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Evaluation database

Evaluation report

2016 Global: Evaluation of UNICEF’s PMTCT/Paediatric HIV Care and Treatment Programme



Author: itad

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 3’ of the report, and the executive feedback summary labelled as ‘Part 4’.

Background:

In 2005, programmes for HIV prevention, care and treatment among children were only starting up in most LMICs and coverage levels were still very low. In 2005, only 9 per cent of pregnant women living with HIV received antiretroviral (ARV) medications for PMTCT,  resulting in more than 600,000 new infections among children. Access to ARV treatment (ART) for people living with HIV remained low, with only 1.3 million people receiving ART and few of them children. 

The prevention of HIV in children is a success story of our time. The scale-up and improvement of PMTCT services reduced the annual number of new infections among children globally by 56 per cent between 2010 and 2015 and by 70 per cent between 2000 and 2015.  Since 1995, an estimated 1.6 million new HIV infections among children have been averted thanks to the provision of ARV medicines to pregnant or breastfeeding women living with HIV.  AIDS-related deaths among children under 5 fell by 62 per cent between 2000 and 2015. 

Progress towards global targets has been uneven, however, and significant challenges remain. Coverage of PMTCT interventions has not increased as planned in all countries, children’s access to treatment remains low in many places and HIV risk remains unacceptably high among young women of reproductive age. The global burden of infection has remained high, with 36.7 million people of all ages living with HIV.  Many women, including women living with HIV, do not have access to the family planning services they need and as a result, HIV exposure of infants remains high.

Purpose/Objective:

UNICEF has commissioned a corporate evaluation of its prevention of mother-to-child transmission (PMTCT) and paediatric HIV care and treatment programme, to reflect back on its contribution over the period 2005–2015.
The evaluation addressed the following objectives:

  • to contribute to improving the organisation’s accountability for its performance by defining and documenting key achievements as well as missed opportunities in UNICEF’s engagement with partners and countries in support of improved PMTCT and paediatric HIV care and treatment outcomes between 2005 and 2015;
  • to generate evidence and learning to enhance the understanding of the organisation and other stakeholders on how UNICEF’s strategies and programmes related to PMTCT and paediatric HIV care and treatment have evolved, what has worked, what has not worked, and why, and make recommendations for UNICEF’s future engagement in PMTCT and paediatric HIV care and treatment.
    The evaluation focused on four thematic areas: (a) Leadership, advocacy, coordination, and partnerships; (b) Resource mobilisation; (c) Strategic information, knowledge generation and dissemination; and (d) Key aspects of UNICEF’s organisation. It also considered three cross-cutting issues – gender, human rights and equity – and examined how the response to PMTCT and paediatric HIV has played out in humanitarian situations.

Methodology:

Evaluation design
The evaluation is framed around a Theory of Change (ToC) to explain and document the processes and causal pathways by which the programme is expected to have led to its intended results and the assumptions made along the way. The ToC formed the basis for the development of 26 key evaluation questions, which built on those presented in the Terms of Reference. The evaluation focused on UNICEF’s contributions to programme responses, and did not seek to address issues of outcomes and impact.
The evaluation approach was based on an ex post analysis of performance against the ToC using data generated from primary sources (through key informant interviews, group discussions, an online survey and seven country case studies), supplemented by secondary data analysis (based on a review of key documents and data sources). Four of the case studies involved country visits (in-depth case studies in Cameroon, India, South Africa and Zimbabwe) and three were conducted remotely (“light-touch” case studies in Cambodia, Haiti and Ukraine).

Findings and Conclusions:

Key findings
Leadership, advocacy, coordination and partnerships
UNICEF has been visible and prominent in advocating for the scale-up of HIV prevention and treatment services for children, though this has been mostly in the programmatic arena, and not so much at the political level. It has forged strong strategic alliances with a range of partners and provided valued support for programme scale-up at country level.

UNICEF has faced challenges in its fundraising for its HIV/AIDS work.

A high proportion of UNICEF’s resource base is tightly earmarked, increasing transaction costs and restricting the ability to flexibly programme resources.

UNICEF has played a valuable role in supporting countries to access external resources, particularly .

Strategic information, knowledge generation and dissemination

UNICEF has worked with partners to generate, analyse and disseminate strategic information on the HIV epidemic in children

UNICEF is especially recognised for its push for age- and sex-disaggregation of data, but otherwise its work on strategic information has had limited visibility, considering the considerable investments that it has made.

UNICEF has championed data-driven approaches to improve programme performance, and piloted innovative data management approaches to improve service delivery. 

UNICEF’s organisation

UNICEF has deployed diverse approaches to address its corporate priority on HIV/AIDS at different levels of the organisation.

UNICEF is generally, although not universally, recognised as integrating the lenses of gender, equity and human rights in its work. However, there are opportunities for UNICEF to strengthen its focus in these areas and be more vocal in defining and driving the agenda.

Recommendations:

Recommendation 1: Expand UNICEF’s advocacy efforts to keep HIV prevention, care and treatment among children high on the global agenda.

Recommendation 2: Clearly define UNICEF’s unique role and contribution to the HIV response in the post-2015 era, building on its comparative advantages.

Recommendation 3: Tailor HIV programming carefully to country needs, capitalizing on UNICEF’s decentralized mode of operations and its focus on making a difference at the country level. 

Recommendation 4: Take the lead on the mainstreaming agenda, demonstrating how HIV can be effectively linked with work in other key programmes and sectors.

Recommendation 5: Develop strategic approaches to keep HIV visible as a key corporate priority within UNICEF, across diverse organizational structures.

Recommendation 6: Consider making equity the focus of continued programme scale-up, while strengthening UNICEF’s programming approaches to more explicitly address gender and human rights. 

Recommendation 7: Clearly position UNICEF’s work within existing partnership frameworks, which may need to be renegotiated or strengthened as required. 

Recommendation 8: Invest effort in ensuring that the necessary funds for UNICEF’s HIV response are mobilized.

Lessons Learned:

Conclusions
Since 2005, there has been good progress in relation to preventing HIV infection in children, as well as in improving treatment use among pregnant women and mothers, although the scale-up of paediatric HIV treatment programmes continues to lag behind. These results came about through the action of countries, supported by many partners; however, UNICEF has had a significant role. UNICEF’s contributions have evolved over the time period covered by the evaluation. The last five years following the development and 2011 launch of the Global Plan have been its most productive in terms of expanding and improving programmes to prevent new HIV infections in children.
UNICEF has played a critical role, with partners, in scaling up HIV prevention, care and treatment programmes among children through its targeted advocacy for children affected by HIV, its convening role at the global, regional and country levels, and its substantive financial and technical support to country level partners across a broad range of areas, spanning policy development, programme planning, support to implementation and knowledge-building activities.


You will find the following attachment as follows:

  • PMTCT Full Report - Report
  • PMTCT Report Summary - Part 2
  • GEROS Quality Rating Review - Part 3
  • GEROS Executive Feedback Summary - Part 4


Full report in PDF

PDF files require Acrobat Reader.


 

 

Report information

Year:
2016

Office:
Evaluation Office

Region:
HQ

Type:
Evaluation

Theme:
HIV/AIDS - Preventing Mother To Child Transmission (PMTCT)

Language:
English

Sequence #:
2016/007

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