” DocumentCP/CCF/SWA/2.

UNDP—Zambia, “Second Country CooperationFramework for Zambia (2002-2006),” DocumentDP/CCF/ZAM/2, 2001.

UNDP—Zimbabwe, “Second Country CooperationFramework for Zimbabwe (2000-2003),” DocumentDP/CCF/ZIM/2, 2000.

United Nations, “Organizing UN Response to theTriple Threat of Food Insecurity, Weakened Capacityfor Governance and AIDS, Particularly in Southernand Eastern Africa,” nd.

United Nations, “Declaration of Commitment onHIV/AIDS,” General Assembly ResolutionA/RES/S-26/2, 27 June 2001.

United Nations, “Facing the Future Together—Report of the United Nations Secretary-General’sTask Force on Women, Girls and HIV/AIDS inSouthern Africa,” 2004.

United Nations, “Discussion paper for round table onresources, to be convened by the Joint UNProgramme on HIV/AIDS, the World Bank, and theGlobal Fund,” UN document A/59/CRP.5, 24March 2005.

United Nations, “In Larger Freedom: TowardsDevelopment, Security and Human Rights for All,”Report of the Secretary-General, DocumentA/59/2005, 21 March 2005.

United Nations, “Progress made in theImplementation of the Declaration of Commitmenton HIV/AIDS, Report of the Secretary-General,”UN document A/59/765, 4 April 2005.

United Nations, “A More Secure World: Our SharedResponsibility,” Report of the High-Level Panel onThreats, Challenges, and Change, DocumentA/59/565, 2 December 2004.

United Nations, “We the Peoples: Civil Society, theUnited Nations and Global Governance,” Report ofthe Panel of Eminent Persons on United Nations-Civil Society Relations, Document A/58/817, 11June 2004.

United Nations, “United Nations DevelopmentAssistance Framework (UNDAF), Angola, 2005-2008,” For Signature, Angola, nd.

Whiteside A et al, “Examining HIV/AIDS inSouthern Africa through the eyes of ordinary SouthernAfricans,” Center for Social Science Research, CSSRWorking Paper No. 11, September 2002.

World Bank, “The Little Green Data Book,” 2002.

World Bank, “Project Appraisal Document on aGrant in the Amount of SDR 14.1 million (US $ 21million Equivalent) to the Government of Angolafor a HIV/AIDS, Malaria and Tuberculosis ControlProject,” World Bank Report No. 28994-ANG,29 November 2004.108


109


World Bank, “Interim Review of the Multi-CountryHIV/AIDS ProgramProgramme for Africa,”October 2004.

World Bank, “Implementing Multi-Country HIV/AIDS ProgramsProgrammes (MAP) in Africa,”Report on Africa Region HIV/AIDS ConsultationWorkshop, Addis Ababa, 14-18 February 2005.

World Bank, “World Development Indicators,” 2004.

World Bank, “The World Bank’s Global HIV/AIDSProgramProgramme of Action,” draft, May 2005.

World Bank, “Global Monitoring Report 2005—Millennium Development Goals: From Consensusto Momentum,” nd.

World Bank—Angola and Carvalho A, “DonorCoordination Meeting,” Powerpoint Presentation,The World Bank, Luanda, November 2004.

REGIONAL

Team Members:Sulley Gariba and Anthony Kinghorn

Batacharia, Shivaji, BDP/ UNDP RegionalMainstreaming Programme

Burungi, Barbara; Tikudo Udu et al., PovertyGroup/ PRSP and Macroeconomics Team

Khanye, Vivian, HIV and AIDS Policy AdvisorNyambe, Sam Sam, Dr., UNDP Regional Manager,

UNDP Regional Service Centre for Easternand Southern Africa

Martineau, Tim, Mr, Senior HIV and AIDSAdviser, Department for InternationalDevelopment (UK), Southern Africa, Pretoria

Msiska, Roland, UNDP Regional Mainstreaming Programme

Sterling, Mark, Coordinator, UNAIDS RegionalSupport Team for Eastern and Southern Africa

Country: AngolaTeam Member: A. Edward ElmendorfAgola, Amimo, Mrs, Consultant, UNFPAAlmeida, Francisco, Mr, Assistant Resident

Representative, UNDPAntonio, Francisco, Mr, AMSA Representative (NGO)Assimbi, Nimi, Mr, Project Coordinator, UNDP

HIV/AIDS Project with Ministry of EducationBenchimol, Luzia, Ms, Peer Educator, UNDPBowes, Cathy J., Mrs, Director of Projects, USAIDCamara, Boubou, Mr, Deputy Resident

Representative, Programme, UNDPCampos, Lauriano, Mr, ANATENO (NGO)Cassoma, Basilio, Dr. , Director of Planning,

Cabinet, Ministry of HealthCauldwell, Jonathan, Mr, Planning and Field

Operations Officer, UNICEFCeita, Camilo, Mr, Programme Specialist, UNDPClark, Laurence, Mr, Resident Representative,

World BankCorsino, Rick, Mr, Country Director, World

Food ProgrammeCosta, Manuel, Mr, Director, MAPESS De Paula, Claudia, Mrs, Consultant, UNDPEdaltina, Monica, Mrs, HIV Focal Point,

MAPESSEndresen, Alida, Mrs, Counsellor, NORAD,

Embassy of NorwayFeio , Raúl, Mr, Senior Advisor, Delegation of the

European Union

Félix , Balbina, Dr., National Programme Officer,WHO

Ferrari, Mario, Mr, Country Representative,UNICEF

Fonseca, Pedro Luis, Mr, Director of Studies andPlanning, Ministry of Planning

Fortes, Iolanda, Mrs, International Consultant,UNDP

Kiangani, N'sungu, Mr, CAASDA (NGO)Lambert, Olivier, Mr, Sr. Operations Officer,

World Bank Country OfficeLeitao, Ana, Mrs, CAJ (NGO)Leite, Julio, Mr, Assistant Resident Representative,

UNFPAMakolulu, Ida, Mrs, Personnel Assistant, UNDPMiguel, N’Zau Mr, Director of Training, Chamber

of CommerceNascimento, Gabriela, Mrs, Programme Associate,

UNDPOuandgi, Bernard, Mr, Senior Economist, UNDPPombal, Maria, Ms, Acção Humana (NGO)Regol, Daude, Mr, HIV Project Officer, UNICEFSantos, Vanda, Mrs, Junior Programme Officer,

UNDPSapalo, Artur, Mr, AJO (NGO)Sebastiao, Timoteo, Mr, VIJU (NGO)Serrano, Ducelina, Mrs, Director, National

AIDS InstituteSilva, Celso, Mr, Luta Pela Vihda (NGO)Simião, Alexandra, Mrs, Vice–Minister, Ministry

of EducationStella , Alberto, Dr., Coordinator, UNAIDSStrom, Nina, Mrs, NORAD Attache, Embassy

of NorwayTenente, Malaquias, Mr, Peer Educator, UNDPVeigas, Rosário, Mr, Peer Educator, UNDPVeloso, Sebastião, H.E. Dr., Minister, Ministry

of Health

Country: EthiopiaTeam Member: Anthony KinghornAbafita, Fatuma, Ms, Head RHAPCO OromiaAbasiya, Gifti, Woiz., State Minster of Women’s

Affair, Chairperson National Women’sCoalition against AIDS

Abebe, Sisay, Journalist, EVMPAAberra, Kumelachew, Director, Civil Service

Reform ProgramProgramme Office, Ministry of Capacity Development

Addis, Yayeh, Dr., Head RHAPCO Amhara110

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 9. LIST OF PEOPLE MET

ANNEX 9. LIST OF PEOPLE MET

111


Amdemichael, Helen, Ms, UNDP-E, HIV/AIDSTeam, CC

Ashenafi, Dr., Head RHAPCO Addis AbabaBaruda, Geira, Ms, UNDP-E, HIV/AIDS TeamBeruktawit, UNDP-E, HIV/AIDS Team Bogalech, Gebre, Dr., Director, KMG, Alaba

Special WoredaCivil Service College Group discussion, Aberra,

Haile Michael Dr., President of the College;Abebe H/Michael Dr, Academic Vice-President and Worku, Konjit Ms,

Cohen, Gideon (chair) and members, DevelopmentAssistance Group, Ethiopia

Community Conversations Groups (X2), AlabaSpecial Woreda

Estifanos, Mr, UNDP-E, HIV/AIDS TeamFaris, Hussein, Mr, HAPCO Plan and

ProgramProgramme Team LeaderFredrikesen, Signe, Ms, UNDP-E, HIV/AIDS TeamFriedman, Joseph; Haile, Alemain; Mengistu,

Dehme, LDP coachesHailemariam, Desalgne, President, SNNP Region

HIV and AIDS programme, CRDA, Addis AbabaKadia, Patricia, Ms, UNDP-E, HIV/AIDS TeamKassa, Derese, Dr., Assistant Lecturer, Sociology

&Anthropology Dept. AA UniversityLendebo, Ersido, Dr., Head RHAPCO SNNPRLundqvist, Bjorn, Mr, UNICEF Country

Representative, Chair UNTGMakinwa, Bunmi, Dr., UNAIDS Country

Coordinator and Focal Point for AfricanRegional Organizations

Merke, Negatu, Mr, HAPCO Head HIV/AIDSPrevention and Control Commission

Noble, Nileema, Ms, UNDP, Deputy Res Rep (Programme)

PLWHA Group, Alaba Special WoredaTekle, Kelemework, Ms, UNDP-E, HIV/AIDS

Team, MainstreamingTsegaye, Legesse, Dr., Head RHAPCO TigrayZeleqe, Gobe, Dr., Deputy Head of Regional

Health Board, SNNP Region

Country: LesothoTeam Member: Ikwo EkpoAlbrecht, Karl, Deputy Chief of Mission,

US EmbassyCarter Perry, June, Ambassador, US EmbassyFanarof, Daniella M., Deputy Country

Representative, PSIFausther, Ernest, Deputy Resident Representative,

UNDP

Feeney, Joseph, Policy Team Leader, UNDPLetsie, Puleng, HIV/AIDS Officer, UNDPMakhakhe, S. K., Principal Secretary, Kingdom

of LesothoMonaphathi Maraka, Coordinator, Policy Project—

RHAP, US EmbassyMashologu, M., Senior Policy Advisor, UNDPMatashane-Marite, Keiso, National Coordinator,

Women and Law in SAMohaheng, M., Director, Administration, LAPCAMosili, ‘Mathato, S., First Lady, Kingdom

of LesothoRwabuhemba, Tim, Country Coordinator,

UNAIDSSackey, Samuel, O., Epidemiologist, World

Health OrganisationWong, Gwyneneth, HIV/AIDS Project Officer,

UNDP

Country: MalawiTeam Member: Sulley Gariba* Chitate, David, Dr., UNAIDS Technical AdvisorChirwa, Alfred, Mr, Population and Health

Specialist, World BankFoote, Robert, Mr, Programme Manager,

CIDA Office: Malawi, Canada ProgrammeSupport Unit

Galafa, Peter, Mr, Director of Human ResourcePlanning and Development, Office of the President

Hauya, Roy, Mr, Director of Policy and Programme,National AIDS Commission

Kawonga, Abel, Mr, HIV and AIDS Specialist,USAID

Keating, Michael, Mr, UNDP ResidentRepresentative/UN Resident Coordinator

Mwathengere, Fred, Mr, UNDP HIV and AIDSFocal Point

Mzamu, Felix, Mr, Director of Planning andDevelopment, Dedza District

Nyirongo, Mexon, Mr, Director, Programme,USAID

Pendame, Dr., Principal Secretary, Ministry of Health

Tawanda, Michael, Dr., First Secretary, RoyalNorwegian Embassy

Salima AIDS Support Organisation, SalimaDistrict – List of Participants, Focus-groupsessions with community members andprogramme officers

* Mandisa Mashologu participated as a country team Lesotho mem-ber and an observer in the IC Team Writer’s Workshop.

Country: South AfricaTeam Members: Sulley Gariba and Ikwo EkpoAllan, Rob, Mr, Treatment Action

Campaign, JohannesburgAloma, Foster, Ms, Assistant Resident Rep.,

UNDP, South AfricaDiaho, Mothomang, Dr., National Programme

Manager, HIV, AIDS and Poverty Programme,UNDP/Ministry of Health, South Africa

Dlomo Zwelli, Mr, Programme Officer, Love LifeDuku, Elizabeth, Ms, GIPA Work place field

worker in the UN systemHill, Julia, Ms, GIPA Programme Manager,

UNDP Programme, UNDP and Department of Health

Kanaka, Connie, Dr., Chief Director, Departmentof Social Development

Luvhengo, Reckson, Mr, M&E Specialist,Sustainable Livelihoods Programme, PMU at the Limpopo Provincial Premier’s Office, Polokwane

Martineau, Tim, Mr, Senior HIV and AIDSAdviser, DfiD Southern Africa, Pretoria

Mathanhire, David, Mr, HIV and AIDS FocalPerson, UNDP CO, South Africa

Morgan, Njogu, Mr, Programme Officer,Treatment Action Campaign, Johannesburg

Ntsoane, Mokgadi, Ms, Prog. Manager, SustainableLivelihoods Programme, PMU at the LimpopoProvincial Premier’s Office, Polokwane

Spanner, Lone, Ms, Counsellor, Royal DanishEmbassy, Pretoria

Swatz, Botha, Mr, Advocacy, Love Life,Johannesburg

Thobejane, Thabo, Mr, Provincial ProgrammeCoordinator, HIV and AIDS & Poverty Prog.Limpopo Province

Van-Dyke, Paula, Ms, National Treasury of South Africa

Country: ZambiaTeam Members: Sulley Gariba,Anthony Kinghorn and Ikwo EkpoBanda, Kunyima, Mr, Local Government

Association of ZambiaBobe, S., Ms, UNDP, CO Chibende B, Dr., Deputy Chairperson –

Siavonga District Aids task Force and DistrictDirector of Health for the District HealthManagement Team

Chikamba, Mrs, Kenneth Kaunda Children ofAfrica Foundation

Chituwo, Brian, Dr., Chairperson, CabinetCommittee on HIV/AIDS and Minister of Health

Choogo, M., Ms, Counsellor – Siavonga DistrictHospital/Member DATF

Chundu, B., Mr, Director, Economic and Technical Cooperation, Ministry of Financeand National Planning

Daly, A., Mr, Health Advisor, Department forInternational Development

Hachitapika, Mary, Ms, Member, Siavonga DistrictAIDS Task Force Sinet (Civil Society)

Kayoba, Faith, Ms, Member, Siavonga DistrictAIDS Task Force, Civil Society

Kumwenda, Rosemary, Dr., Assistant ResidentRepresentative/HIV/AIDS Advisor, UNDP

Matanda, I., Ms, Head, Human ResourceAdministration, Cabinet Office

Mfula, Mr, Kenneth Kaunda Children of Africa Foundation

Motlana, Lebogang, Mr, Deputy ResidentRepresentative, UNDP

Mpuka, Simon, Dr., Director of Programmes,Churches Health Association of Zambia

Mufuzi, Mr, Coordinator, Local GovernmentAssociation of Zambia

Mulele, Crispin, Mr, Programme Officer,Community Response Initiative on HIV/AIDS

Mulenga, Anthony, Mr, District CoordinatorZambia Association for Persons With Disabilities

Musonda, Kennedy, Mr, USAIDMusonda, Rosemary, Dr., Acting Director-General,

National HIV/AIDS/STIS/TB CouncilMwansa, Mr, National Coordinator, Alliance of

Mayors and Municipal Leaders Initiative onAIDS at Local Level

Mwanza, R, Mr, and Banda, M, Ms, ZambianNetwork of People Living With HIV/AIDS(ZNP+)

Mwenya P., Reverend, Treasurer, Siavonga DATFSakala, E., Mr, UNV, SiavongaSchuler, Nina, Ms, Observer, World BankSimunji, F, Ms and members, Kariba OVC and

HBC ProgrammeSimwanza, Alex. Dr., Director of Programmes,

National HIV/AIDS/STI/TB CouncilSozi, C., Dr., UNAIDS Country CoordinatorStridiel, E., Ms, District Commissioner and

Chairperson of the District DevelopmentCoordinating Committee, Siavonga112


113


Sukoto, Rosemary, Ms, World Bank, Zambia Yerokun, Delia, Ms, HIV/AIDS Programme

Specialist, UNDPZulu, D., Mr, ILO, CO

GLOBAL

Team Member: A. Edward ElmendorfAnnan, Joseph, Mr, Senior Policy Advisor,

HIV/AIDS Group, Bureau for DevelopmentPolicy, UNDP, New York

Banda, Mawa, Dr., Focal point for AnglophoneAfrica, HIV/AIDS Department, WHO, Geneva

Bendel, Christine, Ms, HIV and AIDS in theWorkplace Specialist, Bureau for HumanResources, UNDP, New York

Chatora, Rufaro, Dr., Department Director, HealthSystems, WHO/AFRO, Harare

Diaroumeye-Sababier, Gany, Ms, CountryProgramme Advisor, Regional Bureau forAfrica, UNDP, New York

Earle, Duncan, Mr, Cluster Leader for SouthernAfrica, Global Fund to Fight AIDS, TB andMalaria, Geneva

Guerma, Tuguest, Dr., Associate Director,HIV/AIDS Department, WHO, Geneva

Gwaradzimba, Fadzai, Ms, Senior EvaluationAdvisor, Evaluation Office, UNDP, New York

Hansen, Keith, Mr, Chief, AIDS Campaign Teamfor Africa (ACTafrica) Unit, Office of theRegional Vice President for Africa, WorldBank, Washington

Komatsubara, Shigeki, Mr, Country ProgrammeAdvisor, Regional Bureau for Africa, UNDP,New York

Kraus, Stephen, Mr, Head, HIV/AIDS Unit,United Nations Population Fund (UNFPA),New York

Kravero, Kathleen, Ms, Deputy Executive Director,UNAIDS, Geneva

Lewis, Stephen, Mr, Special Representative of theUnited Nations Secretary General (SRSG) forHIV and AIDS in Africa, Toronto

Makhetha, Metsi, Ms, Task Manager, SouthernAfrica Capacity Building Initiative (SACI),Regional Bureau for Africa, UNDP, New York

McDermott, Peter, Mr, Chief, HIV/AIDS Section,ProgramProgramme Division, United NationsChildren’s Fund (UNICEF), New York

Mogedal, Sigrun, Dr., Senior Advisor, NorwegianAgency for Development Cooperation(NORAD), Oslo

Nuru, Zahra, Ms, Senior Advisor on LeastDeveloped, Land-Locked and Small IslandCountries, United Nations Secretariat, New York

Quain, Estelle, Ms, Human Capacity DevelopmentAdvisor for the President’s EmergencyProgramProgramme for AIDS Relief(PEPFAR), United States Agency forInternational Development, Washington

Sy, As, Mr, Director, Operational Partnerships andCountry Support, Global Fund to Fight AIDS,TB, and Malaria, Geneva

Tetteh, Comfort, Ms, Country Programme Advisor,Regional Bureau for Africa, UNDP, New York

Wiesen, Caitlin, Ms, Deputy Chief, HIV/AIDSGroup, Bureau for Development Policy,UNDP, New York

Zewdie, Debrework, Dr., Director, Global HIV/AIDSProgramProgramme, World Bank, Washington

3 by 5 InitiativeACATADCAGEIAGOA AIDSAMICAALLANCANCARTARVASSAAUBCCBCHACAReCBOCCCCECCEPCCFCCMCDCCEDAWCHALCHAZCMTCCOCOSADCRAIDSCSBCSODATFDCIDDCCDfIDECD ECHOEMSAPEOESRAEUFAOFBOFDIFDREFGMFLASFSE/CCG7/G8GDP

WHO Initiative to have 3 million people on ARV therapy by the end of 2005Africa Cooperative Action Trust, SwazilandAIDS Development Committee, ZambiaAfrican Girls Education Initiative, SwazilandAfrican Growth and Opportunities Act, LesothoAcquired immune deficiency syndromeAlliance of Mayors Initiative for Community Action on AIDS at the Local LevelAfrican National Congress, South AfricaAnte-natal Clinic, South AfricaAnti-Retroviral TherapyAnti-Retroviral (drugs)Actuarial Society of Southern AfricaAfrican UnionBehavior Change CommunicationBusiness Coalition Against HIV/AIDSCentre for Actuarial Research, South Africa Community Based OrganizationCommunity ConversationsCommunity Capacity Enhancement, SwazilandCommunity Capacity Enhancement Process, South AfricaCountry Cooperation Framework, UNDPCountry Coordination Mechanism, GFATMCenters for Disease Control, United StatesConvention on the Elimination of All Forms of Discrimination Against WomenChristian Health Association of LesothoChurches Health Association of Zambia Crisis Management and Technical CommitteeCountry Office, UNDPCouncil Against Smoking Alcohol and Drugs, SwazilandCommunity Response on HIV/AIDS, ZambiaCorn Soya BlendCivil Society OrganizationDistrict AIDS Task ForceDevelopment Cooperation IrelandDistrict Development Coordinating Committee, ZambiaDepartment for International Development, United KingdomEmpowerment for Community Development, LesothoEuropean Commission Humanitarian OfficeEthiopian Multi-Sectoral HIV/AIDS ProjectEvaluation Office, UNDPEconomic and Social Reform Agenda, SwazilandEuropean UnionUnited Nation Food Agricultural OrganizationFaith Based OrganizationForeign Direct InvestmentFederal Democratic Republic of EthiopiaFemale Genital MutilationFamily Life Association of SwazilandFederation of Swaziland Employers/Chamber of Commerce, SwazilandGroup of 7/8 major industrial nationsGross Domestic Product114

EVALUATION OF UNDP’S ROLE AND CONTRIBUTIONS IN THE HIV/AIDS RESPONSE IN SOUTHERN AFRICA AND ETHIOPIAANNEX 10. ACRONYMS

ANNEX 10. ACRONYMS

115


GFATMGIPAGCFGNPGOAGOLGOSGRN GTZHAMSETHAPCOHBCHDFHDRHIVHPHQHSHSDPHSRCHTPICICC ICWCIDASAIDCIDPIECILOIMFI-PRSPISRDJPOKKCAFKMGKZL4DL4RLAPCALCNLDPLDRLDSLENASOM&EMAPMDGMEDMEPDMINPANMINSAMLRR MOFMOH

Global Fund to Fight AIDS, TB and MalariaGreater Involvement of People Living with HIV/AIDS, South AfricaGlobal Cooperation FrameworkGross National ProductGovernment of AngolaGovernment of LesothoGovernment of SwazilandGovernment of the Republic of NamibiaGerman Agency for Technical CooperationHIV/AIDS, Malaria and Tuberculosis Control Project, AngolaHIV/AIDS Prevention and Control Office, EthiopiaHome Based CareHuman Development Forum, SwazilandHuman Development Report, UNDPHuman Immunodeficiency VirusHealth PostHeadquartersHealth StationHealth Sector Development Programme, EthiopiaHuman Sciences Research Council, South AfricaHarmful Traditional PracticesInternational ConsultantInterim Community Councils, LesothoInternational Committee of Women Living with HIV/AIDSInstitute for Democracy in South Africa Inter-departmental CommitteeIntegrated Development PlanInformation, Education and CommunicationInternational Labour OrganizationInternational Monetary FundInterim Poverty Reduction Strategy PaperIntegrated Sustainable Rural Development, South AfricaJunior Professional OfficerKenneth Kaunda’s Children’s Foundation of Africa, ZambiaKembata Women Self-Help Organization, EthiopiaKwanza, national currency, AngolaLeadership for Development, UNDPLeadership for Results, UNDPLesotho AIDS Programme Coordinating AuthorityLesotho Council of Non Governmental OrganizationsLeadership Development ProgrammeLeadership for Development ResultsLutheran Development Services, SwazilandLesotho Non Governmental AIDS Service OrganizationsMonitoring and EvaluationMulti-Country Assistance Programme (on AIDS), World BankMillennium Development GoalMinistry of Education, AngolaMinistry of Economic Planning and Development, SwazilandMinistry of Planning, AngolaMinistry of Health, AngolaMinistry of Land, Resettlement and Rehabilitation, NamibiaMinistry of FinanceMinistry of Health

116


MOHSS MOLGMOPMTP NABCOA NACNACOP NACOSANACP NAEC NAMACOC NCNCCINCPNCTPEndNDP NDSNDTFNEPADNERCHANGONORADNPC NPRAPNSPNULNZP+ OAUODAOIOVCPACPAPPRPATFPAYEPDCCPEPPEPFARPGDPPHCPIUPLOWAPLWHAPMTCTPNLSPRPRROPRSPRSPPSCAAL PSDRCRCF

Ministry of Health and Social Services, NamibiaMinistry of Local Government, LesothoMinistry of PlanningMedium Term Plan, NamibiaNational Business Coalition on HIV/AIDS, NamibiaNational AIDS Commission/Council National AIDS Coordination Programme, NamibiaNational AIDS Coordinating Committee of South Africa National AIDS Control Programme, NamibiaNational Aids Executive Committee, NamibiaNational Multi-Sectoral Aids Coordinating Committee, NamibiaNational ConsultantNamibia Chambers Of Commerce and IndustryNeighborhood Care Point, SwazilandNational Committee on Traditional Practices, EthiopiaNo DateNational Development PlanNational Development StrategyNational Disaster Task Force, SwazilandNew Partnership for Africa’s DevelopmentNational Emergency Response Committee (later transformed to Commission), SwazilandNon-governmental OrganizationNorwegian Agency for DevelopmentNational Planning CommissionNamibia Poverty Reduction Action PlanNational Strategic PlanNational University of LesothoNetwork of Zambian People Living With HIV/AIDSOrganization of African UnityOfficial Development AssistanceOpportunistic InfectionsOrphans and Vulnerable ChildrenProvincial AIDS CouncilPrioritized Action Programme for Poverty Reduction, SwazilandProvincial AIDS Task Force, ZambiaPay As You Earn, SwazilandProvincial Development Coordinating Committee, ZambiaPost Exposure Prophylaxis, SwazilandPresident’s Emergency Plan for AIDS Relief, United StatesProvincial Growth and Development Plan, South AfricaPrimary Health CareProject Implementation UnitPeople Living Openly With AIDSPeople Living With HIV/AIDSPrevention of Mother to Child TransmissionNational Programme to Fight AIDS, AngolaPrincipal Recipient, of GFATM GrantProtracted Relief and Recovery Operations, SwazilandPoverty Reduction StrategyPoverty Reduction Strategy PaperPrivate Sector Coalition Against AIDS, LesothoProgramme Support Document, SwazilandResident Coordinator, UNDPRegional Cooperation Framework

117


RRRICASACISACROSACUSADCSAFAIDSSAMDISANACSASOSDPRSPSHAPESIDASIPAASNAJSNLSNNP(R)SOSSRFSTISWACISWApSWAPOLTACTASCTBTDPUKUNUNAIDSUNAMUNCTUNDAFUNDGUNDPUNESCOUNFIP UNFPAUNGASSUNICEFUNIFEMUNSGUNVUSUSAIDUSDOLVACVCTWBWFPWHOZANARAZBCAZNAN

Resident Representative, UNDPRoyal Initiative to Combat AIDS, SwazilandSouthern Africa Capacity Initiative, UNDPSwaziland Association on Crime and Rehabilitation of OffendersSouthern Africa Customs UnionSouthern Africa Development CommunitySouthern African HIV/AIDS Information Dissemination ServiceSouth African Management Development InstituteSouth African National AIDS CouncilSwaziland AIDS Support OrganizationSustainable Development & Poverty Reduction Strategic Programme, EthiopiaSchools Health and Population Education Programme, SwazilandSwedish International Development AgencySupport for International Partnerships against AIDS in AfricaSwaziland National Association of JournalistsSwazi Nation LandSouthern Nations, Nationalities and Peoples (Region), EthiopiaSave Our Souls, SwazilandStrategic Results FrameworkSexually Transmitted InfectionsSwaziland Capacity InitiativeSector-wide Approach (to aid coordination)Swazis for Positive LivingTreatment Action Campaign, South AfricaThe AIDS Support Center, SwazilandTuberculosisTransitional Development Plan, ZambiaUnited KingdomUnited NationsUnited Nations Joint Programme on HIV and AIDSUniversity of NamibiaUnited Nations Country TeamUnited Nations Development Assistance FrameworkUN Development GroupUnited Nations Development ProgrammeUnited Nations Educational Scientific and Cultural OrganizationUN Fund for International PartnershipUnited Nations Population FundUN General Assembly Special Session (on AIDS)United Nations Children’s FundUnited Nations Fund for WomenUnited Nations Secretary GeneralUnited Nations VolunteerUnited StatesUnited States Agency for International DevelopmentUnited States Department of LaborVulnerability Assessment Committee, SwazilandVoluntary Counseling and TestingWorld BankUnited Nations World Food Programme World Health OrganizationZambia National Response to AIDSZambia Coalition on HIV/AIDSZambia National AIDS Network

REPORTS PUBLISHED ON THEMATIC AND STRATEGIC EVALUATIONSn Evaluation of Gender Mainstreaming in UNDP, 2006n Institutional Flexibility in Crises and Post Conflict Situations: Best Practices from the Field, 2004n Evaluation of UNDP’s Role in the PRSP Process, 2003n Assessment of Micro-Macro Linkages in Poverty Alleviation: South Asia Region, 2003n Millennium Development Goals Reports: An Assessment, 2003n Evaluation of Non-Core Resources, 2001n Evaluation of Direct Execution, 2000n Sharing New Ground in Post-Conflict Situations, 2000n The UNDP Role in Decentralization and Local Governance, 1999

FORTHCOMING EVALUATIONS IN THE SERIESn Assessment of National Human Development Reportsn Evaluation of UNDP's Contribution to Crisis Prevention and Recoveryn Tsunami Evaluation Coalition: Joint Evaluation of the Impact of Tsunami Response

on Local and National Capacities

United Nations Development ProgrammeEvaluation OfficeOne United Nations PlazaNew York, NY 10017, USATel. (212) 906 5059, Fax (212) 906 6008Internet: http://www.undp.org/eo

united nations development programme...

Documents