Here is a year-old annual review report on UNDP HIV prevention and care activities in Myanmar. The Executive Summary and Recommendations are presented below. You will have to download the entire report to read it if the summary interests you.
http://erc.undp.org/evaluationadmin/manageevaluation/viewevaluationdetail.html;jsessionid=6DC1C53FFAE4916EAC66A31CA9DABD0A?evalid=2904
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ENHANCING CAPACITY FOR HIV/AIDS PREVENTION AND CARE
UNDP MYANMAR
TECHNICAL REVIEW
APRIL 2009
Bill O’Loughlin
Consultant
Executive Summary
In 1992 UNDP Myanmar initiated a project to support the long-term goal of slowing the further spread of HIV and to mitigate its social and economic impact. Subsequently in 1994, the Governing Council, in re-directing the UNDP assistance to programmes and projects with grassroots impact, included HIV/AIDS as a priority area of intervention. Thus the HIV/AIDS project, executed by UNOPS, was fully integrated into the grassroots oriented Human Development Initiative (HDI) programme implemented since 1994. There are two major HDI projects addressing community development - the Integrated Community Development Project (ICDP) and Community Development in Remote Townships Project (CDRT).
The project is now on its fourth phase and conducting two major forms of activity – supporting rural communities to undertake HIV/AIDS prevention and care activities and providing support to PLWHA.
The annual UNDP Independent Assessment Missions (IAM) over recent years made recommendations for the HIV project. In response the project made the appropriate adjustments.
In 2004 the IAM noted the changed circumstances since the original project design and recommended sharper focus. So the HIV project concentrated upon building the capacities of the community development workers in the ICDP and CDRT projects to mainstream HIV into community development. A Mid Term Review in 2005 identified ways to strengthen mainstreaming and explore HIV prevention amongst communities.
In 2005 the IAM recognised the progress made in re-designing the HIV project and questioned if it could be combined with the health education components of the ICDP and CDRT and if it should continue separately or be re-organised as a support unit for them. In 2006 a follow up technical review recommended building on current community development strategies by encouraging leadership and engagement of men, women and youth. In response the HIV project developed a community outreach education program in selected HDI villages that included capacity to act upon HIV prevention and mitigation activities. The project also supported the Greater Involvement of People Living with HIV/AIDS (GIPA) by participating in a process that lead to the formation of the national network the Myanmar Positive Group.
The 2007 IAM questioned the prevalence of HIV in the HDI areas and recommended the HIV project widen its coverage and focus on high risk groups and areas (regardless of whether they are within or outside HDI areas), and align activities with other HIV agencies.
The 2008 IAM recommended looking at the comparative advantages in focusing on awareness raising or support of people living with HIV/AIDS, and recommended the project concentrate upon training CDRT and ICDP to take over HIV awareness raising responsibilities in the two project areas and wrap up such activities in other areas, freeing resources for work in peri-urban areas.
As a cosponsor of UNAIDS UNDP is also a member of the UN Joint Team on AIDS in Myanmar which has developed a workplan, the Joint United Nations Programme of Support for HIV (JUNSP), to support the implementation of the National Strategic Plan for HIV and AIDS in Myanmar 2006 – 2010. UNDP has made a number of commitments within this work plan. This is consistent with the role of providing leadership and technical capacity that is expected of UNDP, particularly in the Myanmar context where there are limited organisations working in HIV and major constraints on resources and expertise.
Until now UNDP has concentrated upon delivering services and not given enough attention to its role within the UN Joint Team and to contributing at a national level. Hence, many of the recommendations in this review re-emphasise the commitments that UNDP has already made to the Joint UN work plan and encourages UNDP to make it a priority to implement them. Apart from the contribution they will make to the national response to HIV some of these activities will also have direct flow on benefits for UNDP’s activities.
After piloting various activities exploring integration with CDRT and ICDP as recommended by the IAM the HIV project found that it had not been able to accomplish effective integration. This was due to a range of factors: lack of attention to design and implementation, the need for specialist ongoing support to HIV prevention and community mobilisation activities, the stigma associated with HIV, and the complexity of encouraging behaviour change to prevent HIV infection and transmission. Consequently the HIV project’s major activity now operates in parallel with HDI’S CDRT and ICDP projects.
The rationale for the project’s HIV education activities at rural village level is that HIV vulnerability is due to men becoming infected when they have sex when away as migrant workers and then returning home to infect their wives, and, sometimes, children. Yet, as the IAMs have commented, there remains concern that the project is not operating in locations where HIV is a major threat. Various means have been used to identify priority locations but the project is still unable to ensure it is working in sites that are especially vulnerable to HIV. This is reinforced by the research conducted at project sites where it is unclear if the people have high enough rates of sex outside their relationships and visits to sex workers to warrant them being considered at risk of HIV. The JUNSP contains a proposal to support a study of migration flows and HIV vulnerability and UNDP should participate in this. Possibly it could be conducted in some of the townships where UNDP operates HIV activities. Overall, it should result in the creation of frameworks, assessments, and methodologies to use when identifying locations and designing HIV and migration activities that can subsequently be used by the project.
The HDI project is currently in the process of integrating the projects within it, including the HIV project. There are good signs that, unlike previous attempts, this process can successfully integrate HIV. This will be compatible with spirit of the 2008 IAM recommendation by having HIV more integrated within the HDI model but still recognises that it is not suitable to enact the full recommendation to have the CDRT and ICDP staff take on responsibility for HIV education given the unique and specialist features of effective HIV prevention and education.
Great attention is being given to planning this integration. It will apply at programme and operational levels. It is proposed to create operational structures at township level which would allow for a suitable blend between integration and specialist expertise and capacity. A pilot approach will allow for a staged and adaptive process to explore the most effective way to create and implement this integration. It would be valuable to involve the HIV project staff in all stages of this process due to their prior experience with integration and understanding of the requirements of an effective community based HIV programme.
The HIV project responded to the recommendations from the IAM to broaden involvement, and also complied with its global policy, by supporting People Living wi
th HIV and AIDS (PLWHA). This has mainly been in two forms – support with micro finance and support to the development and mobilisation of PLWHA Self Help Groups (SHGs). The micro finance support occurs both at village level as part of the comprehensive community based response model the project establishes as well as through SHGs which the project has supported to operate income generation schemes. The project has also played a key role in supporting the emergence of the national network of PLWHA, the Myanmar Positive Group, which in a short period has become an impressive advocacy and education organisation. There has been very rapid growth of the PLWHA SHGs across the country and UNDP has played a major role in supporting this and responding to the members needs.
It would be consistent with its role and commitment to date for UNDP to continue this support in three ways. One way would be to support a review of the most effective ways to provide income generation support to PLWHA and their households along with the most effective models to use for supporting micro finance amongst groups of PLWHA. The second activity would be to support a national capacity development assessment of PLWHA Self Help Groups. Thirdly, UNDP should meet with MPG and discuss the ways that it can provide ongoing support to this national network, and, particularly, with staffing, advocacy and operational activities. These three activities complement each other. They would result in a strengthened integrated PLHWA movement at local and national level which meets the needs of its members as well as the globally recognised need for PLWHA to be actively involved in the policy, operational and monitoring response at all levels.
Arising from its work with PLWHA is the need for UNDP to attend to HIV impact mitigation. At national level in Myanmar it is recognised that strategies for minimising the impact of HV upon individuals and their families and social networks have been neglected. With ever increasing numbers of PLWHA this has become a critical issue. UNAIDS and members of the UN Joint Team expect it will be a major issue in the coming mid term review of the National Strategy for HIV and AIDS. Given that UNDP has played a major role in support to PLWHA, and that globally it is committed to impact mitigation, it would be appropriate for UNDP to demonstrate leadership and commission a national study into HIV impact mitigation.
Another area of UNDP responsibility is HIV and the workplace. However, it seems that little attention has been given to committing to project activities in this area and, given the range and extent of other activities that UNDP is already committed to and those recommended in this review, it might be prudent for UNDP to delay activities around HIV in the workplace.
The final area of activity is that of men who have sex with men and HIV vulnerability which has been assigned to UNDP in the UN division of labour. Since this group of men are at high risk of contracting and spreading HIV it is necessary for UNDP to demonstrate national leadership on this topic. Since it is a specialist and complex area to work in it is not appropriate for UNDP to directly conduct activities with these men. Within the country some organisations work with these men already and there has been some national level assessment conducted. UNDP should collaborate with the UN Joint Team to identify what is needed at the national level regarding leadership and strategic planning to respond to HIV and MSM.
Overall, the HIV project has concentrated upon implementing activities. Within that it has not managed to create sufficient expertise in particular models that it can contribute to the national response. Neither has it developed the conceptual and analytic understandings of HIV and Development that it should be providing to other development and HIV partners, nor has it shown the leadership that it expected from UNDP in the Joint UN response and in other ways nationally.
The project is going to need external technical assistance in order to rectify this. Currently, for a range of reasons, it does not have sufficient technical, conceptual and analytic capacity, or sufficient exposure to the epidemic in other settings, to be able to meet the project needs. The project needs to engage this technical expertise to assist those who are managing and implementing the project. It is also essential that the project collaborate closely with the JUNSP, including involving them in identifying the frameworks and terms of reference for studies and technical assistance. In this way UNDP is maximising the expertise available in Myanmar on HIV.
In final discussions with UNDP management at the conclusion of this evaluation it was decided that it was not necessary to attend to one component of the tasks expected in the Terms of Reference – review the project’s results framework and recommend indicators if needed – as the project will use this report to inform a process of consideration and reorientation of the project over the near future.
Recommendations:
• That to develop better understanding of migration and HIV and the associated sexual and injecting risk behaviours UNDP act upon its commitment in the Joint UN Programme of Support for HIV in Myanmar to participate in a review of development needs, migration flows and HIV vulnerability in selected townships identified by the National AIDS Programme lead prioritisation exercise.
• That UNDP act upon its commitment to the Joint UN Programme of Support for HIV in Myanmar to participate in improving understanding of the impact of gender on HIV transmission in Myanmar, particularly through: establishing a National Strategic Plan for HIV and AIDS Technical Support Group Gender Working Group; a gender audit of the Joint Team, the Global Fund CCM, and the UNAIDS Country Office; and a multi-partner gender review of the National Strategic Plan for HIV and AIDS.
• That the UNDP HIV Project involve experienced HIV social scientists in all stages of the design of HIV activities, especially education and prevention, and enable the implementation of well designed and resourced studies that assess the impact of project activities and inform subsequent activities.
• That UNDP commission a review of the most effective ways to provide micro finance support to PLWHA and their households, and the most effective model/s for supporting micro finance capacity amongst groups of PLWHA.
• That, in collaboration with the United Nations Joint Support Programme on AIDS, UNDP takes the leadership in addressing HIV impact mitigation and commission a national assessment of impact mitigation.
• That UNDP discuss with the Myanmar Positive Group the forms of support that UNDP can provide with a focus upon core support to staffing, advocacy and operational activities.
• That UNDP provide support for a national mapping, strategy and action plan to address capacity development of PLWHA Self Help Groups in Myanmar
That, in collaboration with UNAIDS and the Joint Team, UNDP ensures that national level leadership and strategic planning is available to inform an effective response to HIV and MSM in Myanmar.
