Developing local government capacity for mainstreaming HIV & AIDS:

Transcription

1 Developing local government capacity for mainstreaming HIV & AIDS: Lessons from two interventions by the Department of Cooperative Governance and the South African Local Government Association Final Report

2 Acknowledgements The authors gratefully acknowledge the contribution made by various people: municipal officials, members of the NTT, members of the PTT, provincial service providers who participated in interviews and shared their insights on how the interventions were implemented in provinces, and idea on what can be done to improve future capacity development interventions for mainstreaming HIV and AIDS at local government level. We would also like to thank everyone who attended the learning event on the 5 th of December 2012 for their useful inputs which strengthened the findings, and recommendations of this report. We would also like to express our appreciation to the project steering committee members who were involved from the conceptualization to the final stages of writing this report. We particularly thank Terence Smith and Johanna Strohecker from GIZ, Winnie Dhlamlenze and Mandu Mallane from SALGA for their contribution, feedback and support in every step of the research process. Finally, as the MRC researchers and authors of this report, we wish to acknowledge and thank SALGA and GIZ who se financial assistance made this research possible. 1

3 Table of Contents 1. Background to the study HIV and local government Objectives of the assignment Structure of the report Research Methodology Description of sample municipalities Sampling methods Data collection method Document review Interviews Learning event Limitations of the study Description of the initiatives Training and mentorship capacity building intervention on HIV and AIDS mainstreaming Provincial workshops on HIV and AIDS mainstreaming Reflecting on the outcomes Were the interventions relevant? Were the interventions effective? Were the interventions efficient? What was the impact of the interventions? Are the interventions sustainable? Findings and lessons learnt Paradigm shift on HIV and AIDS in local government The state of HIV and AIDS mainstreaming in local government Capacity to mainstream HIV and AIDS in local government Sustainability of knowledge of mainstreaming in municipalities Change in political leadership and progress in HIV and AIDS mainstreaming Structural issues of mandates between CoGTA and SALGA Monitoring, evaluation and reporting on capacity development initiatives Multi-sectoral action in the HIV response in local government Setting the scene for implementation of interventions

4 5.10 Exit plan in capacity development interventions Recommendations Guiding principles for the design and implementation of mainstreaming training and capacity development interventions Guiding principles to inform municipalities, the beneficiaries of capacity development interventions, on HIV and AIDS mainstreaming Recommendations from the learning event Need for sustained municipal support on mainstreaming Structure of capacity development initiatives Incremental professional training programme for HIV Coordinators Mandate of SALGA on HIV mainstreaming Role of SANAC on HIV and AIDS initiatives Strategies to enforce implementation of mainstreaming in municipalities Conclusion Annexures Annexure 1: List of municipalities trained by CoGTA Annexure 2: List of municipalities trained by SALGA Annexure 3: List of municipalities included in the review Annexure 4: List of interviews conducted Annexure 5: List of participants in the Learning event Annexure 6: List of possible roles of SALGA in HIV mainstreaming in the future as suggested at the Learning event

5 List of Abbreviations and Acronyms AIDS - Acquired Immune Deficiency Syndrome CMRA - Centre for Municipal Research and Advice CoGTA - Department of Cooperative and Traditional Affairs DAC - District AIDS Council DPLG - Department of Provincial and Local Government DPLG Framework Framework for an Integrated Local Government Response to HIV and AIDS GIZ - Deutsche Gesellschaft für Internationale Zusammenarbeit Handbook Handbook for Facilitating Development and Governance Responses to HIV and AIDS DPLG INCA and MRC HIV - Human Immunodeficiency Virus LAC - Local AIDS Council MRC - Medical Research Council NSP - National Service Provider NTT - National Task Team OECD - Organisation for Economic Co-operation and Development PEPFAR - President's Emergency Plan for AIDS Relief PTT - Provincial Task Team PSO - Provincial SALGA Offices PSP - Provincial Service Provider PCA - Provincial Council on AIDS SALGA - South African Local Government Association SANAC - South African Nation AIDS Council SCG - SALGA Country Guideline SDBIP - Service Delivery and Budget Implementation Plan SLGP - Strengthening Local Governance Programme 4

6 STI - Sexually Transmitted Infection TB - Tuberculosis 5

7 1. Background to the study 1.1. HIV and local government In line with the developmental mandate stipulated in the White Paper for Local Government (1998) and Section 153 of the Constitution (1996), municipalities are expected to respond to HIV and AIDS as a developmental issue. Municipalities are expected to consider and respond to the impact of HIV and AIDS as an employer of municipal staff and as a provider of services to communities infected and affected by HIV and AIDS. Municipalities have engaged in a number of responses to HIV and AIDS. Reviews conducted by the former Department of Provincial and Local Government (DPLG), now the Department of Cooperative Governance and Traditional Affairs (COGTA), highlighted that municipalities were at that time beginning to identify HIV and AIDS as an issue that needed a municipal response, but only a few were able to integrate the implications of HIV and AIDS into their core business of developmental local governance (COGTA, 2007). The Framework for an Integrated Local Government Response to HIV and AIDS was developed and rolled-out by the DPLG in 2007 with the aim to guide municipalities on how to respond effectively and appropriately to HIV and AIDS. The Framework is based on a mainstreaming approach with HIV and AIDS seen through a development and governance lens. Mainstreaming as an approach to HIV and AIDS requires municipalities to analyse how HIV and AIDS impacts on themselves as an organisation and on their core work, currently and in the future. It means that municipalities have to determine how they can respond in terms of their core work and with their comparative advantages (DPLG, 2007: 14). The Handbook for facilitating development and governance responses to HIV and AIDS was developed by INCA Capacity Building Fund and the Medical Research Council as a resource which was adopted by DPLG. It was intended as a resource to assist local government practitioners in implementing the Framework. In 2008, the former DPLG subsequently embarked on providing hands-on capacity development support to pilot municipalities in three provinces to mainstream HIV&AIDS using the Framework and Handbook. The South African Local Government Association (SALGA) developed the Country Guidelines on HIV and AIDS for Local Government in 2008 which outlines the role of local government in the national response to HIV and AIDS. SALGA also initiated a subsequent intervention in the remaining six provinces. This report focuses on a review of these two interventions. 1

8 The National Strategic Plan (NSP) on HIV & AIDS, STIs and TB ( ), launched in December 2011, highlights the mainstreaming of HIV and AIDS as well as its gender and rights-based dimensions into the core mandates of all government departments and SANAC sectors. The NSP states that government at national, provincial and municipal level has a critical role to play in addressing the social, economic, and structural factors driving HIV and TB i. The Guidelines for Gender Sensitive Rights Based HIV&AIDS, STI s and TB mainstreaming into public administration and public services were developed by the Department of Public Service and Administration (dpsa) to assist national and provincial government departments in the implementation of the NSP. The goal of the guidelines is to increase the capacity of departments to develop HIV & AIDS through mainstreamed operational plans that are gender sensitive, and rights-based ii. New SANAC guidelines, on the role of structures such as the district and local aids councils, are in development and at the time of writing in December 2012, they were not yet finalised. The extent, to which these new guidelines will impact on capacity development for HIV mainstreaming in municipalities, is unknown. 1.2 Objectives of the assignment The aim of the assignment was to document, assess outcomes and to capture lessons learnt from the CoGTA and the SALGA interventions (introduced above) which focused on developing municipal capacity to mainstream HIV and AIDS. The specific objectives are as follows: Describe the CoGTA ( ) and SALGA ( ) municipal capacity development initiatives on HIV and AIDS mainstreaming Assess the outcome of each of the two CoGTA and SALGA municipal capacity development initiatives on HIV and AIDS mainstreaming Draw lessons learnt from implementation of the two CoGTA and SALGA municipal capacity development initiatives on HIV and AIDS mainstreaming Make recommendations that can be used to inform and benefit future capacity development initiatives on HIV and AIDS mainstreaming in local government 1.3 Structure of the report This report has been organised according to the objectives of the assignment into the following sections: Section 1 provides the background on why local government should respond to HIV and AIDS, including an indication of the legislative frameworks that inform local government responses to HIV and AIDS in South Africa. It also outlines the objectives of the assignment and explains the structure of the document. 2

9 Section 2 outlines the research methodology used in this study to document and review implementation of the two CoGTA and SALGA capacity building initiatives on HIV and AIDS mainstreaming in local government. Section 3 describes the two capacity building initiatives on HIV and AIDS mainstreaming that were implemented by CoGTA and SALGA in local government in Section 4 provides the review of the outcome of the two capacity building initiatives implemented by CoGTA and SALGA on HIV and AIDS mainstreaming in local government during Section 5 presents the findings and lessons learnt during implementation of the two capacity building initiatives by CoGTA and SALGA on HIV and AIDS mainstreaming in local government in Section 6 outlines recommendations that can inform and benefit future capacity building initiatives on HIV and AIDS mainstreaming in local government. Section 7 presents the recommendations from the consultative learning event set up to discuss the findings of the study. 2. Research Methodology This section focuses on the research methods used in this study to document and review implementation of the two COGTA and SALGA capacity building initiatives on HIV and AIDS mainstreaming in local government Description of sample municipalities The research was carried out over a period of three months, between September and December A sample of ten municipalities was included in the review covering both CoGTA and SALGA capacity development initiatives (See Table 1 for list of municipalities). Municipalities were selected to ensure that all three category municipalities are included, namely metropolitan, district and local municipalities. Out of the 10 municipalities included in the sample, 3 municipalities were visited and interviewed face to-face (refer to highlighted municipalities on the list). Municipality Gert Sibande District Municipality Nelson Mandela Metropolitan Municipality Albert Luthuli Local Municipality Victor Khanye Local Municipality Capricorn District Municipality City of Cape Town Randfontein Local Municipality Emadlangeni Local Municipality Msunduzi Local Municipality Joe Gqabi District Municipality Intervention CoGTA CoGTA CoGTA CoGTA SALGA SALGA SALGA SALGA SALGA Table 1: List of municipalities in the review with shading indicating that that they were visited during the study 3

10 2.2. Sampling methods Three methods were used to select participating municipalities included in the review and documentation. The first method involved drawing on the experience of actors directly involved in the CoGTA training (the three provincial service providers) to suggest municipalities that they think should be included based on their engagement and what they observed. They were also requested to motivate why those municipalities should be included. One of the conditions given to service provider to guide the recommendation process was that they needed to ensure that they select both municipalities that were doing well and those that struggled with mainstreaming HIV and AIDS to ensure that lessons can be learnt from both. A list of suggested municipalities from each of the service providers was then screened by the Steering Committee (established to guide this study s review and documentation process) to ensure that they met the criteria described in section 4.1. A total of five municipalities were selected through recommendation by the provincial service provides. s were then sent to municipalities from the remaining provinces to ascertain their interest in participating in the review process. Four municipalities ed back and requested to participate. The self-selected municipalities were also screened by the Steering Committee to ensure they met the criteria - all four were included in the study. There was an outlier municipality that was selected by the Steering Committee based on a different method. This municipality was selected in order to track one area on the sustainability of knowledge on HIV and AIDS mainstreaming. The IDP Manager of this municipality was one of the provincial service providers during the time when the interventions were implemented. He is now working for the KwaZulu-Natal province, and was a service provider for Free State province Data collection method Data collection for the review and documentation process involved reviewing available documents developed at the time when the initiatives were implemented as well as interviews with a wide range of stakeholders involved in the two initiatives in their different capacities. Documents were reviewed as a first step towards addressing the objectives of the study and to also inform interviews with respondents. The interviews were not only used as a method for collecting new data, but also as a platform to clarify some of the things that were not clear from the documents reviewed. A tool in line with the objectives of the review was developed to guide the data collection process. This was assessed and approved by the Steering Committee. 4

11 2.4. Document review A range of documents was accessed from the service providers, CoGTA, SALGA and GIZ and reviewed (See Annexure 4). The document review included provincial training reports, mentorship workshop reports, meeting reports, monitoring and evaluation tools, quarterly reports, provincial workshop reports, financial reports and presentations from provincial meetings held by service providers. It was observed that different formats were used by the provincial service providers to develop provincial reports. Some reports were more detailed than the others providing all the necessary information to understand how the initiatives were implemented. However, this was not the case in others. We recommend that future capacity development initiatives should develop standard reporting templates that can help guide those responsible for reporting, especially when there is more than one person responsible Interviews A range of interviews was undertaken with stakeholders involved in the conceptualisation and implementation of the two capacity development initiatives under review. Some of the interviews were conducted telephonically and others face-to-face. Key informant interviews were conducted with stakeholders, namely national service provider, provincial service providers, members of the provincial task team, and representatives from SALGA provincial offices. In addition, semi-structured interviews were conducted with municipal practitioners from the sample municipalities. At least one municipal practitioner was interviewed from each municipality and many were HIV Coordinators and Special Programme Unit Managers with IDP Managers only interviewed in a few municipalities. There were cases where two practitioners from one municipality were interviewed, but this was guided by the first interview. This strategy was used when the first interviewee could not answer some of the questions and recommended that we speak to somebody else to get the information required. A focus group interview was conducted with some members of the NTT since not all were available at the time when the initial focus group took place. The NTT was at the heart of the initiatives and had representation from both SALGA and CoGTA who were then also the main drivers of the initiatives. The rationale behind the focus group was so that people could reflect and remind each other what and how the initiatives were implemented, what successes and challenges were encountered as well as how they were addressed. Many of the respondents struggled to think back in time to when the initiatives were implemented reiterating the time past explaining that some of the things are no longer in their memory. It is therefore important that the review and documentation process is undertaken at least within the 5

12 first six months after implementation when people s memories are still fresh and able to provide rich data. The data collected was analysed with the aim to draw lessons learnt and make recommendations that can be used to inform future implementation of capacity development initiatives Learning event SALGA hosted a learning event on the 5 th of December 2012 to present the findings in the draft report of the research. The learning event also presented the opportunity to add to and enrich the recommendations of the research. Invitations were sent out to a wide audience which included municipalities, government departments (national and provincial) including COGTA (national and province), SANAC, PCAs, researchers, development agencies, SALGA (national and province) and PTT members involved during implementation of the interventions. For a list of participants refer to Annexure 5 attached. The objective of the learning event was to share with participants the findings, lessons learnt and recommendations from the research; to give participants a platform to comment and make inputs on the recommendations and lessons learnt based on what was shared with them as well as to engage on a discussion on how to take the recommendations of the report forward. Although smaller than expected, the participants on the day made valuable contributions and recommendations that can help inform future capacity building initiatives on mainstreaming, presented in section 7 of this report. In addition, participants suggested roles that SALGA can play in taking forward the mainstreaming agenda in local government (See Annexure 6) Limitations of the study The study was limited by inadequate and dated records. Another limitation was access to individuals that took part in the interventions since they had either moved on or up within the municipality, to other municipalities to then to other spheres of government. Further, the small sample of municipalities selected as well as the time lapse between the CoGTA interventions and the review limits the representativeness of the findings. 3. Description of the initiatives This section focuses on the two municipal capacity development initiatives ( ) on HIV and AIDS mainstreaming implemented by CoGTA and SALGA between 2008 and There were two capacity development interventions, the first implemented by CoGTA national office and thereafter a second by SALGA national office, set up after CoGTA experienced internal restructuring 6

13 affecting the continuation of implementing the capacity development initiative. The implementation of the CoGTA intervention received technical support from the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) Strengthening Local Governance Programme (SLGP) and SALGA. While both interventions implemented were on HIV and AIDS mainstreaming in local government, the implementation models undertaken by the two organisations (CoGTA and SALGA) differed, with each having valuable lessons that can help inform future capacity building interventions on HIV and AIDS mainstreaming Training and mentorship capacity building intervention on HIV and AIDS mainstreaming After the Framework was developed, CoGTA with technical support from GIZ-SLGP and SALGA, provided hands-on capacity development support in three provinces in South Africa to selected municipalities during : Eastern Cape (Joe Gqabi District Municipality) and its local municipalities, and Nelson Mandela Metro), Free State (Lejweleputswa and Motheo District Municipalities and their local municipalities) and Mpumalanga province (Nkangala and Gert Sibande District Municipalities and their local municipalities). The three provinces were selected as pilot provinces and the selection criteria was guided by CoGTA s prioritisation of provinces, those with high HIV prevalence at the time and an expression of interest by the provinces to participate in the study. The train the trainer approach was used to implement the intervention in the three pilot provinces through service providers. The service providers were trained on HIV and AIDS mainstreaming using the Framework for an Integrated Local Governance Response to HIV and AIDS and the accompanying implementation tool - the Handbook for Facilitating Development and Governance Responses to HIV and AIDS- while at the same time also receiving training in facilitation methodologies that they were expected to use to in turn train municipalities. The service providers were trained by a national service provider, the Centre for Municipal Research and Advice (CMRA), and where then tasked to train selected municipal officials (HIV Coordinators and IDP Managers) who in turn were expected to then train others in their municipality on HIV and AIDS mainstreaming (SeeTraining Organogram: Figure 1). 7

14 National SP (National taskteam Provincial SP (provincial task - team) HIV Coordinator IDP Manager Sectors within their municipality Other municipalities Sectors within their municipality Figure 1: Training Organogram Other municipalities In each of the three provinces a provincial service provider was selected and appointed by CoGTA on a one-year contract and trained by the NSP to implement the intervention. The conditions of appointment as a service provider included that they had to be based in that province to ensure sustainability of local knowledge and capacity on the concept of mainstreaming. However, in the course of the implementation it emerged that not all the service providers were based in the province they were assigned to. The service providers were required to undertake two tasks: (1) To train municipalities on how to mainstream HIV and AIDS, and (2) to provide ongoing mentorship to HIV Coordinators and IDP Managers as the targeted beneficiaries of the intervention for the duration of the contract period of their appointment. The selection of these two specific functions within the municipalities was based on an understanding that firstly, HIV Coordinators are the focal persons dealing with day-to-day activities on HIV and AIDS issues in municipalities and that secondly, the integrated development planning process coordinated by the IDP manager is the corner-stone for mainstreaming HIV and AIDS in local government. However, other municipal practitioners and councillors also participated in the training, such as Members of Mayoral Committees, Human Resources Officers, and Transversal Managers. 8

15 One national and three provincial task teams were established to oversee the process and to support the service providers during the implementation process. The National Task Team (NTT) had representation from the CMRA, Medical Research Council (MRC)/ WITS University, SALGA, CoGTA and GIZ. The NTT was a reference group to the national CoGTA Equity and Development Directorate and responsible for guiding the overall implementation process in all three provinces. While the Provincial Task Teams (PTTs) were different from one province to another, general representation included members from SALGA province, CoGTA province, Provincial AIDS Council (PCA), Office of the Premier and selected municipalities. PTTs were responsible for supporting and monitoring the service provider in the province, as well as reporting provincial progress on the implementation process to the NTT. The quality of training and mentorship provided by the three service providers varied across provinces. The training and mentorship process went well in municipalities that were trained and mentored by a service provider that had expertise and knowledge on HIV and AIDS mainstreaming and was also familiar with the local government environment. In such cases, the service provider was able to deal with and resolve challenges encountered during the implementation process, even without the intervention of the PTT - for example finding ways and strategies to obtain political buy-in. Each pilot province was also allocated a President's Emergency Plan for AIDS Relief (PEPFAR) funded intern to provide additional support. While the interns were helpful in some provinces, there were challenges experienced in provinces where the expectations were too high especially when considering the level and capacity of the interns. In certain instances, the expectations of the interns exceeded their capacities and this created frustration between them and some members of the PTT who then felt that the interns were not helpful. Some of the activities that were undertaken by the service providers in provinces included conducting orientation meetings with senior managers and political leaders to introduce the project, training sessions with HIV Coordinators and IDP Managers, exchange visits between municipalities to share experiences, site visits by the service provider to support the HIV Coordinator and IDP Manager in preparation of departmental plans as well as participation in IDP Forums to advocate for HIV and AIDS mainstreaming. These activities yielded a number of promising outputs and outcomes which included a commitment by IDP Managers to integrate HIV mainstreaming in the following year s IDP, some directorates managed to integrate HIV and AIDS mainstreaming into their Service Delivery and Budget Implementation Plan (SDBIP), district action plans to mainstream HIV and AIDS were also developed in some municipalities. HIV and AIDS budget allocation were also drafted and meant to be presented to 9

16 senior officials by the HIV Coordinators and IDP Managers. The promising outputs and outcomes that were anticipated required long-term monitoring, which was outside the scope and timeframe of the service providers as they were only appointed for a one-year period Provincial workshops on HIV and AIDS mainstreaming After the CoGTA intervention was rolled out in the 3 provinces, some provinces (namely Western Cape, North West and Limpopo), which were not part of the pilot provinces, sent letters to SALGA National requesting that the project be rolled out in their provinces as well. The restructuring process that took place within CoGTA during 2010 however, disrupted the intended process of expanding the roll-out to the remaining provinces. A number of institutional changes were made within CoGTA affecting the Equity and Development Unit that was driving the pilot process in the three provinces where the CoGTA intervention was implemented. The restructuring process impacted negatively on the conclusion of the pilot and subsequent implementation of the CoGTA intervention in the six provinces that were not included in the pilot. SALGA proposed to continue the initiative in a revised format by introducing the non-pilot provinces to the concept of HIV and AIDS mainstreaming and this proposition was well received by CoGTA who also participated in the initial stages of the process. Building on the lessons learnt during the CoGTA pilot process, SALGA undertook to implement sensitisation workshops on HIV and AIDS mainstreaming in the other six provinces: Western Cape, Northern Cape, North West, Limpopo, Gauteng, and KwaZulu-Natal. Two-day workshops were undertaken in each of the provinces during The target beneficiaries in the SALGA intervention included Councillors and municipal officials strategically positioned to lead HIV and AIDS mainstreaming in their municipal initiatives. These are the IDP Managers, HIV and AIDS Coordinators or Transversal Managers/Coordinators, Members of Mayoral Committees responsible for either community or social development, including as well any other portfolio wherein HIV and AIDS related work is located in the participating municipalities. Municipalities were requested to send at least three representatives, each from one of the specified portfolios. The targeting of the aforementioned role players was informed by two key factors that were defined as critical during the pilot process in three provinces: (1) Awareness that mainstreaming is an institutional process that should involve everybody in the municipality, as opposed to being a departmental responsibility. (2) There was also an understanding that mainstreaming HIV and AIDS requires political support and leadership in creating a mainstreaming friendly environment that allows for implementation of HIV and AIDS mainstreaming activities. 10

17 The SALGA service provider was appointed for a 1 month period, with days spread across the two year process to implement the SALGA intervention through conducting two day provincial workshops in each of the six provinces. The short duration that the service provider spent implementing the intervention in each province meant that none of the six provinces received the ongoing hands on support that was provided to pilot provinces through the CoGTA intervention. While this has a number of negative implications in terms of the quality of support provided, the SALGA model was more cost effective. The SALGA intervention was implemented using minimal human resources compared to the CoGTA intervention since the service provider was only supported by the SALGA national office and the SALGA provincial offices to conduct the provincial workshops. While the two municipal capacity development interventions on HIV and AIDS mainstreaming were implemented through different models (breadth vs. depth), valuable lessons were learnt from each and are highlighted in the latter sections of the report. In the SALGA initiative, presentations based on the content of the Framework and Handbook were made by the service providers to introduce participants to the HIV and AIDS mainstreaming related concepts and approaches. The presentations were followed by question and answer sessions to clarify mainstreaming related issues that were raised during the workshops. Provincial workshops also provided a platform for municipalities to share experiences on mainstreaming HIV and AIDS in their municipalities, including challenges they face in carrying out general special programmes such as HIV and AIDS. The outcome of the provincial workshop included a self-report by the participants which, when analysed, expressed that the workshops deepened their understanding of the concept of mainstreaming as a strategy to respond to development challenges and that the workshops further raised their interest on HIV and AIDS mainstreaming. There was also a commitment from the beneficiaries that they will convey the message and lessons learnt back to their institutions. 4. Reflecting on the outcomes This section reflects on the outcomes of the two capacity development initiatives on HIV and AIDS mainstreaming by using the Organisation for Economic Co-operation and Development s (OECD) five criteria for the evaluation of development programmes. The criteria explore the relevance, effectiveness, efficiency, impact and sustainability of the interventions. 11

18 4.1. Were the interventions relevant? Relevance of the content: The interventions implemented are in line with the local government legislative framework of developmental local government and were prepared to respond to the recognition of a widespread inadequate response of municipalities to the developmental factors associated with HIV and AIDS. HIV with TB remains a major contributor to the national burden of disease, especially considering premature mortality. Morbidity and death of those in the potentially economically active and reproductive age group has a number of developmental impacts that can be prevented and mitigated through targeted strategies. At the time that the interventions were developed and implemented, the ANC antenatal prevalence had stabilised in the country at between 29% and 30% iii ; although the prevalence varied widely between and within provinces and districts. As a result municipal plans and responses needed to be appropriate to the local context and one standard formulaic guideline to help municipalities would thus not be appropriate. The intervention should be correctly aimed to build the capacity of key actors in municipalities so as to mainstream HIV responses into all sectors plans. Relevance of the implementation approach used in the intervention: The intervention was implemented in response to the findings from the internal reviews conducted by CoGTA showing that municipalities needed guidance in responding to HIV to be able to fulfil the envisaged developmental local government model. Setting up a training intervention to address directly the seemingly abstract nature of the issue mainstreaming HIV and AIDS -allowed participants to move beyond assumptions used and acknowledged the importance of learning through doing under the support of service providers. The review has shown that the SALGA approach was not sufficiently geared to the needs of the municipalities. The workshops provided did not fulfil all the needs of municipalities as they expressed that the training was not enough Were the interventions effective? The intervention by CoGTA was initiated with a set of monitoring and evaluation tools developed by CMRA, the national service provider for CoGTA, working together with the NTT. These were not used for reporting by the service providers because they did not know that the tools were available. As a result it is not possible to assess the extent to which there was a post training change from the baseline review undertaken by CMRA for the NTT/ CoGTA. However, judging from the activities undertaken during the implementation process, the objectives of training, mentoring and sensitising municipalities on how to 12

19 mainstream HIV and AIDS in local government were achieved. The objectives were however, achieved outside of the anticipated time-frame. The pilot process took longer than projected due to challenges experienced by CoGTA in setting-up provincial task teams and in appointing provincial service providers. The review has shown that a mind-shift has been achieved in participants in some of the participating municipalities in terms of knowledge and understanding of the role of local government on HIV and AIDS and what mainstreaming HIV and AIDS is about. The knowledge and understanding did however, not always translate through to implementation in HIV mainstreaming in the IDP and sectors. While some municipalities have started mainstreaming, some are still planning to mainstream HIV and AIDS. There is an opportunity to monitor the effectiveness in the long term through the use of carefully selected indicators e.g. how the IDPs refer to HIV before and after the interventions. 4.3 Were the interventions efficient? The pilot process was definitely a learning curve for all parties involved in the project. One of the lessons learnt was that while pilots are important to inform the next step, they can be costly both in terms of time and resources. Significant human resources were invested in the CoGTA model of training and mentorship especially when compared to the SALGA model of provincial workshops. Through the support of GIZ through the SLGP programme, substantial funding was invested in the CoGTA model, with nearly R invested in covering the cost of time spent by the national service provider in preparation for the pilot, including developing monitoring and evaluation tools and the training framework as well as the training of provincial service providers. In addition, there were the costs of the three provincial service providers who were contracted by CoGTA for a one-year period and other expenses accumulated in setting-up workshops to establish and formalise provincial task teams, orientation workshops, strategic planning and assessment meetings, training workshops and other expenses. While the CoGTA model ensured that municipalities had mentorship support in implementing what they were trained in, the SALGA model of provincial workshops was more resource efficient. Lessons from these two approaches should be used to inform an intervention that is both resourceefficient and effective, incorporating targeted ongoing support (missing from the very cost efficient SALGA two-day workshops). 4.4 What was the impact of the interventions? Positive changes resulted from the intervention in some of the municipalities. Municipalities and provincial practitioners involved in the process have become more sensitive to HIV and AIDS mainstreaming in local government. While there are still implementation challenges experienced by 13

20 beneficiaries in some municipalities, they now know how to act or, in other words, how to mainstream HIV and AIDS. A major constraint in mainstreaming HIV at a municipal level has been the lack of a driver both in terms of the human resource post as well as the recruited and trained warm body. The review found that HIV and AIDS focal persons have been appointed as the initial step towards integration of HIV and AIDS issues in some municipalities and discussions to make some of those positions permanent are ongoing. From the interviews it emerged that there are some HIV Coordinators who still incorrectly interpret mainstreaming as requiring a separate budget and had success in their motivation to allocate budgets for HIV and AIDS programmes. This indicates a need for ongoing support and reinforcement of the underlying principles and approach. It was impossible to measure any change in the HIV prevalence or incidence because that would require long term monitoring. 4.5 Are the interventions sustainable? The envisaged CoGTA model of appointing service providers who can then be used by the province to continue providing training support on HIV and AIDS in the respective provinces did not materialise as envisaged. None of the three service providers have been approached to undertake HIV and AIDS mainstreaming training in the provinces that they supported. The sustainability of the HIV mainstreaming initiative has also been undermined by structural factors. The limited capacity in the provincial departments that became apparent during the roll-out in the three provinces is now exacerbated by the redeployment of the national CoGTA Equity and Development Directorate team who coordinated and drove the CoGTA intervention. In the absence of an ongoing national departmental initiative, SALGA has played an important role in ensuring that the other six provinces were able to benefit to some extent from the materials developed for the DPLG intervention. The intervention s results and effects are now invested in those who were trained. With high staff turnover in municipalities and competing demands placed on HIV coordinators, there is a need for ongoing training and support. At present the lack of profile given to HIV and AIDS mainstreaming politically and the absence of a national department invested in HIV and AIDS mainstreaming in municipalities does not bode well. This, despite the National Strategic Plan on HIV & AIDS, Sexually Transmitted Infections (STIs) and Tuberculosis (TB) , clearly identifying the need for HIV and AIDS specific responses in all departments and at all levels in government. 14

21 5 Findings and lessons learnt This section presents the findings and lessons learnt from the documentation and review process of the two capacity building initiatives implemented by CoGTA and SALGA on HIV and AIDS mainstreaming in local government ( ). Section 5 starts by presenting a summary table that describes the two initiatives that were implemented by CoGTA and SALGA before the findings and lessons learnt are then presented. CoGTA SALGA Rationale for the intervention To build municipal capacity to respond to HIV and AIDS through HIV and AIDS mainstreaming approach in three pilot provinces with the view to modifying the interventions for national roll out. To sensitise remaining six provinces on HIV and AIDS mainstreaming in local government, after CoGTA experienced internal restructuring challenges and could not continue with the roll out in non pilot provinces. Resources used Framework, Handbook Framework and Handbook Nature of the intervention Table 2: Summary table describing the two capacity building interventions on HIV and AIDS mainstreaming Who implemented the intervention? 3-day training workshops X2 in Mpumalanga, including one-year mentorship of municipalities. 3-day training workshop in Eastern Cape, including a one-year mentorship of municipalities. 2-day training workshop X3 in Free State, including one-year mentorship of municipalities. CoGTA with technical support from GIZ- SLGP, SALGA and support from the provincial service providers, NTT and PTTs. 2-day provincial workshops run in six provinces (Western Cape, Northern Cape, North-West, Gauteng, KwaZulu-Natal and Limpopo) by a national service provider who had been one of the provincial service providers in the CoGTA pilot intervention. SALGA with support from service provider, SALGA provincial offices and CoGTA during early phase of implementation. Who was targeted? HIV Coordinators and IDP Managers. IDP Managers, HIV and AIDS Coordinators or Transversal Managers/Coordinators, Members of Mayoral Committee responsible for community or social development, as well as any other portfolios wherein HIV and AIDS related work is located. Who participated? Targeted selected municipalities in pilot provinces: Free State Eastern Cape, and Mpumalanga (See list of municipalities attached as Annexure 1). All municipalities from the remaining six provinces were invited to attend. (See list of municipalities attached as Annexure 2). National and provincial reference groups: National Task Team, and 3 Provincial Task Teams. Duration of training? Duration of support? Training and one year mentorship of 2 day workshops in each of the 6 provinces 15

22 selected municipalities by service providers. Who drove it? CoGTA SALGA Who funded it CoGTA and GIZ-SLGP SALGA Role of SALGA? NTT member supporting CoGTA. Lead agency, getting political by-in/ support. Role of CoGTA Lead agency supported by NTT. CoGTA supported the initial implementation process of the SALGA intervention, but were not involved until the end Paradigm shift on HIV and AIDS in local government One of the successes of the interventions is that municipalities are now thinking differently about HIV and AIDS. While this varies across the municipalities included in the review, there is a broader recognition of the social and developmental drivers and impacts of the epidemic. In the interviews municipal officials now recognise the developmental implications of HIV and AIDS as well as the coordinating role of local government in the HIV and AIDS response advocated in the Framework. While the Municipal Systems Act (2000) advocates for integrated development planning in municipalities and introduced an IDP as a strategic vehicle for integration; incorporation of HIV and AIDS in IDPs remains a challenge for most municipalities. In most IDPs, HIV and AIDS is only identified as a priority issue in the situational analysis section, with no strategies and projects to address the issue later on. Many other IDPs have HIV and AIDS appearing only in the health section of the document, with programs that focus more on prevention and treatment and very little on impact mitigation. There are very few IDPs in which the drivers and consequences of the HIV epidemic are well discussed. What became clear is that what is known and understood about the social drivers and consequences is not always reflected in IDPs. Lesson learnt: IDPs are not always a true reflection of how municipalities think about HIV and AIDS and that what they think and how they respond is not always included in the IDP. 5.2 The state of HIV and AIDS mainstreaming in local government Municipalities are at different levels of knowledge, understanding and implementation of HIV and AIDS mainstreaming. The municipalities can be grouped according to three categories: The first category: Those municipalities that know about the concept of mainstreaming, with HIV responses that only focus on internal mainstreaming of HIV and AIDS. They are only concerned with HIV and AIDS as it involves the municipal staff. HIV responses implemented by this group include awareness 16

23 campaigns, VCT, providing treatment and support usually undertaken as once-off or twice a year events. Workplace HIV and AIDS policies have played a critical role in ensuring that municipalities comply with internal HIV and AIDS mainstreaming. Over a third of the municipalities included in the review fall under this category. The second category: Municipalities that go beyond internal mainstreaming and start external HIV and AIDS mainstreaming in their work, but without a conscious awareness. They are still struggling to get other sectors involved and express the need for sensitisation programmes that target all municipal officials. The third category: Municipalities integrating HIV and AIDS into all aspects of their work in the municipality. They have established structures that have representation from all service departments in the municipality and civil society. The coordination of structures varies from one municipality to another, where in some the structures are coordinated by the District AIDS Council, municipal health departments or in others by the Office of the Mayor. The process has been a struggle to get where we are, we had to fight and knock on the doors that were closed, and convince people to see the importance in addressing HIV holistically. We had to even make a gardener see the value of putting a poster with an HIV and AIDs message in his garden for people to see as they walk pass. The good thing is that we had the support and commitment of our Mayor who was very much involved and even chairing the District AIDS Council. He was well informed of the depth of the HIV challenge, the statistics for our district, and the need to respond with urgency (HIV Coordinator, District Municipality, 9 November 2012) Lesson learnt: Internal HIV and AIDS mainstreaming is a dominant municipal response in local government. Only a few municipalities, especially metro s and some districts are doing external mainstreaming of HIV and AIDS. The majority of municipalities that are struggling to do external mainstreaming of HIV and AIDS are small municipalities. 5.3 Capacity to mainstream HIV and AIDS in local government A key issue, raised repeatedly by the respondents, was a lack in the capacity needed to mainstream HIV and AIDS in municipalities. Some of the municipalities are still without an HIV Coordinator. The HIV Coordinator positions remain vacant mainly in local municipalities, for whom filling the post is not a priority. 17

24 As a district we struggle to work with municipalities that do not have Coordinators. You also find that such municipalities are silent on HIV issues, and do not even have functioning LACs because one of the roles and responsibilities of HIV Coordinators is to coordinate the LACs, if they are not there, either the LAC does not exist, or does not function (HIV Coordinator District Municipality, 24 October 2012). Some municipalities have transversal focal points responsible for all equity considerations. In such cases one typically finds that HIV and AIDS issues are only addressed in preparation for World AIDS Day and not as a year round priority. The junior status of HIV Coordinators was also raised as a concern requiring attention. There was a general sense that HIV Coordinators do not have the authority or confidence necessary to suggest the mainstreaming related changes in the municipality. In general, some respondents were not convinced that HIV Coordinators are the right people to facilitate the process of HIV mainstreaming in municipalities. HIV Coordinators in municipalities are very junior, some of them don t even have grade 12 and know nothing about HIV in local government. They couldn t even make an input during the provincial meetings that we had with them. They used to come to meetings because they were sent to come, sit there and not even open their mouth until the meeting is adjourned. Can you really expect that person to be talking to municipal staff, politicians, and senior managers about HIV mainstreaming, and command respect in the municipality? It is not realistic (PTT member from Provincial AIDS Council, 13 November 2012). Some respondents also raised the issue of HIV Coordinators being political appointees rather than a professional cadre. They articulated that this creates a problem in that it has a negative impact on performance and continuity. Many of them show poor performance due to lack of HIV and AIDS training, and they are appointed for a short duration based on the political term of the Mayor. Lesson learnt: On the whole, the junior status and position of HIV Coordinators in municipalities do not allow them to make decisions related to HIV and AIDS mainstreaming. HIV and AIDS mainstreaming requires that certain changes are introduced in the thinking and day-to-day activities within the municipalities and HIV Coordinators do not have the power necessary to make such decisions. 5.4 Sustainability of knowledge of mainstreaming in municipalities There was a general concern amongst respondents about high staff turnover in municipalities. This also became evident in the study when trying to locate people who were beneficiaries of the two 18