A five-year national HIV/AIDS strategic framework has been developed which focuses on five strategies: prevention of new HIV/AIDS infections; caring for people living with AIDS; creating an institutional and legal framework to enable a national response; a decentralised response, and a monitoring and evaluation framework. Promoting safer sex among the youth and other vulnerable groups have been highlighted, which is of particular importance to UNICEF.
Since 1996, Ireland Aid has supported UNICEF Ghana in the implementation of activities that aim to promote behaviour change to limit the spread of HIV/AIDS and STIs. After an evaluation of these projects in 1997, Ireland Aid provided a second round of funding for the continuation of these activities in different areas of Ghana.
Purpose / Objective
This evaluation focuses on the period of the second round of funding from Ireland Aid, from 1998 to 2000. The purpose of the evaluation is to
- Identify the projects gains and achievements (intended and unintended)
- Describe the lessons and examples of best practice
- Provide options for future developments
The evaluation was based on in-depth interviews and focus group discussions with peer educators, outreach workers and members of the target group. Interviews were carried out with staff of UNICEF, the management of collaborating NGOs, District Assembly staff, staff in the Ministry of Health, and senior projects staff at national, regional and district level.
Background documentation was reviewed, as were reports from various levels. Health workers at the relevant health centres and hospitals were interviewed and Pharmacy Shops and Chemical shops were visited. Feedback workshops were held with peer educators, outreach staff and the management committee.
Site visits were conducted in Tamale, Yendi, Bole, Bolgatanga, Zebilla, Bawku, Navrongo, Sandema and Bongo in the Northern and Upper East Regions, in Obuasi in Ashanti Region, and Ga Mashie in Greater Accra Region. Observation was another methodology used during these field visits, such as during the visits to the Youth Friendly Centres.
Key Findings and Conclusions
Gains and Achievements:
- Youth to youth peer education component in Northern and Upper Eastern Regions
This component had clear objectives and its educational activities were found to be in line with the project document. The project centred on talks about sexual health, using active participatory methods - some game-based - to capture the interest and attention of young people. The expected output was achieved, as a total of 514 peer educators aged between 15 - 30 years were trained between 1998 and 2000. Almost all the peer educators were retained. The peer educators in turn reached out to more than 60,000 young people in and out-of-school. An additional 20,000 adults where reached indirectly with HIV/AIDS messages.
Because of unclear financial agreements between the District Health Management Teams, the District Assemblies of Bongo, Yendi and Bawku-East and the Ghana Red Cross Society, the proposed Youth Friendly Centres could not be completed for use before the end of 2000.
- HIV/AIDS prevention through peer education with commercial sex workers in Obuasi, Ashanti Region
The Obuasi programme component was managed by the Adansi West District Assembly. This was found to have been quite successful in terms of outreach, with more than 2,000 individuals contacted. However, problems with the management of loans prevented the programme resettling commercial sex workers by providing them with alternative incomes.
During its planning for the new Country Programme (2001-2005), UNICEF decided to phase out its interventions in Adansi West. Agreements have been reached with various NGOs (such as CARE International, SCF) and the District Assembly (District Response Initiative) to take over the various activities previously funded by UNICEF. It can hence be anticipated that UNICEF's pulling out of this project component would not significantly threaten the continuation of activities.
- HIV/AIDS prevention amongst young people, including street children in urban Accra
This component was part of the Urban Community Based Development Project and implemented by various NGOs:
CENCOSAD was responsible for a peer education programme for in and out-of-school youth in the Ga Mashie area of Accra. The programme achieved its expected output by training 252 Peer Educators, 50 counsellors and 50 supervisors who provided HIV/AIDS education to more than 12,000 young people. The educational materials used were appropriate for all young people. All the peer educators are volunteers.
The programme was successful in retaining the majority of the peer educators. The leadership skills they obtained and the heightening of their self-esteem seem to be major factors for their continuation in the programme. As a general point, the issue of transportation for peer educators as the project expands to hard-to-reach communities will have to be addressed.
UNICEF also collaborated with 3 other NGOs in the Urban Community-Based Development Project: the Salvation Army, Catholic Action for Street Children (CAS) and Street Girls Aid (SGAID). The HIV/AIDS component implemented by these NGOs was not based on peer education, but on classroom health education in the refuge centres of SGAID and CAS. In addition, social workers and nurses provided a health education service through health kiosks and a mobile van in the streets. All expected results emanating from these activities have been reached and even exceeded expectations, as each day about 300 children are reached in the street and the refuges where they receive information, and health services if needed.
Peer education as a successful intervention strategy:
The projects supported by UNICEF are sensitive to gender issues and this has been taken into account in developing materials and in the way peer education is organised. The projects are also conscious of the need to develop different approaches to in-school and out-of-school youth
The careful selection and training of peer educators are critical to the success of the peer to peer approach. The involvement of school authorities and parents (for in-school youth) and of community leaders (for out-of-school youth) makes it more likely that suitable candidates are selected, thus reducing the need for frequent replacements. Very few have dropped out after the training.
Peer educators, even though young, reach out to adults and are well received by them. This demonstrates a high demand in the communities for accurate information on HIV/AIDS.
The effective management of the project requires a critical mass of local staff working full time. The reliance on volunteer managers can create delays in programme implementation, leading to the frustration and de-motivation of peer educators.
Monitoring and evaluation:
Most projects are quite capable of maintaining process indicators but measuring the success of HIV prevention interventions is more problematic, especially in terms of its impact or effectiveness. Data collection in government systems was not always consistent and there is very little evidence of analysis of the data collected.
Building ownership has been a strong element in all the UNICEF supported projects under review. By identifying NGO partners with strong links to the community it has been possible to get strong community support from the outset. Strong ownership at community level can ensure that the impact of particular project interventions is sustainable
There is certainly evidence from the interviews conducted that peer educators will continue to reach out to their community even if external support is not available. Interventions which are integrated into government systems are also more likely to be sustainable.
It is to the credit of the programme designers, namely Red Cross, Action Aid, CENCOSAD, SGAID and CAS, that the programme has been well received by the target group and community members. The high demand for HIV/AIDS and STIs education in the communities demonstrates the need to continue support for the projects. Continuation would go a long way to boost HIV/AIDS prevention and control activities for young people.
Building ownership at local government and national government level will be important in terms of the scaling up and the long term sustainability of the interventions. UNICEF is in a strong position to ensure that future HIV prevention activities are integrated into government structures. It is also well positioned to help build the capacity of the NGO sector to undertake effective HIV prevention activities and to play a role in co-ordinating the efforts of the various players.
In looking at supporting a District Response Initiative, UNICEF needs to consider whether it is in a position to give comprehensive support to the initiative or whether it should form a strategic alliance with other partners for this purpose. Projects dealing with in-school youth can be institutionalised through negotiations with the educational authorities and can be scaled up in this manner. Out-of-school youth are not a homogenous group and it is important to develop a variety of strategies to reach the various sub-groups.
A key issue in scaling up is the selection of effective partners. The NGO partners that UNICEF works with have clear limits in terms of capacity, but some of them - such as CENCOSAD - are in a position to assist in the capacity building of other NGOs. Scaling up would also require a deepening of the relationship with key ministries including health and education.
Strengthening the Monitoring and Evaluation System:
The difficulties encountered on the UNICEF projects with monitoring and evaluation are by no means unusual. Some NGOs involved in the project such as YPIC and CENCOSAD have particular strengths in developing monitoring systems, but ongoing support would be needed if they are to be used effectively.
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HIV/AIDS - Young People