CHAPTER 1: INTRODUCTION

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1.1 HIV/AIDS in Ethiopia

1.2 HIV/AIDS Prevention and Control Office (HAPCO)

1.3 Rationale for a National M&E Framework

1.4 Goal and Objectives of the National M&E Framework

1.5 Methodology and Development Process of the M&E
Framework

1.6 Organization of the Document

1.1 HIV/AIDS in Ethiopia

Ethiopia has a population of about 70.7million (UNFPA 2003) and a total area of approximately one million square kilometers. About 85% of the population lives in rural areas. Administratively, the country is divided into nine Regional states and two city administrations that are further divided into Zones, Woredas (districts) and Kebeles.

The first evidence of HIV infection in Ethiopia was recognized in the early 1980’s. The first two AIDS cases were reported in 1986. Since then, the disease has spread at an alarming rate. Currently, the Country is home to the third largest HIV/AIDS infected population next to India and South Africa. According to a recent report by the Ministry of Health, a total of 2.2 million people are estimated to live with the HIV virus, of which 200,000 are AIDS cases. Evidences show the adverse effects of HIV/AIDS on life expectancy. HIV/AIDS resulted in a life expectancy of 46 years instead of 53 years in 2001 (a decline by 7 years). If the spread of the disease is not checked, by 2014, the life expectancy at birth is estimated to be 9 years below projected life expectancy had there been no HIV/AIDS (MoH 2002).

The prevalence of HIV infection in the adult population is estimated to be 6.6 percent, while pregnant women aged 15-24 years have the highest mean HIV prevalence of 12.1 percent (MoH 2002). The most affected groups are people in their prime productive and reproductive years resulting in loss of the Country’s human capital. Heterosexual transmission is responsible for the majority of infections followed by mother-to-child transmission route.

Realizing the devastating effect of HIV/AIDS on national development and poverty-reduction efforts, the Government of Ethiopia took the leadership to scale up the response in the fight against HIV/AIDS by forging multi-sectoral and multi-level partnership with various stakeholders. A National Policy on HIV/AIDS was enacted in August 1998. Following that, the Ministry of Health coordinated a process of strategic planning and program development in Ethiopia’s nine Regions and two city administrations. This process involved National and Regional governmental institutions, the major regional sector offices, NGOs, religious organizations, and other key stakeholders. It resulted in the five-year Federal Level Multi-Sectoral HIV/AIDS Strategic Plan and accompanying Regional Multi-Sectoral HIV/AIDS Strategic Plans. Together, these plans were synthesized into the Strategic Framework for the National Response to HIV/AIDS in Ethiopia for 2001-2005. The National Strategic Framework (NSF) focuses on reducing the transmission of HIV and associated morbidity and mortality, and its impact on individuals, families and the society at large. The strategy is built on four issues: multi-sectoralism, participation, leadership, and efficient management (including adequate monitoring and evaluation). The NSF is currently being revised and the priority areas redefined. The proposed intervention areas are the following:

• Behavior Change Communication (BCC)

• Condom Promotion and Distribution

• Blood Safety

• Management of Sexually Transmitted Infections (STIs)

• Voluntary Counseling and Testing (VCT)

• Prevention of Mother to Child Transmission (PMTCT)

• Universal Precautions and Post-Exposure Prophylaxis (PEP)

• Care, Support and Treatment

• Legal and Human Rights

• Surveillance and Research

• Mainstreaming

• Capacity Building

In-order to implement the various interventions, the government has adopted a multi-sectoral approach. This has resulted into an expansion and scaling-up of the national response to HIV/AIDS into a multiplicity of interventions in various sectors and levels of government structures, as well as NGOs, FBOs, CBOs, Civil Associations and multilateral and bilateral organizations. The expanse and diversity of interventions require a coherent and well-structured framework for monitoring and evaluation that can generate reliable data for tracking progress and effective decision-making. The priority intervention areas are the basis for identifying the indicators in this M&E Framework.

1.2 HIV/AIDS Prevention and Control Office (HAPCO)

The National HIV/AIDS Prevention and Control Council and its Secretariat were established in April 2000. The Council is chaired by the President of the Federal Democratic Republic of Ethiopia and comprises the Deputy Prime Minister and other higher officials and representatives from government, NGOs, religious bodies, and civil society. The Council oversees the implementation of the NSF and examines and approves annual plans and budgets, and monitors performances and impact.

At its fourth regular session in June 2001, the Council declared HIV/AIDS a national emergency. The Council appointed the National HIV/AIDS Board of Advisors, which meets monthly. The board includes eight Ministers, local NGOs, PLWHA representatives and National technical experts on HIV/AIDS. The National HIV/AIDS Prevention and Control Office (HAPCO, formerly the National HIV/AIDS Council Secretariat) was reestablished by Proclamation Number 276/2002 in June 2002 as the executive arm of the Council.

The powers and duties vested into HAPCO include the following (Federal Negarit Gazeta, 11 June 2002).

Powers and Duties of HAPCO Submit for the approval of the Government a national HIV/AIDS program prepared on the basis of the recommendations of the Council: follow-up and coordinate the implementation of the same Coordinate the activities of Federal and Regional government organs and non-governmental organizations engaged in HIV/AIDS prevention and control activities and facilitate conditions for integration Collect and compile information on general situation of HIV/AIDS in the country and disseminate same to all concerned, as deemed necessary Ensure that money secured in donation and the budget allocated by the government is properly utilized Duty to Cooperate The concerned Federal and Regional government organs and non-governmental organizations shall have the duty to cooperate with the office with a view to enabling it to effectively discharge its responsibilities with regard to coordinating and directing the implementation of the HIV/AIDS Policy

Figure 1: Organizational Structure of Federal HAPCO

1.3 Rationale for a National M&E Framework

There are a number of reasons that justify the necessity of having a National HIV/AIDS M&E Framework:

a. To strengthen the multi-sectoral response and the national commitment and action against HIV/AIDS

b. To systematically track progresses and evaluate the effects of the national response

c. To meet the international reporting requirements for funds secured to fight HIV/AIDS in the country (e.g. EMSAP, GFATM and multilateral and bilateral funded programs)

1.4 Goal and Objectives of the National M&E Framework

The goal of the National M&E Framework is to provide information that will enable tracking of progress and to enhance informed decision-making at all levels in the implementation of interventions under the multi-sectoral response to HIV/AIDS in Ethiopia.

The specific objectives of the National M&E Framework are:

i. To promote importance of M&E, the need for systematic data collection and utilization of monitoring and evaluation results in the further planning of HIV/AIDS interventions by the government and its partners

ii. To strengthen the M&E capacity of HAPCO, Federal Sector Ministries, Regions, Woredas, NGOs, CBOs, FBOs, and Civil Associations to collect, analyze and use data

iii. To increase the understanding of trends and explaining the changes in the levels of HIV/AIDS prevalence overtime

iv. To give guidance on National and International HIV/AIDS reporting requirements (e.g. EMSAP, UNGASS and GFATM)

1.5 Methodology and Development Process of the M&E
Framework

The M&E Team was tasked for the development of the National M&E Framework. Participatory methods were applied to develop the Framework as a way of enhancing ownership that will in effect bring effective accountability at the stage of implementation. The M&E Team organized meetings and consultations with different organizations and the draft version of the document was also distributed for comments to technical experts. All the meetings, consultations and comments received were very helpful and the Framework was reviewed accordingly.

The methods used and/or process followed include:

• Building on the consultative meeting with different stakeholders (government offices, UN agencies, NGOs, CBOs, FBOs) held in Nazareth (Ethiopia) from October 9 to 11, 2002

• Regular meetings of the M&E Team under the Planning and Programming Department of HAPCO and the Head of HAPCO

• Consultative meeting held with key staff of MoH’s HIV/AIDS Unit, and HMIS Unit, WHO and HAPCO M&E Team, June 21-22, 2003

• Consultative meeting held in Addis Ababa with Regional HAPCO Heads and their M&E focal persons and RHBs, 4-5 July, 2003

• Discussions held with key informants in Federal Ministries, Authorities, Commissions and Agencies

• Meeting held with Regional Health Bureau Heads at the Health Sector HIV/AIDS Annual Program Review held in Nazareth, November 27- December 4, 2003

• Identification and review of national level survey reports such as the DHS, BSS, UNGASS 2003 and other documents on HIV/AIDS and monitoring and evaluation

• The draft M&E Framework was distributed to stakeholders and National Technical Experts and comments gathered.

1.6 Organization of the Document

The document is organized into six chapters. Chapter one is introduction to the M&E Framework. The chapter briefs about the HIV/AIDS status in Ethiopia and Government responses to the epidemic. The rationale for a National HIV/AIDS M&E Framework and its goal and specif objectives are also indicated.

Chapter 2 gives very brief introduction about basic concepts on M&E. The third chapter focuses on the implementation strategy and coordination of the M&E Framework. In this chapter, the main data sources of the National level HIV/AIDS indicators are mentioned; hierarchy and frequency of reporting on program indicators is shown; coordination roles at National, Regional and Woreda levels are indicated; CRIS is briefly explained; what is expected of donors regarding data/information is mentioned; and HIV/AIDS information dissemination strategy is described.

Chapter 4 consists of all National level HIV/AIDS indicators categorized into intervention and program support areas. The indicators are classified into four broad categories: impact (labeled ‘Imp’), prevention (labeled ‘Prv’), care, support and treatment (labeled ‘CST’) and program support (labeled ‘PS’).

The fifth chapter tries to show the limited M&E capacity, especially at Regional and Woreda levels, and emphasizes the need for allocation of enough resources and management support for strengthening M&E capacity at all levels. The chapter also mentions the remaining activities to start implementation of the National M&E Framework.

The last chapter consists of reference pages for each of the indicators in Chapter 4. For each indicator, the reference page describes the purpose of the indicator, the measurement tool (whether the indicator is collected though survey, special study or program report), the frequency of data collection, who is responsible for data collection or reporting, and the method of measurement.