Misión Alianza de Noruega en Bolivia, Hiv/aids project, final report, external evaluation

Background:
The project “HIV/AIDS El Alto Town” was developed from 2002 until 2004 in public Educational Units, covering nearly one third of the secondary school population. The project considered training and information activities and the implementation of means to consolidate the Strategic Health Plan (PES) of the MSD, besides activities to strengthen the regular secondary school study plan of the Ministry of Education.

In the project period 2005-2009 the HIV/AIDS Project of Misión Alianza de Noruega en Bolivia has the following three components:
1. Institutional Strengthening of the Departmental STIs‐HIV/AIDS Programme of SEDES La Paz
2. Strengthening of organisations of PLWHAs and of support networks;
3. Provide Information, Education and Communication (IEC) in STIs‐HIV/AIDS, with an emphasis on adolescents from the North Zone of the city of El Alto, but also the population in general of El Alto and La Paz.

Purpose/objective:
The objectives of the evaluation were to verify Project development in years 2005‐2008 and compliance of the proposed goals through achievement of the indicators defined in the Operational Plan.

Methodology:
The evaluation covered years 2005 to 2008. The evaluation was based on 1,180 surveys among students, 819 (69.4%) of whom from Educational Units covered in the intervention and 361 (30.6%) from Educational Units from outside the intervention, as a control group. On the other hand, there were focal groups and interviews with students, principals of the Educational Units, teachers, healthcare personnel and PLWHAs, aimed at identifying their perception of the Project. A revision was made of the diversity of instructive/educational materials produced and distributed in the population. Moreover, the administrative and financial performance was analysed and assessed.

Key findings:
The evaluation of the different project components yielded the following results:
- Institutional Strengthening of the Departmental STIs-HIV/AIDS Programme of SEDES La Paz- The perception gathered from the interviews is that although there are other institutions working on this topic, there is not one that works systematically in the Educational Units, which other programmes consider to be a complementary activity. On the other hand, the education and information materials produced in conjunction with the project are important to reach the population in general, besides benefiting the health workers.

The future office of the CRVIR El Alto has not yet been concluded, although the Project has disbursed its complete financial contribution. Though the construction works have not been suspended, progress is slow.

- Strengthening of organisations of Persons Living With HIV/AIDS (PLWHAs) and of Support
Networks.- As regards this component, the evaluation work consisted of a meeting with three members of the organisation “Una Luz en el Camino” (A Light on the Road) and a meeting with five participants of the Handicrafts Workshop. The perception of both groups is that the project has strengthened the groups of PLWHAs, through development of the workshops, confraternity meetings, participation in radio programmes and the production of information for the PLWHAs. Still, they mention that there continue to be weaknesses, which is why it is necessary to work on the empowerment of these groups with the Departmental Programme. On the other hand, they consider that implementation of the nutritional service and construction of the new CRVIR building in El Alto contribute to an improvement of integrated PLWHA care.

- Information, Education and Communication (IEC) in STIs-HIV/AIDS - According to the student surveys, statistically significant and very important differences were found between the two groups; in other words, the students from the Educational Units that were part of the intervention have more knowledge of STIs-HIV/AIDS and the prevention thereof.

The students’ perception of the Project is positive, because thanks to the information they were given on STIs-HIV/AIDS, they learned about prevention and about taking care of their body. They mention that the information must be detailed and broad, including also issues like drugs and alcoholism.

As regards the teachers and principals, in the meeting they said that the Project is effective as it informs youth of STIs-HIV/AIDS, though they think parents should be involved as well. In this sense, it would be necessary to produce the information in the native language. They also think the project should reach out to other districts.
 
The administrative-financial analysis shows that quantitative compliance of the activities in the different components is highly satisfactory, except for construction of the CRVIR in El Alto. The annual per capita cost by component is considered adequate (around USD 8.00 for PLWHAs and USD 11.00 for the IEC Projects in EUs, including 50% of all operational expenses) and the cost-benefit ratio is highly remarkable, considering the cost for AIDS treatment. However, Project sustainability is still weak in the years covered by the evaluation.

The indicators proposed for measuring the impact of the intervention are favorable and the results of the interviews show that the teachers, principals, health workers and PLWHAs are deeply satisfied with the Project and have great expectations as regards continuity and extension of the intervention area. The outputs reported as accomplished have been fully confirmed by the team of consultants and so we can conclude that Project implementation was characterised by a high degree of seriousness and transparency.

Recommendations:
In view of its findings, the evaluation team recommends continuing with the Project and turning each component into a project with broader action lines. As regards the IEC component, the teacher training activities and the informative talks for students should be widened to other districts. This means that more teachers should be trained, more instructive/educational materials should be developed for dissemination, and part of the material should be written in the native language so as to reach the parents. Within this point, we recommend insisting on the application of Law 3729, dated 8 August 2007, which provides for the inclusion of STIs-HIV/AIDS in school curricula.

As regards the strengthening and support for PLWHAs, we recommend coordinating the work for empowerment of the PLWHAs with the Departmental Programme, fomenting the identification, care and support for PLWHAs in hospital and in jail. On the other hand, with a view to income generation for the PLWHAs, business projects with an income-generating perspective should be proposed and developed, considering the PLWHAs’ work as a matching contribution. As in the groups of PLWHAs, there is a need for the children exposed to HIV (children of mothers with HIV) to consume milk until they are two years old, strategic alliances could be entered into with institutions that can supply this input. An alternative source could be the productive projects involving PLWHAs, part of the income of which could be used to buy milk.

In the component for institutional strengthening of the Departmental STIs-HIV/AIDS Programme of SEDES La Paz, follow-up is required for concluding construction of the CRVIR in El Alto. Local authorities should sign a commitment in which they undertake to use the building solely for the ends agreed upon. Activities could be coordinated with the Programme regarding the development of strategies to improve epidemiological HIV/AIDS surveillance.

Comments from the organisation, if any: