HIV AND AIDS RESPONSE 2010-2013. A Review of Save the Children’s HIV and AIDS International Programmes

Background   
This report is a review of Save the Children Norway’s (SCN) HIV and AIDS portfolio.  The thematic priorities for SCN’s work are set out in “Save the Children Norway’s strategy 2010 – 2013” approved by the SCN National Congress in September 2009. In the 2010-2013 Strategy. SCN’s main thematic priorities are child rights governance and children’s right to basic education. The strategy also intends that SCN will increase its capacity to prevent and respond to humanitarian crises. Throughout the period, protecting children against violence and abuse and against the impact of HIV and AIDS have also been thematic areas for work.

In order to fulfil the right of children to protection against the impact of HIV and AIDS, SCN invested nearly NOK 30 million during 2010-2013 in eight countries in Africa, Asia, and Latin America. The planned objectives for the HIV and AIDS thematic area were:

• Strengthened capacity within the community to protect children against the impact of HIV and AIDS
• More young people protect themselves and others against HIV infection
• Newborn children are protected from mother to child transmission of HIV

This Review of SCN’s HIV and AIDS portfolio assesses investments made at a time of considerable change for Save the Children (SC) member and country offices. The effort and ramifications of the changes were substantial and required considerable time in some countries. Country office unification and entering into SCI, and the HIV Global Initiative ceased to exist in 2012 with a new Global Initiative on Health and Nutrition (including HIV and WASH) from 2013 onwards. SCN’s total HIV and AIDS expenditures declined during the review period from 3.7% of SCN´s total budget in 2010 to 0.9% in 2013. Global HIV and AIDS funding also levelled off over this period. 

Purpose/objective (including evaluation questions)  
The purpose of this Review is to document results achieved as a result of the investments made by SCN, Norad, and the Norwegian Ministry of Foreign Affairs to fulfil the right of children to protection against the impact of HIV and AIDS during the period 2010 – 2013. The Review should also help SCN in documenting key successes, challenges and make feasible recommendations for SCN and country offices in how to ensure that the rights of children within the field of HIV and AIDS are taken care of or get enough consideration in future programming.  Countries covered in the Review are Nepal, Nicaragua, Ethiopia, Uganda, and Zimbabwe.

The overall objective of the review is to assess if the planned objectives in the strategy have been achieved and document any significant lessons and evidences that can be drawn from country specific experiences in the area of HIV and AIDS intervention.
The review process shall respond to the following issues:

1. Assess SCN’s HIV and AIDS investment in terms of relevance and effectiveness.
2. Assess if considerable results have been documented when measuring against SCN’s key HIV and AIDS indicators; if not why and have there been any unintended consequences;
3. Analyze data from Save the Children´s monitoring and evaluation systems within HIV and AIDS and assess type of results, number of children and youth benefiting from holistic HIV and AIDS programmes;
4. To which extent HIV and AIDS programs financed by SCN in Zimbabwe covered specific niches that were not covered by other partners/donors that financed work against HIV and AIDS?
5. Assess the existing capacity at country office levels and identify capacity needs for better HIV and AIDS intervention in the future (in the case of Zimbabwe program);
6. Assess if the investment in HIV and AIDS has contributed (based on desk review) to any policy formulation, changes and response in the respective countries, and if not why;
7. Assess the role and engagement of civil society and partnership (based on desk review and interview of selected partners) among stakeholders towards HIV and AIDS intervention in the intervention countries;
8. Assess to which extent HIV and AIDS is integrated, referring country reports and information available) into other thematic sectors like education, health, protection and child rights governance and the potential benefits or disadvantages with this approach.
9. Document lessons learned and challenges encountered during the intervention period;
10. Advise how to ensure the rights of children are taken care of in future programming.

Methodology  
The Review is largely a desk study.  The main documents used are SC country office documents, international reports, national strategies and plans, SCN documents, and Save the Children International (SCI) OneNet archive. The document review was supplemented by a field trip to Zimbabwe 8 – 15 April, 2014.  Key informant interviews with thematic advisor in Oslo, country level focal points, focus group discussions with beneficiaries, representatives of civil societies, government authorities and other stakeholders. Further information was also gained through Skype interviews with key informants and/or implementing partners in the four countries that were not visited.

Key findings  
1) Relevant To country context in terms of a) prevalence and b) country context
2) Effective a) OVC support well anchored in communities b) Strategic choice of partners c) Selected platform that gave a wide range of actors
Reasons for effectiveness:
• Orphans and Vulnerable children (OVC) apparent in Zimbabwe with Child Protection Committees, local communities recognise their responsibilities at duty bearers to address care issues for children.  Suspect that this was true in Nepal and Ethiopia maybe Uganda
• Selecting an effective partner: Zimb- Ministry of Public Service, Labour and Social Welfare (MLPSSW), district level. Ethiopia with coordinated response – Univ of Gondar,  Nic – MOH and MOE, Nepal: local authorities
• If not entirely apparent from documentation, clear that SC country office had established its reputation as a reliable partner e.g. in Nepal where it was named as a Principal Recipient for GFATM and a Government of Nepal model for piloting a cash transfer programme
• In Ethiopia, ties with Univ. of Gondar and production of toolkit for good practice which were disseminated at an international conference.
• Platform with wide range of central actors:  again in Z: at district level:  district AIDS committee with reps from all sectors.
3) Integration into other thematic areas? Looked at the narrative parts of the reports and the matrices with expected results for other thematic areas. Nicaragua and Uganda: cross- cutting (Uganda – also standalone). Nepal, Zimbabwe, Ethiopia:  standalone. Both advantages and disadvantages:  when integrated into other programs, can get lost. When stand alone, the overall linkages can be overlooked and focus boils down to the “results type” reporting
4) Role & engagement of Civil Society? Difficult to analyse from a document review. In its 2012 reporting to UNAIDS, all countries were expected to complete a National Commitments and Policies Instrument (NCPI).  This tool provides information about the role of CSO, bilateral agencies, and UN organisations in their country´s HIV and AIDS response. This is self-reporting and not all respond. SC would benefit from looking at these when reviewing country programming
5) Policy impact? Again, difficult to analyse from SC documents.  For this review, would have required a different type of review with interviews with wider range of informants in the country´s HIV & AIDS arena.  Or, wider document review of country level documents. Policy impact results from pushes and pulls from many directions, of which SC activities are only one component. Difficult to assess in short period. Some past programming have had policy impact prior to this strategic period (OVC protection program adapted as a national plan of action in Zimbabwe).

Recommendations:  
1. SC should continue HIV programming in high prevalence countries: Important to recognize HIV as an important contextual factor influencing many children’s lives, especially in high prevalence countries. Orphans and vulnerable children must be recognized among the most marginalized children. HIV+ children growing up into adolescence have particular Sexual and Reproductive Health Rights (SRHR) needs. Stigma and discrimination must be recognized and addressed in programming components.
2. Country programming should continue its strategic choice of partners
3. Reporting should focus more on documentation for learning: Available documents give an insufficient picture of breadth and depth of SC´s HIV and AIDS work. Suggest outcome pathways reporting; use ecological model. Programme planning should make greater use of theory of change with emphasis on voice, Innovation,   results at scale, and participation in relation to HIV & AIDS
4. SCN should have an HIV focal person in the other thematic areas to ensure mainstreaming of HIV aspects
5. SCN and country offices should examine programme areas for HIV relevant links: Long list of suggested programming opportunities across education, health and nutrition, child protection and child rights governance in the report.
6. Annual programme planning should continue to be flexible but better document the reasons for changes in focus
7. SCN should find other ways to report on HIV prevention: Prevention knowledge needs to be supplemented with knowledge about health services, voluntary counselling and testing and condoms. Moreover, skills competency for autonomous decision-making and behaviour change for uptake of services and safer sexual behaviour. Use more qualitative reporting, including output results that impact on more than one outcome – but all leading to prevention of the spread of HIV.
8. “Strengthened community capacity” should be defined. Suggested dimensions on which it could be assessed are participation, social networks, involvement in policy-making, problem solving, formal linkages, delivering services, and/or increased trust among individuals and groups.

Follow up:  
A follow-up plan of the HIV response 2010-2013 review is being discussed by SCN Management , and an action plan will be developed and implemented, taking into consideration findings and  recommendations of the report.