End of Programme Evaluation Report PLHIV Stand Up for Your Rights! Programme, Trócaire Zimbabwe

Transcription

1 End of Programme Evaluation Report PLHIV Stand Up for Your Rights! Programme, Trócaire Zimbabwe Summary of End of Programme Evaluation (December 2013)

2 1. Background The HIV Programme was a three year programme implemented from October 2010 to September 2013 with funding support from Comic Relief and Irish Aid and technical and grant management support from Trócaire. The broad goal of the programme was to contribute to the promotion, protection and fulfilment of the rights of people (in particular women and girls) living with and affected by HIV and AIDS in Zimbabwe. The HIV Programme was implemented against the backdrop of an unstable socio-economic and political environment in Zimbabwe. During this period, the state social services sector nearly collapsed and people living with HIV (PLHIV) were particularly vulnerable as there were widespread shortages of antiretroviral (ARV) drugs, frequent drug stock outs, critical staff shortages in the health sector and severe food shortages. The evaluation was conducted in line with Trócaire s Field Programme Evaluation Policy. Its main purpose was to assess the extent to which the HIV programme had achieved its objectives and expected outcomes and based on the findings, draw key lessons learnt and recommendations for future programming. 2. Methodology The evaluation adopted a participatory approach where Trócaire and implementing partners, district stakeholders, community leaders and programme participants/target groups participated in the process either as key informants or Focus Group Discussion participants. Trócaire and implementing partners participated in the design of the evaluation framework, development of evaluation tools and the actual data collection process. Quantitative data was analysed using SPSS while qualitative data was analysed using thematic based content analysis. 3. Key Findings Specific Objective 1: To strengthen the 'Voice' of People Living with HIV (PLHIV) for increased influence on issues that affect their lives related to policy, service delivery and law reform. Some of the issues successfully advocated for include: decentralisation of antiretroviral therapy (ART) treatment, improved supply of ART drugs, improved quality of health delivery services, recognition and respect of PLHIV s rights by service providers, reduction in user fees paid for CD4 and other HIV related diagnostic procedures, access to the Basic Education Assistance Module (BEAM) and increased accountability for the AIDS Levy. Specific Objective 2: To contribute to improved health status of People Living with HIV (especially women). The final evaluation established that there were significant improvements in access to health services from the situation at baseline. These improvements included: improved availability of essential drugs with fewer cases of drug stock outs; waiting time for ARVs at clinics decreased from about 8 hours at baseline to less than 30 minutes at some centres; user fees for medical investigations and tests have ~ 2 ~

3 either been reduced or removed in most districts thereby removing a key barrier to accessing treatment; ART literacy significantly improved through intensive trainings resulting in improved adherence. PLHIV reporting good adherence increased from 76% at baseline to 93% at end-term evaluation; and decentralisation of ART services increased the number of PLHIV accessing ART through shortening distances and the reduction in related costs. Through an economic strengthening pilot project, a total of 40 groups, with partners Batanai and the Zimbabwe National Network of People Living with HIV (ZNNP+), were being assisted by the programme to start income generating activities (IGAS) through the internal savings and loans (ISAL) model. The evaluation established that some of the IGAs have performed very well, while others performed below expectations. Specific Objective 3: To reduce the levels of stigma and discrimination experienced by People Living with HIV. Through programme awareness activities and a notable improvement in the health status of PLHIV. The percentage of PLHIV reporting low levels of enacted discrimination increased significantly from 51% at baseline to 87% during the final evaluation. More men (92.8%) compared to women (87%) are experiencing low levels of enacted discrimination. Specific Objective 4: To further the attainment of rights by People Living with HIV through the law. The proportion of PLHIV aware of their rights increased from 70% at baseline to 85% during the final evaluation. A total of 18 cases (5 males and 13 females) have been handled by partners directly benefiting the litigants through the formal court system. These cases involved discrimination of PLHIV, gender based violence (GBV), police corruption, inheritance issues, right to access ARVs by PLHIV, unfair labour dismissal on the basis of HIV status and arrests of women for loitering for the purpose of prostitution. Specific Objective 5: To ensure target communities benefit from the achievement of objectives through improved programme management. There has been significant progress by partners in terms of strengthening capacity on gender mainstreaming. At baseline, all the partners except Diocese of Mutare Community Care Programme (DOMCCP) (75%) scored 50% and below in terms of gender mainstreaming capacity. During the final evaluation three partners scored 100% while Mashambanzou scored 88%, (no gender focal person) and Batanai 75% because their gender policy is awaiting board approval and a focal person has not been appointed. The adoption of gender policies by organisations, coupled with training on gender mainstreaming, has improved internal and external gender mainstreaming. All the partners at baseline scored 71% and below in terms of MIPA 1 implementation. During the final evaluation, all partners scored 100% save for Mashambanzou (92%) and Batanai (95%). 1 The principle of Meaningful Involvement of People Living with HIV and AIDS in all aspects of HIV and AIDS Programming. ~ 3 ~

4 4. Conclusions The programme was found to be highly relevant as it sought to address both the strategic and practical needs of PLHIV and resonated strongly with national legal and policy frameworks such as the New Constitution, National AIDS Policy and the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP). The programme was largely effective, premised on its strategic design that ensured value addition by Comic Relief and Trócaire; strong and complimentary partnerships; involvement, participation and collaboration of key stakeholders at national, district and local levels; capacity strengthening strategy for PLHIV and stakeholders; advocacy strategy and collaboration and cross-learning between implementing partners. Overall, the programme performed very well as it has managed to satisfactorily accomplish its objectives and outcomes which ultimately led to improvements in the health, livelihoods and general well-being of PLHIV. Sustainability potential of the programme is anchored on the design of the programme which empowered PLHIV and local institutions that service them. Future threats to sustainability include voluntarism and lack of adequate financial resources to support the work of volunteer cadres in the communities. 5. Recommendations Close monitoring of partners for both programme and governance issues is very important. Some partners, though strategic, require strong monitoring and evaluation, accountability and governance systems in order for them to fulfil their mandate. Advocacy Strategy: More work needs to be done to promote particularly the rights of groups that have been left behind in the response or marginalised. Advocacy Teams: ZNNP+ needs to have at least one programme officer per district instead of having one officer covering two districts located far apart from each other. The model in Mutare, Masvingo and Gutu, where advocacy teams exist at ward level and feed into district and provincial teams should be expanded to all the programme areas as it has been found to be effective. Role of Zimbabwean Lawyers for Human Rights (ZLHR): ZLHR s overarching role in terms of human rights law awareness creation and litigation requires a change in the partnership model where ZLHR gives strategic support to the other partners instead of playing a direct mobilising and implementing role. Economic Strengthening: IGAs are key in improving the livelihoods of PLHIV and in sustaining programme benefits and activities and hence every effort should be made to ensure expansion of this intervention beyond the pilot phase and success of this intervention. Stigma and Discrimination: Although the programme has been successful in reducing stigma and discrimination, continuous effort, particularly with regard to addressing selfstigmatisation by women is needed to ensure consolidation of gains already made. ~ 4 ~

5 Involvement of children: The initiative taken by the programme to establish support groups for children is commendable and should be scaled up in all the programme areas to ensure that the needs of children living with HIV catered for. A booklet on Rights of PLHIV: There is need for the programme to develop a handy booklet on the Rights of PLHIV for use by PLHIV at community level. Although the handbook will be developed in English, it can be translated to vernacular languages. Research: There is need to expand the scope of research beyond legal issues. Research should also focus on social, economic and political issues that impact on PLHIV s health and livelihoods. 6. Management Response to the Evaluation Overall thoughts on the evaluation Overall the evaluation report was positive and provided a critical analysis of each indicator as well as validated the Year 3 report to Comic Relief that captured both progress and challenges experienced in the programme. The report shows that high levels of empowerment were attained by PLHIV during the lifespan of the programme. Endline measurements indicated that the majority of targets were reached and in some instances surpassed. Where targets where missed, there was progress and results that could still be reported. The report also confirmed the relevance of the programme thematic focus on HIV and Human Rights and the programme contributed to the needs of the target groups as well as the national response on HIV. Summary of recommendations that management is committing to Management accepted the recommendations and agreed that most of them will be taken on board and will inform the development of a new HIV programme. The recommendations include: upscaling the work in the districts we worked in and in new ones as well, upscaling economic strengthening for PLHIV and stigma pieces of work, focus more on advocacy that includes the marginalised groups, research, continue close monitoring of partners and giving them support, linking HIV activities to the new constitution and addressing individual recommendations made to the partners. Much has been learned over the past three years and it is essential to take this learning forward into the new programme. Already the Self Stigma work is growing and expanding based on the learning from this programme. The success of the IGA s has also been well captured and will also be a key area of development as we build on the success of this programme. ~ 5 ~