EAPRO 1999: External Review: Mekong Subregion STD/HIV/AIDS Project
The UNICEF Mekong Subregion STD/HIV/AIDS Project started operation in mid-1996. Participating countries are China, Cambodia, Lao PDR, Myanmar, Thailand and Viet Nam. The Project is due to be completed at the end of 1999. The review was initiated by the Netherlands Ministry for Development Cooperation, UNICEF EAPRO and the Netherlands UNICEF National Committee, and takes place near the end of the Project period.
Purpose / Objective
The objective of the review was to:
- Assess the benefits of the Subregional structure of the Mekong Project and programming from UNICEF EAPRO
- Assess UNICEF's role within and contribution towards UNAIDS structure and functioning at Subregional and country levels
The review took place in two phases. Country level reviews were undertaken by six external consultants in late 1998 and early 1999. The regional level review built on, and synthesised, the results of the country reviews. It also utilised a number of smaller external and internal evaluations of components of UNICEF STD/HIV/AIDS programming in some of the countries participating in the Mekong Project and UNICEF country programme Medium Term Reviews. The regional review team's work included: briefing sessions with the external country reviewers; semi-structured interviews and group discussions with regional level experts; field visits, interviews and discussions with UNICEF staff, national government officers and a range of project partners in Cambodia, China, Myanmar, Thailand and Viet Nam; and review of relevant documents.
Key Findings and Conclusions
The UNICEF Mekong Project has been successfully implemented and made valuable contributions at both country and inter-country levels to strengthen capacity of a range of partners to respond more effectively to STD/HIV/AIDS prevention and care needs. It has stimulated a regional/inter-country approach, which has achieved good results and should be further developed, taking into account the information from improved STD/HIV surveillance countries in the region and the impact of improved commitment and capacity for national level programme responses.
UNICEF has made valuable contributions to the development of the operation of UNAIDS under the agreement among the six co-sponsoring agencies. Currently, there is no major overlap or duplication of effort between the Mekong Project and activities undertaken by governments, NGOs/CBOs, UN agencies, bilateral donors or INGOs at country or regional levels.
In concluding that the Mekong project has been successful, the regional review team notes:
- Project implementation has been well managed and technical guidance has been good. There has been considerable effort contributed at all levels of project implementation. UNICEF EAPRO HIV team has managed the complexity of the Project very well. Project implementation has maintained a focus on the core values and objectives of the original project design.
- The activities undertaken have been appropriate, consistent with national priorities and responsive to emerging trends in the epidemic. Activities have been well designed and delivered, can be demonstrated to have had considerable impact and have the potential to be sustainable.
- UNICEF's ability to operate flexibly with a wide range of partners at country level, combined with the additional flexibility of the subregional operating capacity, has provided an effective setting for the activities. The commitment to collaborate with a wide range of national and international partners has meant that the effort is not isolated and has had an impact on, and benefited from, the programming approaches of other agencies.
- A programming weakness identified is the limited integration of HIV with UNICEF country level reproductive health programmes. There were implementation weaknesses resulting from the limited number of staff in the UNICEF EAPRO HIV team, including occasional lack of timely follow-up after initial inputs had been given and delays in initiating work in some areas.
Benefits of the Subregional structure of the Mekong Project and programming from UNICEF EAPRO:
All country reviewers and the regional review team concluded that the subregional approach has produced tangible results that stand alone country programmes either would not have facilitated or would have taken a much longer time to facilitate. Most importantly, the subregional approach has facilitated:
- the engagement of Myanmar and China with other countries in the Mekong region
- increased political commitment at subnational levels, notably in Yunnan province in China
- strengthened capacity for programme design and implementation at subnational levels in all countries
- the mobilisation and strengthening of UNICEF country office HIV/AIDS programming in all countries
- the rapid sharing of lessons learned from the response to the epidemic in Thailand and, increasingly, other countries participating in the Mekong Project that have led to changes of attitude and approach of major programs for prevention and care
- the rapid development of resource materials through sharing and adaptation of existing materials
- fast responses to new issues, such as mother-to-child transmission
- building of informal networks in various sectors
- cross border meetings and work with ethnic minority groups in countries in the region and in border areas
- advocacy and capacity building for the provision of support and care for, and involvement of, people with, and affected by HIV/AIDS
- assessment of situation, needs and design of responses for work with mobile populations
- leveraging of extra funds for UNICEF country and regional programming and encouragement of other donors to align extra funding input with the Mekong Project
The UNICEF role within, and contribution towards, UNAIDS structure and functioning at Subregional and country levels:
UNICEF has consciously implemented the Mekong Project as part of its participation as one of the co-sponsoring agencies of UNAIDS. UNICEF Country Representatives have served as Chairpersons of the UN Theme Groups on HIV/AIDS on a regular basis. In at least two countries, UNICEF has contributed funds for UNAIDS administrative costs or to support UNAIDS consultants. UNICEF works closely with UNAIDS Country Program Advisors in all four countries where they are in place. UNICEF Mekong Project has made efforts to coordinate project activities with UNAIDS work plans at country level, where they exist, and has invited co-sponsoring agencies to participate in activities, as appropriate.
At subregional level, the Mekong Project has consistently taken opportunities to develop collaborations with UNAIDS APICT and with the other co-sponsors. The UNICEF EAPRO Project Officer, HIV/AIDS has participated in APICT as a member of the team and assisted in the development of the APICT strategic and work planning. UNICEF has provided valuable leadership in several of the UNAIDS APICT Task Forces. Activities that the Mekong Project might have undertaken independently have been placed under the UNAIDS umbrella at times when that increased opportunities for collaboration and coordinated use of funds.
Key Result Areas:
The four key result areas in the Mekong Project are: 1) Behaviour Development and Change/ Prevention; 2) Development of Reproductive Health Services; 3) Care and Support for People Affected by HIV/AIDS; and 4) Capacity Building for National and Sub-national Government Officials and Local Implementing Partners. In all four areas, country reviewers and the regional review team have identified innovative and important achievements that have contributed to the increased capacity, in all countries, of local communities and organisations and district, provincial and national government agencies to design and implement effective HIV/AIDS prevention and care programmes and activities.
Some examples of effective activities are:
- the application of the Lifeskills approach in schools and in the community in all countries, including the SHAPE Project in Myanmar and the out-of-school program in Viet Nam
- the support for people affected by HIV in Northern Thailand and the creative advocacy for increased acceptance and compassion in other countries in the region through the Living Film video project and the Sangha Metta Buddhist monks project
- the work with ethnic minorities in China, Lao PDR and Thailand; the media and communications effort in Cambodia, which has produced interactive IEC resources; the trialling of a home-based reproductive health service in An Gian, Viet Nam near the border with Cambodia
- assistance to the creation of multi-sectoral provincial level AIDS management structures in Yunnan province in China and four provinces in Cambodia; and the development and application of the rapid assessment methodology for mobile populations used in Lao PDR and in the Seafarers project
Overall, programming has been responsive to local situations and needs, and has shown flexibility and adaptability in the context of diverse and challenging political and cultural environments. At the same time, the programming has managed to provide cohesion in regard to the underlying principles and priorities of the Mekong Project. The Project was implemented at a time when the responses to HIV in countries in the region were very limited, and there was resistance to acknowledging its potential impact. There were constraints on introducing effective public health or harm reduction approaches to sexual and injecting drug use HIV transmission. Discrimination made it almost impossible for people with HIV to go public and seek support. The Project has managed to function effectively within this context, and has played a part in helping to change these conditions. There is still a need for this programme to continue in order to strengthen and expand the existing achievements.
The overall recommendation is that the UNICEF EAPRO office should maintain a sub-regional approach to HIV/AIDS programming to support country efforts.
Behaviour Development and Change/Prevention:
- refine the targeting of activities and introduce more outreach and peer-based activities for very vulnerable populations, consistent with UNICEF's mandate and the priorities of the UNICEF country programme
- provide further specialist technical input, sectoral reviews and cultural analysis/social and behavioural research support to assist implementing partners to review progress and strengthen design for next phases of activity
- further emphasise work with cross border and ethnic minority populations
- give greater consideration to the needs of children who are especially vulnerable to STD/HIV
- revise resource materials regularly to address misconceptions and gaps in knowledge and to take advantage of social and cultural change that allows more specific information to be provided to young people
- pay greater attention to the development of Lifeskills supplementary resource materials for in-school and out-of-school youth.
- systematically integrate HIV/AIDS prevention elements into Safe Motherhood training materials
- seek new opportunities to use reproductive health networks and projects to promote HIV/AIDS prevention
Care and Support for People affected by HIV/AIDS:
- define the most appropriate UNICEF role, strategies and priorities for UNICEF at country level to be doing more in supporting the development of care and support services
- continue to support development of counselling capacity
- continue to advocate for, and support development of, a range of care and support services including self-managed advocacy, and support programmes by, and for, people affected by HIV
- develop policies and programmes to meet the needs of women and children affected by HIV
- strengthen input at sub-national levels in ministries of education in some countries where the main emphasis so far has been at central level for policy, curriculum and teacher training development
- support more refresher or regular, ongoing training at sub-national level in mass organisations and local NGOs delivering Lifeskills to out-of-school youth and women
- deliver more specialised sectoral technical assistance to UNICEF country offices to develop, or cover all technical areas in, a mainstreamed programme
- involve UNICEF country office staff more in prioritising, design and planning for inter-country work
- encourage UNICEF country offices to bilaterally and independently initiate inter-country or cross-border activities within an agreed overall subregional programme framework
- on a priority basis, facilitate work between Cambodia and Viet Nam to address the problem of young women crossing from southern Viet Nam to Cambodia to work in the sex industry.
UNICEF contributions to UNAIDS:
- involve UNAIDS staff and/or technical advisors to participate in UNICEF regional gatherings of Representatives for discussions of HIV/AIDS
- request UNAIDS to give briefings to Chairpersons of UN Theme Groups on HIV/AIDS on the role and mandate of UNAIDS and HIV/AIDS best practices
Preventing Mother-to-Child Transmission:
- follow up assessments and planning at country level, and offer technical assistance, where necessary
- support efforts to prevent mother-to-child transmission of HIV that are safe, affordable, appropriate, replicable and effective
Programme Coordination, Management and Implementation:
- Strengthen monitoring and evaluation systems and conduct more regular, sectoral technical reviews
Full report in PDF
PDF files require Acrobat Reader.