2004 Global: Fighting HIV/AIDS: A Strategic Review
Author: Hodge, M.
Globally, an estimated 40 million people were living with HIV/AIDS at the end of 2003, of whom as many as 70% are living in Sub-Saharan Africa. In addition, an estimated 3 million people died of HIV/AIDS during 2003, of whom as many as 80% were living in Sub-Saharan Africa. The context in which UNICEF is implementing its MTSP priority — Fighting HIV/AIDS — is thus one of increasing numbers of people at risk of infection, increasing numbers of people living with HIV or AIDS and increasing numbers affected by HIV/AIDS. To-date, UNICEF’s MTSP has prompted action focused in four areas: young people, parent-to-child transmission, care and support, and orphans and vulnerable children.
In June 2002, the UNICEF Executive Board directed the Evaluation Office to complete a series of thematic evaluations over the life cycle of the 2002-2005 MTSP. This strategic review is intended to deliver on the direction from the Executive Board regarding a thematic evaluation of the organizational priority of fighting HIV/AIDS.
It is based primarily on the review of UNICEF documents and interviews with UNICEF Headquarters and Supply Division staff working on HIV/AIDS. This work does not explicitly assess progress towards the targets but rather examines UNICEF’s progress to-date in implementing the organizational features and mechanisms commensurate with translating the priority accorded to fighting HIV/AIDS into programme excellence.
Findings and Conclusions:
Organization-wide efforts to integrate and coordinate workplans and budgeting for HIV/AIDS activities have acted as a pathfinder. Realizing their full benefit will require renewed attention to linkages and accountabilities regarding financial matters and staff performance assessment between HQ, RO and CO. PD may wish to evaluate whether the current matrix management/distributed staff model would benefit from modification.
Care and support remains underdeveloped within UNICEF’s activities. The ‘3 by 5’ initiative (WHO’s stated goal of 3 million people in resource-poor settings receiving ARV by 2005), representing a clear commitment to increasing the numbers of people in high prevalence, resource-poor settings who receive treatment for HIV/AIDS suggests that the time is ripe for some strategic thinking about what role UNICEF is to play in both the ‘3 by 5’ initiative and the broader area of care and support. One option would be a conceptual integration, accompanied by technical guidance, of care and support into the other three action areas: preventing HIV infection among young people, preventing parent/mother-to-child transmission and meeting the needs of orphans and vulnerable children. In addition, UNICEF’s Supply Division may represent an underutilized resource in improving access to commodities and pharmaceuticals that can prolong the life of people living with HIV/AIDS. For HIV/AIDS, Supply Division can play two distinct but critical roles. The first of these is the more obvious one of procurement but the second is arguably as or more important, namely to contribute to the strengthening of delivery systems. Such strengthening cannot be the sole responsibility of programme or supply but requires a working integration of the two.
Approaching the MTSP’s midpoint creates an opportunity to ensure that capturing and disseminating strategic information receives greater attention. Regardless of the form of particular goals, systems to monitor progress, disseminate successes, and identify laggards for intensified mentoring or coaching in a more up-to-date fashion than the midterm review of the country programme, and with strengthened verification, means beyond the current annual report approach are needed. If implemented, such measures would also provide valuable input to evidence-based advocacy and contribute to creating a culture of evaluation as part of ensuring the optimal protection and promotion of the rights of children and young people.
Particularly in highly-affected countries, it would be impossible to underestimate the impact HIV/AIDS is having, and will have, on the lives of UNICEF staff, particularly national officers. While stigma reduction and anti-discrimination consciousness-raising efforts are helpful, there is no substitute for ensuring that all UNICEF staff and their family members, regardless of level or country of origin, have access to confidential treatment for HIV infection. For staff hired on limited-term contracts, consideration should be given to how continuity of care can be ensured. Succession planning should also become a standard part of UNICEF’s operations in highly-affected countries. The expense, while an increase from current spending, is negligible in comparison to the positive impact of putting into practice what the organization has called on others to do.
UNICEF does not work alone and a key forum for partnership is UNAIDS. Recently the subject of a five-year evaluation, UNAIDS has a multi-faceted relationship with UNICEF that is likely to deepen as the challenge of intensified support for highly-affected countries continues to grow.
Within UNICEF, the MTSP priority accorded to HIV/AIDS has engendered innovative management structures. This innovation has, in turn, highlighted the need for intensified managerial effort to ensure adequate resource mobilization, results-driven resource allocation, attention to alignment of financial, managerial and accountability mechanisms across all levels of the organization to ensure focus on effective interventions delivered at scale to children, young people and their families, and the significant capacity development needed for UNICEF staff to make a forceful impact in the fight against HIV/AIDS.
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