Ethiopia HIV/AIDS

Strategic Initiative

Ethiopia HIV/AIDS

Partnering for Maximum Impact

This initiative operates in the capital city, Addis Ababa, as well as in towns and villages in Oromia and Amhara regions addressing the issue of HIV/AIDS by equipping Ethiopian youth, women, families, communities, and church and school communities with skills to (1) prevent the spread of HIV through abstinence, fidelity, and recognition of the harmful effects of some traditional practices and gender biases, (2) decrease stigma surrounding HIV/AIDS and increase compassion and support for HIV-infected and HIV-affected persons, and (3) offer home-based care for the infected and affected and create referral systems for sustainable basic services.

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SECTOR

Health

TOTAL INVESTMENT

US$ 7,083,668

LOCATION

Ethiopia

LIVES CHANGED

966,208

SOCIAL IMPACT INDEX

76.1 (out of 100)

AVERAGE COST PER LIFE

US$ 7.33

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SI Breakdown:

Key Achievements

Number of beneficiaries doubled from original benchmarks – By strengthening the capacities of 31 sub-partner organisations, the number of lives impacted in multiple ways was doubled to almost one million.
Programme extension – As a result of the programme’s success, USAID awarded our grant manager, Geneva Global, an additional US $3 million to reach more beneficiaries in fiscal year 2011.
HIV prevention education – The programme succeeded in educating 710,644 people in HIV prevention, over twice as many as we expected to reach.
Support of orphans and vulnerable children – 14,948 orphans and vulnerable children were supported through this Initiative. This was over three times as many as were initially expected.

The Problem

Densely populated, Ethiopia has a generalised HIV epidemic, with higher prevalence rates in the country’s urban settings. Ethiopia’s capital city, Addis Ababa, and towns and villages in the Oromia and Amhara regions are home to: 54 percent of the 82.5 million population, 87 percent of HIV prevalence, 87 percent of HIV-positive pregnancies, 85 percent of new HIV infections, 88 percent of new AIDS cases, 88 percent of AIDS-related deaths, 58 percent of people living with HIV/AIDS (PLHA) and 61 percent of orphans and vulnerable children. HIV/AIDS has had devastating impacts on the orphans and vulnerable children who are left behind when family members become ill or die. They face a multitude of problems, including a lack of basic necessities, psychological distress and depression, and stigmatisation and discrimination. Moreover, they are vulnerable to street life, abuse, child prostitution and rape, as well as HIV-infection themselves.

Solution

This Initiative was a strategic partnership between our grant manager (Geneva Global), the Legatum Foundation, the US government’s PEPFAR programme, the United States Agency for International Development (USAID), and 31 implementing sub-partners. It operated in the capital city, Addis Ababa, as well as in towns and villages in the Oromia and Amhara regions. The partnership addressed the issue of HIV/AIDS by equipping Ethiopian youth, women, families, communities, and church and school communities with skills to (1) prevent the spread of HIV through abstinence, fidelity and recognition of the harmful effects of some traditional practices and gender biases, (2) decrease stigma surrounding HIV/AIDS and increase compassion and support for HIV-infected and HIV-affected persons and (3) offer home-based care for the infected and affected and create referral systems for sustainable basic services. The partnership also reached sexually active youth, women who resort to transactional sex for family income, uniformed service members, migrant workers, and other at-risk groups with the HIV prevention message, including correct and consistent condom use, and providing them and their households with care and support services and referrals. This US $7,083,668 (US $3,000,000 Legatum Foundation investment) reached nearly one million people.

Critical Analysis

This Initiative started in Ethiopia in 2007. In the first year, efforts were devoted to selecting the most effective community- and faith-based organisations (C/FBOs) through a due diligence process, while establishing office set-up, networking, and creating the momentum required for smooth programme implementation. In the following years, programme efforts focussed primarily on strengthening the technical and institutional capacities of the implementing partners. The collective efforts of the three-year capacity building activities, technical assistance, and optimal grant management practice have brought about a noticeable change in sub-partners’ institutional and technical capacities. The programme achieved, and in some cases overachieved, almost all of its targets in prevention and care.

Recognising that C/FBOs are the best way to reach the grassroots level in the collective fight against HIV/AIDS, PEPFAR created NPI. Our grant manager recognised the opportunity at the onset, but was nevertheless unprepared for the immensity of work involved in managing 31 sub-partners inexperienced in technical award administration. Our grant manager devoted itself to strengthening the capacities of the sub-partners, and the rewards of these efforts have been gratifying. The rigorous process culled 10, but supported the 21 C/FBOs that can now demonstrate, at the very least, comprehension in transparent financial reporting, accurate programme data management, and meeting or exceeding minimum standards in HIV/AIDS interventions. Moreover, this intense process maximised returns on investment, doubling the number of lives impacted to one million.

In similar future programming, it may yield greater depth and sustainability of impact to work with fewer sub-partners – perhaps in a more concentrated geographical area, where efforts are directed toward reaching as many lives as possible by establishing referral systems, linkages and networks among the sub-partners, communities, and service and resource providers from the government and civil society. Overall, this Initiative achieved its purpose as envisioned by PEPFAR in coordination with UNAIDS and WHO: to create a critical mass of C/FBOs that will reach people who are underserved by governments or international non-governmental organisations (INGOs). This Initiative successfully strengthened the capacities of 21 smaller organisations, well positioning them for future partnerships that will continue to save and improve lives in a country where the HIV/AIDS epidemic remains beyond the government’s ability to curb it.

Lessons Learned

Successes:

Created coalition of organisations – This Initiative achieved a major goal for which it was established: to create a critical mass of community and faith-based organisations on the grassroots level.

Training – A number of trainings were organised for implementing partners’ staff and our grant manager's staff in the last three years. The trainings were based on needs and gaps identified in organisational capacity assessments. Partner organisations and our grant manager's staff benefitted from these tailored and high-quality trainings.

Mentoring – Our grant manager's Ethiopia programme, finance and M&E staff (GGI-ETH) worked to address cited capacity gaps following the assessment results of sub-partners. This process of mentoring and skills transfer was between our grant manager's Ethiopia staff and sub-partners’ project officers, M&E officers and financial officers responsible for this programme. In the one-on-one coaching, our grant manager's Ethiopia staff interacted with the appropriate line staff of the sub-partner organisations. The mentoring and coaching played a great role in ensuring that programme and finance officers continued to have outstanding performance in project implementation.

Consultative meetings – Our grant manager's Ethiopia staff organised a series of consultative meetings with respective programme coordinators over the three years. The meetings aimed to review their quarterly implementation processes, as well as the project’s progress, challenges, and lessons. It further clarified the programme shift, minimum standards and programme packages in line with the PEPFAR Next Generation Indicators. The meeting also re-oriented the participants on the reporting formats and associated data collection tools.

Systems improvement – In the third year, our grant manager provided the top performing sub-partners with customised, in-house technical assistance from hired experts to address gaps from capacity assessment in three highly critical organisational management systems: financial resources, monitoring and evaluation, and management and human resources. In a participatory process, the sub-partners’ executive directors and concerned staff periodically met with our grant manager's Ethiopia staff and the hired experts to agree on the priorities for systems improvement and the course of action and to evaluate progress. The sub-partners were ready to graduate after all agreed-upon systems gaps were addressed.

Challenges:

Data quality – Our grant manager spent a great deal of time going back and forth with sub-partners to verify the accuracy of the quarterly programme and financial reports. In terms of programme data, reported figures that did not adhere to PEPFAR’s minimum standards or “best” practices for HIV/ AIDS interventions were not counted. We also constantly looked out for double-counting of beneficiaries. In terms of financial data, US government cost regulations for award administration were strictly followed.

Fast pace – The short quarterly period exacerbated the issues around data verification. USAID required this reporting frequency, and our grant manager still recommends it for better management of a programme with very detailed requirements, such as NPI. But the cyclical work it entailed almost entirely consumed our grant manager's time, not leaving much room for higher-level reflection and discourse.

Number of sub-partners – The programme had a total of 31 sub-partners. With NPI’s fast pace and many detailed requirements, it was very demanding to manage this large portfolio of sub-partners that had had no previous introduction to technical award administration. Additionally, each sub-partner had more than one implementation site and we visited at least two sites per year. Nevertheless, our grant manager's rigorous monitoring and evaluation process eventually culled ten non-performers: six after year one, one after year two, and three more during year three.

Lack of health facilities – Some implementation sites did not have proper medical facilities for necessary referral systems, especially for services such as HIV testing and counselling, antiretroviral therapy (ART), pain treatment, diagnosis and treatment of infections, and infant and maternal health, including prevention of mother-to-child transmission.

Mobility of most-at-risk persons – Provision of the full HIV prevention package to most at-risk persons (street children, traders, truck drivers, commercial sex workers) was limited, due to their mobility. Networking among PEPFAR partners working in the project sites helped track mobile people and also allowed sharing of lessons and experiences.