AEGiS-15IAC: Assessing M&E of national HIV/AIDS programs: Findings from four developing countries.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Assessing M&E of national HIV/AIDS programs: Findings from four developing countries.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrE1385)

Ainsworth M
World Bank, Washington, D.C., United States

BACKGROUND: Monitoring and evaluation (M&E) of national HIV/AIDS programs are important for accountability, improved project management, and cost-effectiveness. They also can be used to raise government commitment: Monitoring trends in HIV prevalence and risk behavior can be a powerful tool to launch public action when the epidemic is "invisible". Evaluation of pilot projects can demonstrate the feasibility and effectiveness of controversial interventions. This study assessed the M&E activities of 4 national HIV/AIDS programs supported by more than $450 million in World Bank investment since 1992.

METHODS: Independent evaluations of World Bank-supported national HIV/AIDS projects in Brazil, Cambodia, India, and Kenya are compared with respect to the relevance and adequacy of M&E systems. The evaluation methodology involved: (a) review of the epidemiological data and literature, research and evaluation documents, and internal project files; and (b) in-depth interviews with national pro gram officials, NGOs, donors, researchers, and World Bank staff.

RESULTS: Major weaknesses in M&E include: Lack of baseline data Failure to monitor outcomes in the groups of greatest consequence to the epidemic Aggregation of sentinel data from a changing number of sites Using HIV prevalence or AIDS cases as a proxy for incidence in countries with high AIDS mortality or widespread treatment Few attempts to measure incidence, its proxies, or adult mortality Proliferation of indicators with no evaluation design that links inputs to outputs & outcomes and considers the counterfactual Little or no evaluation of NGO activities financed by national programs Refinements in indicators over time, compromising the ability to track changes Failure to link M&E to programmatic decisions

CONCLUSIONS: The failure to implement sound M&E and to link it to programmatic decisions has resulted in lack of accountability and lost opportunities to improve the efficacy of national programs.

Keywords: AEGIS, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Developing Countries, HIV Infections, United Nations, Evaluation Studies, Federal Government, Prevalence, Incidence, HIV Seroprevalence, India, Brazil, Kenya, Cambodia, Adult, economics, diagnosis, therapy, organization & administration

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ThOrE1385