2011 Ghana: Evaluation of the UNICEF/UNFPA Joint Programme “Support to Ghana’s National HIV and AIDS Response: Scaling up Best Practices on Prevention, Care and Support Interventions for Young People
Author: Ernst & Young and ACMA
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Like other countries worldwide, HIV/AIDS is present in Ghana. As of 2004, an estimated 404,000 people infected with the virus. HIV prevalence is highest in the Eastern Region of Ghana and lowest in the northern regions of the country. Irish Aid’s support to Ghana’s national response to HIV and AIDS from 2006 to 2010 was within NSF II. In 2008 Irish Aid and UNICEF signed an agreement for pass through fund management of the joint UNICEF/UNFPA programme to support the implementation of key elements of the GPRS II and NSF II in achieving the millennium development goal target number 6, “Halting and reversing the spread of HIV and AIDS by 2015”. The overarching objective of the support was to strengthen capacities of the Government of Ghana in implementing the national response on HIV and AIDS.
The purpose of this evaluation is to assess (1) how efficiently UNICEF and United Nations Population Fund (UNFPA) worked together to achieve common purpose (2) how effective they were in the context of Delivering as One, and how the joint programme could have been carried out better (3) how well the principles of the Paris Declaration on Aid effectiveness and the Accra Agenda for Action were applied in support of Ghana’s HIV and AIDS effort (4) the extent to which the support provided has contributed to achieving the goals and objectives of National Strategic Framework 2006-2010 (NSF II) and Ghana Poverty Reduction Strategy (GPRS II) (5) how the assistance given by UNICEF/UNFPA to strengthen Ghana’s national HIV and aids response through the main stakeholders involved in funding and implementing the programme was achieved.
A four tier stakeholder consultative approach was adopted for the evaluation; the first tier involved programme owners including staff members of UNICEF and UNFPA, the second tier involved state actors, the third tier involved non-state actors (NGOs/CBOs) and the fourth tier included sampled beneficiaries in specific locations where the programme was implemented. Relevance, effectiveness, efficiency, sustainability and impact and results recorded were among the evaluation criteria.
Findings and Conclusions:
The findings are composed by five components:
1. Prevention of HIV and AIDS among school children; HIV and AIDS alert school model (ASM). This component (The Flagship of the programme) targeted in-school children at the Junior High School (JHS) level (ages 10-14) for HIV education. A Knowledge, attitude and Practice (KAP) study revealed that ASM exposure significantly influenced HIV and AIDS knowledge. The impact of the ASM was at times inconsistent. The non-implementation of the Reward component of the ASM may affect its sustainability. The Urban children tend to abstain longer than the other groups (Peri-urban and Rural) from the control to the inception phase, but by the time they get to the Alert face they have deteriorated in their ability to delay sex.
2. Prevention of HIV and AIDS among out-of-school children. This component was a pilot programme to expand the ASM outside the school environment by involving members/groups in the immediate community. UNFPA was responsible for the implementation of this component and the joint effort was expected to provide an extensive coverage of HIV and adolescent sexual reproductive health (ASRH) for youth.
3. Prevention of Mother-to-Child Transmission (PMTCT) and medical care for children of HIV positive mothers, including Antiretrovial Therapy (ART) is the third component. Support for system strengthening and human resource development was basically in the form of support to the Ghana Health Service (GHS). Support was also provided in the form of technical assistance to the ministry of Health (MOH), GHS and the national AIDS control Program (NACP).
4. The primary objective of the fourth component was to support and facilitate the deinstitutionalisation of orphaned and vulnerable children (OVC) and the protection, care and support for these OVC in residential homes and re-unite them with their families. The focus on residential homes was in response to the seemingly increasing and high growth rates of the establishment of residential homes for OVC in Ghana, and the capacity of the state to properly regulate these residential homes and promote and protect the rights of the children in these usually private owned facilities.
5. The fifth component involves cross-cutting and strategic monitoring and evaluation, and the district response initiative. Support was in the area of generation of strategic information and strengthening of local governments in their district medium-term development plans, to make them more responsive to HIV issues/interventions.
Overall, al 5 components were assessed as being relevant to the broader framework of the NSF II. Secondly, all components were relevant to the global mandate of UNICEF and UNFPA with respect to the target groups and communities who were expected to directly and indirectly benefit from the interventions and support. Finally the components were also aligned to the UNDAF 2006-2010, which gives broader strategic areas of support of the UN in the country. Some strategies, as outlined in the initial UNICEF proposal, were adjusted during implementation without adequate documentation to enable independent recognition of the need and justification for these adjustments. It was generally observed that these adjustments, changes, and/or alterations did not result in the same expected outcomes as agreed in the proposal.
With respect to the joint programme envisaged between UNICEF and UNFPA (components 1 and 2), there were some initial challenges in putting into place the agreed modalities as documented in the Joint Programme Agreement between UNICEF and UNFPA. These challenges resulted in the late disbursement of funds allocated to UNFPA.
There is sufficient evidence to support the fact that most of the interventions undertaken under all five components could be sustainable over the short- to medium-term as most of the support was provided to existing state institution programmes and activities. It can be reasonably concluded that barring no significant shift in the focus of government and other development partners, gains from these interventions could be sustained.
Overall programmatic implications for Unicef:
Four main recommendations were made by the evaluation team to improve the design, development, and implementation of future programme interventions by both UNICEF and UNFPA.
• Specific project reviews, such as gender and human rights assessments, have to be made prior to each intervention in the future. Where not available, baselines should be established and indicators developed for purposes of monitoring and evaluating progress on these issues during and on completion of the interventions.
• Assessing the extent of implementation of strategies proposed and any changes made should be a critical component of progress reporting on all interventions. The extent to which designed and agrees strategies are applied, and any changes that occur, should be recorded and explained in the progress reports.
• Future joint activities/programmes should develop joint work plans with common monitoring and evaluation (M&E) plan which should not only capture information relevant to reporting on the intervention, but also be relevant to the data needs of the agencies involved, and ensure it is aligned to the national M&E framework. Interventions which are sector specific or geographically limited should not use national indicators to assess performance as this may pose some difficulties in gauging the extent of progress in the sector or geographic scope.
• In the design and development of project proposals, project outcomes should be better stated to make it possible to measure them objectively.
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