Introduction

Contraceptive Requirements and Logistics Management Needs

Training

Coordination and Collaboration

Monitoring and Evaluation

JOICFP-Executed Projects

Centres of Excellence for South to South Cooperation

Safe Motherhood Projects

HIV/AIDS Prevention Interventions

Implementing the Reproductive Health Approach

UNDAF Assessment

In 1998, a major thematic evaluation of UNFPA support to HIV/AIDS-related interventions was completed. The evaluation assessed the relevance, effectiveness, efficiency and sustainability of strategies and modalities of recent UNFPA support. Seven countries — Côte d'Ivoire, the Dominican Republic, Indonesia, Kenya, the Sudan, Thailand and Uganda — and an additional seven specific projects were selected as case studies. The country cases were examined at both the country and project levels. At the country level, the focus was on approaches to integrate support of HIV/AIDS interventions; linkages among projects; programme management; coordination; and programme performance. At the project level, specific strategies and modalities of HIV/AIDS intervention were examined, as were their design, delivery process, performance and sustainability.

The evaluation found that UNFPA has provided effective leadership in some countries, encouraging inter-agency collaboration and influencing government policy and strategies on HIV/AIDS. In addition to interventions aimed at women of reproductive age, UNFPA has developed and funded innovative programmes targeted at young people, sex workers, people living with HIV/AIDS, soldiers and truck drivers. Services and information were delivered through a wide range of channels, including maternal and child health/family planning (MCH/FP) service and information providers, youth centres, condom social marketing, community-based distributors, agricultural extension workers, barbers, peer educators and radio programmes.

The interventions targeting at-risk groups, however, tended to be few and reached relatively few people. Also, baseline studies, performance indicators and cost-effectiveness were seldom taken into account at the design stage to facilitate replication and sustainability. This resulted in missed opportunities to derive lessons for future programming. Attempts to integrate HIV/AIDS components into programmes and projects did not always give due consideration to issues related to human sexuality and gender issues or to potential obstacles to planned interventions. Constraints to effective interventions included the discomfort of service providers and clients in discussing sexual issues, the low status of women, social stigmas concerning condom promotion and use, and fragmented government structures and programmes. The effectiveness of IEC efforts was limited, because they did not necessarily target groups most at risk, nor were they designed specifically to bring about measurable changes in behaviour.

The evaluation found that UNFPA is well positioned within the United Nations system to work on HIV/AIDS prevention, in part because of its long-standing relationships with governments (particularly with health and population ministries). Contributing to the relative strength of the UNFPA position is the Fund's success as a global- and country-level advocate for reproductive health issues. Moreover, UNFPA is viewed as having a comparative advantage in furthering understanding of how HIV/AIDS impacts on women and in developing effective programmes to help them.

Despite these advantages, in the past UNFPA programme development and management had been adversely affected by the Fund's technical and managerial limitations in the area of HIV/AIDS. The evaluation recommended that the awareness of UNFPA staff be raised to ensure that HIV/AIDS prevention is not simply an "add-on" but is integral to UNFPA programming. The Fund needs to build up its technical and programme expertise in relation to HIV/AIDS, the evaluation found, so that it can be more strategic and systematic in its programming. In particular, UNFPA needs to do a better job at integrating HIV/AIDS-prevention activities into reproductive health programmes to meet the needs of women, who are its core constituency. Efforts to empower women to discuss sexual issues, including condom use, must be part of the strategies to protect them against HIV infection.

The degree of UNFPA collaboration with other organizations varied among the countries studied in the evaluation. In this context, the United Nations resident coordinator system's country- level theme groups on HIV/AIDS proved to be a potentially useful mechanism for working with governments to develop and implement more coherent programme interventions. Currently, other donors and NGOs active in HIV/AIDS prevention are not always a part of the theme groups. To strengthen the theme groups' effectiveness, it is necessary to broaden the base of the groups and to move beyond mere information exchange, to joint planning and programming.

The evaluation recommended that UNFPA continue to develop partnerships with other organizations, including those civil-society organizations that have comparative advantages in reaching certain target groups. The Fund should also seek out financial institutions that can provide support to bring pilot attempts to scale.

Logistics management needs to be strengthened, the evaluation found, despite the fact that UNFPA procurement of condoms has increased dramatically in recent years. Condoms are not always distributed to those who are most likely to be infected and most likely to infect others. Also, the fact that condoms offer double protection — from unwanted pregnancy and HIV/AIDS — has not been aggressively promoted. 

Evaluation results were reviewed by the UNFPA Policy and Planning Committee, which decided that UNFPA operations should incorporate its many recommendations. Towards this end, programme advisory notes will be prepared and disseminated to provide practical guidance for future programming.