2019 Zimbabwe: UNICEF Zimbabwe HIV and AIDS Programme mid-term evaluation
Sustainable Development Goals: 3
- SDG 3 - Good Health and Well-Being
OVERVIEW OF THE EVALUATION UNICEF
Zimbabwe contracted hera to conduct the mid-term evaluation of the current HIV/AIDS programme. The evaluation was carried out from January-June 2019. The UNICEF Zimbabwe HIV and AIDS Programme is a five-year programme that commenced in 2016 and will run until December 2020. The three main programme output objectives are:
- Increased national, provincial, district, facility and community service delivery capacity to provide essential rights- and gender-sensitive HIV information and services for women, children and adolescent girls and boys, including in humanitarian situations.
- Strengthened leadership, commitment, accountability and capacity for evidencebased equity-focused planning and budgeting for scale-up of HIV and AIDS prevention and treatment interventions for children and adolescent girls and boys.
- Enhanced capacity for children, adolescents and caregivers to adopt behaviours that empower them to prevent HIV and facilitate utilisation of relevant HIV and AIDS services.
The Programme’s Theory of Change (ToC) states that if the three programme outputs are achieved, then by 2020 children, pregnant women and adolescents in Zimbabwe will be able to access and use equitable, high-impact and quality HIV prevention, care and treatment services. The allocation for the Zimbabwe HIV and AIDS Program (app $3.5 million per year in each of 2017 and 2018) is only around 3% of the total UNICEF Country Program budget, but the importance of HIV as a public health issue in Zimbabwe means that to an outside observer the HIV/AIDS Program has a larger prominence than its smaller budget would suggest.
The overall objective of the evaluation was to assess the extent to which the progress of the UNICEF Zimbabwe HIV and AIDS Programme has achieved its targets and to provide a learning opportunity for future efforts by UNICEF’s HIV team. The evaluation reviewed and assessed the relevance, effectiveness, efficiency, equity and sustainability of the programme and provided specific recommendations for eventual new strategic directions, focused targets and scaling-up plan, in the context of UNICEF’s Strategic Framework for HIV in Eastern and Southern Africa (2016).
The evaluation adopted a mixed-methods approach: primary and secondary data (both qualitative and quantitative) were collected through literature and document review, review of statistical and financial data. interviews with key informants (44 men, 35 women), site visits to health facilities, and group discussions (12 held, with HIV-positive adolescents, mothers of HIV-positive infants, young men, village health volunteers and community elders). Approval for the evaluation was obtained from the Ethical Approval Committee of the Medical Research Council of Zimbabwe (MRCZ). Five districts were selected to be visited: Gweru, Mangwe, Hopley, Zvimba and Buhera.
FINDINGS AND CONCLUSIONS
The UNICEF HIV and AIDS Programme is relevant with its outcome, outputs and indicators consistent and in line with the needs and priorities of the beneficiaries, country needs, global priorities and partners’ and donors’ policies. The Programme design, strategies and approaches are appropriate to the context and the expected results and are aligned to international and regional HIV/AIDS priorities as well as to the Constitution of Zimbabwe and a number of national policies and strategies. UNICEF’s contribution to national goals and HIV and AIDS programming is based on evidence, with the Programme focussing on interventions that address identified gaps and strengthen areas of need.
Most indicators at outcome and output level were achieved, with some already surpassing the 2020 targets. Working centrally and in demonstration models, UNICEF has influenced policy and action through evidence and contributed to the revision of national strategies and policies. UNICEF had a key role in (among other things): strengthening coordination and scale up of the Early Infant Diagnosis (EID) and Viral Load (VL) use; adopting/applying research findings and evaluation results; increasing use of quality disaggregated data through “districts’ cascade analysis”; linking implementing partners with the districts for implementation, capacity-building, fostering ownership and buy-in; supporting effective pilot programs such as the young mentor mothers and Community Adolescent Treatment Supporters (CATS). Despite success in achieving set targets, scale-up of practices is hampered by weak capacity and resources at the district level to ensure supervision, follow-up and further implementation. The social protection needs of all children living with HIV, adolescents, young people and their families cannot be covered with the limited resources available.