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[ Recorded presentation ] Recorded presentation

Increasing the effectiveness of African HIV/AIDS programs: Evidence from an independent evaluation of World Bank support

Martha Ainsworth, PhD, Independent Evaluation Groujp, World Bank, 1818 H Street, NW, Washington, DC 20433, 202-473-4121, mainsworth@worldbank.org

Through mid-2004, the World Bank committed $2.5 billion for prevention, treatment, and mitigation of HIV/AIDS, more than half of it to Africa. The Independent Evaluation Group (IEG) has just completed the first comprehensive evaluation of this support, which yields insights on the performance of national AIDS programs in Africa. The evaluation used multiple methods, documenting the “results chain”, from inputs to outputs, outcomes, and impacts, and it assessed what would have happened without the support. Field work took place in Brazil, Cambodia, Chad, Ethiopia, India, Indonesia, Kenya, Russia, Uganda, and Zimbabwe. The evaluation also assessed the assumptions, design, and implementation of two dozen ongoing projects in the Multi-Country AIDS Program (MAP) for Africa.

Political commitment has risen, institutions have been created, and services expanded. However, the highest risk behavior often has not been addressed. Little is known about the effectiveness of government and civil society responses because of lack of evaluation. The efficacy and efficiency of the MAP approach relies on the guidance of each country's national strategic plan, strong M&E, extra supervision, and the existence of proven, locally evaluated pilot projects. The MAP projects have contributed to increased political commitment and have engaged civil society on a broader scale. However, the projects are complex, national strategic plans are not prioritized, implementation of M&E is weak, supervision is no greater than other AIDS projects, and many activities are being scaled up that have never been evaluated locally. There is a risk that many actors are implementing activities for which they have little capacity, expertise, or comparative advantage, reducing efficacy and efficiency. These projects will be evaluated as they are closed for additional lessons.

The findings point to the need to address high-risk behavior, to evaluate and adapt AIDS institutions to local conditions, and to create incentives for M&E by linking funding decisions to results. Programs can be more effective by: (1) anticipating political obstacles; (2) being more strategic; (3) strengthening institutions for the long-run response; and (4) acting on local evidence. Governments and donors need to show that greater commitment and service delivery are reducing new infections and extending lives.

Learning Objectives:

Keywords: Evaluation, HIV/AIDS

Related Web page: www.worldbank.org/oed/aids/docs/report/hiv_complete_report.pdf

Presenting author's disclosure statement:

Any relevant financial relationships? No

[ Recorded presentation ] Recorded presentation

AIDS Evaluation in Africa: What Have We Learned?

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA