Final Evaluation of the El Alto HIV/AIDS Project
Background The Norwegian Mission Alliance in Bolivia (MANB) through cooperation agreement with Den Norske Misjonsalliansen (NMA), has implemented for thirteen years the HIV/AIDS contract in El Alto city, La Paz Department. On its pilot phase (2002 – 2004) it conducted actions to strengthen PLWHA organizations, in phase I (2005 – 2009) implemented a health centre for epidemiological assistance and monitoring; in phase II (2010 – 2014) continued fostering knowledge and disseminating information about HIV/AIDS, principally to school students. Purpose/objective Evaluate the results of the HIV/AIDS Contract, with an emphasis of the second phase of the project, and estimate the contribution it has made to reducing the incidence of the epidemic by analysing qualitative and quantitative information. Methodology To achieve this objective, an impartial and integrated approach was adopted, enabling judgments to be expressed about the impacts that appear to have been brought about as a result of the project’s implementation, as well as aiming to contribute to learning for future improvements. The evaluation was based on a systematic and objective process, the purpose of which was to determine the relevance of the work carried out by the project and the results achieved in relation to its objectives. The evaluation also aimed to identify any unforeseen changes that were brought about. The methodology called “Most Significant Change” was therefore used. This sought to identify, together with the stakeholders, the significant trends and changes achieved as a result of the work carried out by the project. Key findings As for pertinence, the HIV/AIDS project in it design and throughout its implementation has met the needs of the context, carrying-out its actions in line with the HIV/AIDS health policies, promoting prevention, treatment adherence, and raising awareness against stigma and discrimination. It is important to highlight that delivered training, materials elaboration and dissemination was conducted under strict coordination with public health programs’ responsible officers, and with their active participation. Regarding project efficiency, considering cost-efficiency for infrastructure and equipping, USD 209,085.00 were invested for 850 PLWHA of El Alto city, having an investment of USD 250/person. As for students, teachers, and parents, from 2010 to 2014, 49,772 individuals were reached with an investment of USD 339,728.00, having an investment of USD 7/person for training and information dissemination. This investment is minimum compared to the potential benefit; however, it is worth noting that staff downsizing and turn-over in the last period affected its implementation. Project effectiveness, target population perception regarding habits and attitudes change in students, parents, teachers, PLWHA, and even in indirect beneficiaries is positive. It was found that PLWHA have strengthened their impact on legal issues; what’s more, they have managed to protect against stigma and discrimination, having fostered – as well – the timely delivery of free anti-retroviral treatment. On the other hand, multi-stage training from teachers to students has been effective; also, life histories from PLWHA have been key for information transparency and awareness raising, impacting – not only – in students, but also on PLWHA since they assume their condition and promote prevention. Implemented infrastructure is used as a focal point for PLWHA in El Alto city, having 59 reported cases in 2014. As for sustainability, there is a trend that project’s achievement will last in time, considering that – above all –attitude and habits change has been generated regarding HIV/AIDS prevention. Individual and group empowerment of PLWHA helps them demand their rights before the respective bodies. Health Centre sustainability is guaranteed since it depends from the Municipal Health Unit, for which budget has been allocated. Recommendations Stability and good implementation of this and any other project depend on staff job security/stability, it is important to generate the necessary conditions to provide such stability. It important to collect the experience and lessons obtained by the HIV/AIDS project, for which it would be interesting to mainstream this theme to other MANB intervention areas. Participation of PLWHA in training activities – by providing their life histories – has been vital for habits and attitudes change of students and parents, being recommended that such strategy continues for other interventions. It is important to define project’s technical, economic, and moral support to avoid a paternalistic attitude with PLWHA; thus, strengthen their action and avoid dependency from the institution. This experience can be replicated and disseminated to primary level students from the rural area, considering that education starts at an early age. It is vital to have the commitment of school teachers for the sustainability of results, information dissemination, and attitude/habits change. Lessons learnt Having staff committed with diaconia has facilitated project’s implementation. Diaconia shall not be done compulsory; it shall come from a person, as a daily way of living and practice. PLWHA strengthening on technical skills has been positive for their personal and productive development, since many were able to achieve their economic and personal independence. Incorporation of Christian values and ethics as a crosscutting theme has contributed to the empowerment of the target population, contributing to change in sexual health habits and way of living, aspect broadly recognized by beneficiaries. Project staff stay is necessary for a good implementation of activities, especially for the good monitoring and follow-up of actions.