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CHAPTER 4: NATIONAL LEVEL HIV/AIDS INDICATORS (cont.)

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4.4 HIV/AIDS Program Support

4.4 HIV/AIDS Program Support

4.4.1 Mainstreaming

Expanding multi-sectoral response is crucial in fighting against the HIV/AIDS epidemic. This demands that government sectors, NGOs, private sector entities, church organizations, etc. mainstream HIV/AIDS into their day-to-day activities. The different sectors/organizations can mainstream HIV/AIDS into two areas (i) internal or workplace domain in which attention is on the vulnerabilities and risks of people within the sector/organization; and (ii) external or target community domain in which HIV/AIDS becomes part and parcel of the interaction between the sectors/organizations and their target or client communities (UNAIDS & GTZ 2003).

Main strategies:

  • Advocacy and sensitization for understanding HIV/AIDS mainstreaming and capacity building for action

  • Establish partnerships among the different sectors/organizations based on human, technical and other resource capacity. For example, sharing IEC materials and counseling. Mainstreaming does not require sectors, programs or projects to include all components of a comprehensive response to HIV/AIDS.

  • Formulate appropriate, gender sensitive and responsive HIV/AIDS work place policy

  • Develop a comprehensive national mainstreaming guideline as well as training manual

  • Assist institutions with financial, professional and material support for mainstreaming HIV/AIDS within their existing institutional structure

    Key objective

  • HIV/AIDS is mainstreamed into the core mandate, activities and business of all sectors/organizations in the country

    Indicators

    PS1

    Percentage of large enterprises/companies that have HIV/AIDS workplace policies and programs

    PS2

    Percentage of government offices that have integrated specific HIV/AIDS activities into their sector plan in the last 12 months

    4.4.2 Surveillance and research

    Surveillance refers to the continuous and systematic recoding of trends of HIV infection and AIDS cases in a population and tracking behavioral data to inform and explain trends recorded in HIV/AIDS. Research is a systematic process that uses scientific methods to draw lessons or generate new knowledge. In the area of HIV/AIDS, research may include pure or basic research that takes place in a laboratory (e.g., development of a vaccine), epidemiological research (e.g., to establish an association between breast feeding and HIV infection), anthropological research to assess the cultural feasibility of introducing new nutritional habits, or economic research to assess the economic impact of HIV/AIDS.

    Surveillance and research is a key component of HIV/AIDS prevention and control programs, to guide the design of appropriate programs, assess whether efforts are successful and draw lessons. Ethiopia has adopted the Second Generation HIV Surveillance. The Second Generation HIV Surveillance stresses the need to design a surveillance system that is appropriate to the stage of the epidemic in a country, focusing surveillance resources on population groups in which HIV infection is most likely to be concentrated. Second Generation HIV Surveillance uses data from Behavioral Surveillance, STI Surveillance and AIDS case reporting to interpret data gathered from sero-surveillance efforts (UNAIDS 2000).

    The 2002 HIV prevalence in Ethiopia has been estimated from the HIV surveillance system based on 34 sentinel sites (antenatal clinics). In 2002, Ethiopia did the first National Behavioral Surveillance Survey (BSS) on ten target populations in selected Regions of the Country. However, the number of sentinel sites should be expanded to get better representation of the population and good estimate of HIV prevalence. Also, the BSS should cover all the eleven Regions of the Country for major target populations. In general, HIV/AIDS related epidemiological and seriocomic researches are not many in the country and require financial and technical support.

    Main strategies:

  • Initiate and support HIV/AIDS epidemiological research and studies on the impacts of the epidemic on different sectors at the National and Regional levels

  • Expand and strengthen HIV sentinel sites

  • Encourage operational research on all aspects of ART, treatment and prophylaxis of opportunistic infections, and applicability of treatment guidelines in local situations as well as ABE and PEP

  • Establish ABE surveillance in health institutions and conduct research on rate of accidental transmission in different settings and conditions including transmission during sexual assault

    Key objective

  • To monitor trends of the HIV epidemic and its impacts, study the associated factors, assess the performance of interventions and draw lessons so as to make evidence-based decisions on issues pertaining to HIV and AIDS

    Indicators

    PS3

    Number of national level HIV/AIDS related researches carried out in the last 12 months

    PS4

    Number of National HIV Sentinel Surveillance sites existing at the time of data collection (disaggregate by region and urban /rural)

    4.4.3 National commitment and action

    Decades of experience in highly politicized areas such as family planning have shown that strong political commitment is crucial to program success (MEASURE Evaluation & UNAIDS 2000). Formulation of supportive policies, strategies and legislations; government funding for HIV/AIDS activities and breaking the silence surrounding the epidemic are the main areas by which national commitment and action are reflected.

    As mentioned in Chapter One, the Government of Ethiopia has taken several measures in response to the epidemic. However, as the HIV/AIDS situation is worsening, government supports need to be maintained and further strengthened to meet the challenges HIV/AIDS presents to infected and affected individuals, to employment, and health services in the country.

    Main strategies:

  • Convince policy-makers to recognize and understand the nature and magnitude of the problem, and to put the problem firmly on the national agenda

  • Develop and/or approve policies and guidelines (such as Safe Blood Policy, OVC, Mainstreaming HIV/AIDS, PEP, etc.)

    Key objective

  • Enhance political support and government funding for the prevention and control of HIV/AIDS

    Indicators

    PS5

    Amount of national funds spent by the government on HIV/AIDS

    PS6

    National composite policy index

    PS7

    Existence of policies, strategies, guidelines and frameworks produced at national level

    PS8

    Operationalization (at all levels) of policies, strategies, guidelines and frameworks produced at national level

    4.4.4 Monitoring and evaluation

    Without an efficient monitoring and evaluation capacity at all levels, it is difficult to assess progresses made towards achieving set objectives and targets. An M&E capacity can be built if sufficient budget is allocated for recruiting staff, training, purchase of necessary materials and equipment, field supervision and data collection (including surveys). Besides budget allocation, higher bodies at all levels should give management support for the smooth implementation of M&E activities.

    Main strategy:

  • Awareness raising and sensitization on the vitality of M&E for HIV/AIDS projects/programs and necessity for budget allocation and management support

    Key objective

  • Efficient M&E capacity established at all stakeholders implementing/supporting HIV/AIDS activities

    Indicators

    PS9

    Percentage spending for M&E by HAPCO in the last 12 months

    PS10

    Proportion of all stakeholders implementing/supporting HIV/AIDS projects/programs that submit timely reports to HAPCO using standard reporting formats

    4.4.5 Capacity Building

    Capacity gaps on project/program management, leadership, implementation, monitoring & evaluation and effective resource absorption affect the national response against HIV/AIDS. Also, the lack of effective coordination and information sharing results in duplication of efforts and mal-distribution of services. Such problems are more sensitive to countries, like Ethiopia, where resources are scarce. This demands developing the infrastructure, strengthening the human resource capacity through short- and long-term training packages, building better coordination among actors and creating an enabling working system set to effectively address the national emergency. Networking among public and private sectors and NGOs, CBOs, FBOs, Civil Associations and others that are implementing/supporting HIV/AIDS activities is also instrumental.

    Main strategies:

  • Establish and strengthen Partnership Forums to promote and facilitate sustained collective response

  • Strengthen human resource capacity, both managerial and technical, at all levels

  • Establish networks of private and public sectors and NGOs, CBOs, FBOs, Civil Associations and others in which regular meetings/forums can be held about HIV/AIDS and related issues

  • Establish electronic networks to facilitate communication and information sharing among the different actors

    Key objectives

  • Develop the implementation capacity of all actors through infrastructure development, training and experience sharing for an intensified, better coordinated and effective national response

  • Establish effective coordination and information sharing among the different actors in order to avoid duplication of efforts and fulfill the information need of actors

    Indicators

    PS11

    Number of National Partnership Forum and Joint Review meetings organized by HAPCO in the last 12 months

    PS12

    Number of Regional HAPCOs that have installed CRIS and established an online access with National HAPCO

    PS13

    Number of staff at Regional and Woreda level trained on M&E and Project Management by HAPCO in the last 12 months

    4.4.6 Financial Utilization

    One of the key purposes of M&E is to assess financial utilization of projects and programs. Monitoring and evaluation of physical achievements alone measures the effectiveness of a program – the extent to which the program attains its objectives. When M&E measures physical achievements in comparison with financial utilization, then it measures the efficiency of the program - how economically inputs (funds, expertise, time, etc.) are converted into results. Therefore, monitoring the financial utilization of HIV/AIDS activities helps to get an idea of the efficiency of programs and produce an overview of physical achievements against expenditures at national level.

    Key objective

  • Efficient utilization of resources allocated for HIV/AIDS

    Indicator

    PS14

    Financial allocation and utilization in the last 12 months (disaggregated by component: BCC, Condom promotion and distribution, etc.)



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