| Grant Profile: |
| Project Title: |
Support to Capacity in HIV/AIDS in Zimbabwe |
| PCF/LICUS/SPF: |
LICUS |
Status: |
Closed |
| File Number: |
34
| Region: |
AFR |
| Sector: |
Health and other social services |
Country: |
Zimbabwe |
| FY approved: |
2006 |
Grant Theme : |
Human development |
| Keyword(s): |
Donor harmonization;HIV/AIDS;Health |
Approved Amount: |
$618,450.00 |
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Grant Recipient:
UNDP |
Grant Purpose:
The purpose of the project is to strengthen the efforts of Zimbabwe and development partners in the fight against HIV/AIDS by: (i) improving capacity to monitor and evaluate the epidemic throughout the country, (ii) assisting in the enhancement of the national technical capacity to carry out the ongoing treatment program, and (iii) better understanding the rural demand for counseling and testing (CT) in order to design and implement a CT program in rural areas.
The project aims to support the implementation of the recently approved Global Fund for AIDS, TB, and Malaria (GFATM) within the framework of the upcoming Zimbabwe national AIDS strategy (2005-2009), and would focus on priority areas that complement activities on the ground (by Zimbabweans, and those of the major technical assistance and financial resource partners).
The project activities are will strengthen:
(i) US Centers for Disease Controls (CDC) ongoing assistance to the National AIDS Council (NAC) in establishing a nationwide HIV/AIDS surveillance system including an electronic database, and trained personnel;
(ii) the Global Fund for AIDS, TB, and Malaria (GFATM) programs for HIV/AIDS;
(iii) national objectives of quality counseling and testing services (CT) for rural areas.
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Grant Activities:
Component 1: Monitoring and Evaluation System Roll-out and Initial Supervision
This component will support the rollout of the tested and approved Monitoring and Evaluation package to the District level. This will be done through training of trainers who are based in the ten Provinces.
The project will provide the training and also on-the-job supervision of the entire system for the initial phase of the roll out. In addition to the provincial roll out support, supervision and more intensive support will be provided for 22 underserved Districts. Some complementary goods such as computers, essential and minimal vehicle needs, and operational support, will also be financed.
Component 2: Assistance to Pre-Service Training of Laboratory Technical Professionals
This component will support the training of laboratory professionals by providing learning and teaching materials and financing an experienced expert consultant to assess and redesign the curriculum, in close consultation with local advisors, WHO, CDC , the Zimbabwe Association of Church Hospitals (ZACH), the Extended UN Thematic Group on HIV and AIDS. The project will also fund the purchase of associated hardware, in order to enhance the learning environment, such as computers, printers, and basic laboratory equipment.
Component 3: Qualitative Assessment of Rural Demand for Counseling and Testing (CT)
Building on the urban Counseling and Testing study already done in Zimbabwe, this component will support a complementary CT study in rural areas. The objectives of the qualitative survey is to establish general attitudes, perceptions and stigmas regarding HIV/AIDS, assess the knowledge and impressions of HIV/AIDS testing and counseling services, and determine what would motivate or demotivate participants within the target groups to seek CT services as well as obtain indications of what a CT service should offer. The study would specifically seek rural population knowledge and impressions of CT.
The assessment will help public sector and non-public sector decision makers understand rural CT needs better, to design and target their rural CT efforts in areas of greater impact. The project will also support discussion of findings and CT options for different regions during a national reporting-out workshop, complemented by sub-national workshops.
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Results:
- The project overall had mixed results. Some sub components achieved their objectives whilst others did not.
- The first subcomponent, the M&E System roll-out, was completed after further adjustments to the activity design. The sub component achieved the grant objectives even though it took two extensions.
- The LICUS TF M&E activity trained and improved the capacity of 172 District Aids Coordinators and key implementing partners in monitoring and evaluating HIV/AIDS activities in 22 underserved districts in the country. NAC monitoring and evaluation department confirmed that their quarterly reports have improved as a result of the training. Coordination of activities at district level has improved as requirements are clearly tabulated and monitored. Capacity in terms of resources use is not yet known.
- Laboratory and computer equipment were procured and distributed to Zimbabwe Institute of Medical Lab Scientist (ZIMLS), but no curriculum redesign was done.
- The grant objective of the second sub component was not met according to the output in the proposal but the equipments are being used to teach SCMLT students, thus helping in capacity enhancement.
- The consultancy to assess and redesign the curriculum was not undertaken due to unavailability of consultants at the right time, time constraints and cumbersome UNDP procurement system.
- The objective of the last component, the Qualitative Assessment of Rural Demand for Counseling and Testing sub component , was to improve knowledge of rural HIV/AIDS counseling and testing needs. The activity produced very interesting and important insights on the gaps and demand for C&T in rural areas. The report came up with a number recommendations for improving the access and quality of CT in rural areas. These recommendations have been taken up by donors, national programs and other stakeholders in their design and implementation of C&T programs nationally.
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Lessons Learned:
Specific project lessons:
-The second activity within the HIV/AIDS proposal, Pre-Service Training of Medical Laboratory Professionals, was a complex activity especially regarding institutional arrangements.
- ZIMLS, though legally constituted, had initial difficulties that should have been identified at the design stage. ZIMLS had no office of its own. It had no training facilities of its own. Its key officers were also serving government officials who were moonlighting in their training functions.
- a thorough institutional analysis in activity design must be undertaken before a project is approved.
Lessons from the LICUS package as a whole:
There was a lack of coordination between the different activities: The LICUS TF for Zimbabwe 2005 did not have one coordination mechanism, but had different implementing modalities, which were not adequately coordinated either from the World Bank or under UNDP. There was no mechanism for sharing experiences or drawing lessons from each other. The three components under UNDP were also managed by two different managers who did not share experiences.
Management arrangements in many cases were not clear and in some cases were not based on adequate analysis of the institutions involved. For example, for the support to HIV/AIDS, ZIMLS was not adequately assessed at design stage and institutional linkages between CDC, CEPHI, NAC and Ministry of Health were not adequately taken into account.
Leadership and coordination at Bank Country Office: While sub contracting the LICUS TF to UNDP was appropriate at the time, there was a need to clearly specify the role of the Country Office in management and monitoring activities. For activities managed by the Bank and the Country Office such as the SSDA, progress was clearly monitored. It is important to clarify the role of the Country Office in implementation/ supervision.
There was limited day-to-day management attention paid to the LICUS TF in the World Bank, especially after the task manager retired. As most activities started implementation during the second half of 2006, there was no one in the country office to follow up on the ground. No field visit was made to assess progress.
Ownership of the activities by beneficiaries influences the rate of implementation. World Bank interventions are normally guided by Country Assistance Strategies which take note of the country priorities for clear ownership. The ISN 2005 was more focused on what the Bank had to do to remain engaged in Zimbabwe. Successful components had a higher level of ownership by the government. In activities where the LICUS TF was assisting activities identified by the beneficiaries fared better e.g. PASS II and the SSDA where the Government of Zimbabwe was clearly interested fared much better. Government made resources, especially personnel, available for implementation. Without direct transfer of funds, government agencies did not find it easy to remain engaged.
Effective demand from clients: Effectiveness of interventions is better with client demand. If clients do not see clear benefits, their involvement is slow and limited. It is therefore necessary to ensure that the activity is demand driven otherwise there is lack of participation on the clients side.
Role of Trust Funds in increasing Bank relevance and mandate: One of the key lessons learnt from LICUS TF 2005, is that even the small amount of funds, if appropriately programmed and targeted, can make a difference in capacity enhancement and knowledge building.
Institutional assessments at design stage: There is need to have deeper and clearer institutional capacity assessments. Weaknesses must be factored into the implementation process e.g. CSO staff shortages and ZIMLS institutional void. The role of parent ministries in the different sectors needs to be clearly defined.
Development Partners involvement: The strategic objective of the ISN was partnership and dialogue. Under LICUS TF 2005, there were linkages and discussions between UNDP, WHO, WB. However stronger partnerships should have been cultivated with development partners especially in SSDA. DfID was able to come in to sponsor other work in line with the SSDA and the OVC report was consolidated with the health and education report to produce a more comprehensive report.
Key challenges:
The major challenge was the delayed start-up of the activities. This was an indication of a design that did not take account of i) what was required for a quick start-up, and ii) how to package the activities to suit the implementation mode of the implementing agency UNDP.
UNDP procurement procedures proved to be a major challenge. Hiring international consultants for all the activities took very long thereby delaying their implementation.
Recommendations:
LICUS Trust Fund activities must be aligned with country priorities for the program to be demand driven and sustainable
Terms of Reference (TOR) for consultants should be part of the Trust Fund Proposal, or developed as soon as possible, to lessen delays in the implementing the activities.
Project management arrangements should be clarified, with clear upfront definition of roles, responsibilities, and procedures for implementers and beneficiaries.
Task teams should manage and monitor progress and review quarterly reports.
There is need for thorough institutional assessments especially in a country going through severe human resources constraints such as Zimbabwe.
LICUS Trust Fund activities should be attractive to governments. The recipient questions genuineness of intentions with such limited funding available.
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