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Bratislava Regional Centre, July 2007

Regional Capacity Assessment initiative (HIV/AIDS area) in Eastern Europe and the Commonwealth of Independent States. Bratislava Regional Centre, July 2007. Rationale and general objectives of the project Methodology Main Findings and Recommendations Regional Country Specific example

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Bratislava Regional Centre, July 2007

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  1. Regional Capacity Assessment initiative (HIV/AIDS area) in Eastern Europe and the Commonwealth of Independent States Bratislava Regional Centre, July 2007

  2. Rationale and general objectives of the project • Methodology • Main Findings and Recommendations • Regional • Country Specific example • Lessons Learnt • Next Steps

  3. Regional Research Initiative Regional Challenges • Lack of Multi-sectoral approaches linking different stakeholders • Lack of approaches looking at short-term and long-term horizon • Weak/variable health systems and implementation capacity • Major increase in resources available (Global Fund, WB, Gov.) UNDP Mandate • HIV/AIDS and Human Development • Governance of the HIV/AIDS Response Regional Capacity Assessment • 5 Countries • Stand-alone tool • Policy recommendations • Follow-up projects? +

  4. Project Objective and Results Objective: Systematic analysis of capacity requirements to meet the long-term needs for organization and management of the thematic area of HIV/AIDS in Eastern Europe and the Commonwealth of Independent States (CIS). Capacity constraints were identified at 3 levels: i) Enabling Environment; ii) HIV/AIDS Thematic Level; iii) Organizational Level Results: 1. Analysis of needs for short and long-term capacity building in individual countries; 2. Regional recommendations 3. Tested methodology with assessment tools for the three levels of assessment

  5. Methodology • Capacity Assessment and Human Development Methods and Tools for Use by UNDP(Developed in 28 May 2005) • Tailored to fulfill the needs of the research initiative • Rapid Assessment Response Approach (qualitative and quantitative elements)

  6. Potential users of methodology • International aid agencies for internal planning purposes - policy makers and programme planners; • Decision makers and key governmental civil servants and technical staff responsible for implementing the HIV/AIDS programme; • NGOs and CSOs; • Researchers, seeking particular tools to study institutional/organizational needs.

  7. Conceptual Framework

  8. Desirable Outcomes and Gap Analysis

  9. Method overview

  10. Quantification of the Questionnaire Scores do not have an absolute meaning but may be used for relative comparisons WITHIN the country

  11. Regional Findings – Common Achievements Achievements: • Dramatic expansion in access to ART (GFATM) • All countries have adopted the Three One’s principle (except Russia which still significantly lags behind) • Great advances by all in w/respect to policy frameworks and improving the main legislation relating to AIDS and the corresponding risk groups • Except in Croatia, epidemic is mainly being fueled by sharing contaminated equipment. All the countries (excluding where there is no harm reduction) have embraced the principle that the potential double harm of injecting opiates and HIV, Hepatitis C/B infection can be reduced by courageous policies (most successful Croatia-methadone countrywide) • Availability of laboratory testing is up to par

  12. Regional Findings – Common Challenges Challenges: • Need to encourage more PLHIV to come forward and seek ART - GIPA • Slowest progress in the M&E area (except in Croatia and Moldova) • Although some progress, there still is a great deal of stigma, discrimination and intolerance both by the general public as well as by the medical profession and police towards PLHIV, MSM, SWs, and IDUs • Confidentiality of test results and the HIV positive status of PLHIV remains an issue in all countries • Law enforcement; inclusion of components related to the HIV/AIDS law within the university curriculum and educational/training campaigns aimed at law-enforcement institutions essential • All countries (except perhaps Moldova) some negative experiences with mass media • All countries have improved their involvement of NGOs working on prevention. In Croatia and Kyrgyzstan, active NGOs are functioning relatively well, but there are still not enough to meet the demand for an effective HIV/AIDS response. In Tajikistan, Russia, and to a lesser extent Moldova, the NGO sector remains very weak • Poor economic status of several of the countries: a significant brain drain and corruption • There is not enough proper pre- and post-test counseling • Officials in Tajikistan and Russia are still receiving objections from various interest groups to introducing methadone, despite scientific evidence in its favor

  13. KYRGYZSTAN – Summary Findings Enabling environment level: • Positive aspects: improved political leadership where government officials speak publicly about HIV/AIDS; necessary human rights laws in place; NGOs working relatively well; substitution therapy available • Challenges: over-reliance on donors; lack of financial support of NGOs; prevailing stigma and discrimination against vulnerable groups (MSM) and PLHIV by the general population, police, and health care staff; and gender stereotypes which create problems for women to exercise their rights; severe issue w/drug trafficking; and qualified HR needed to work with HIV/AIDS patients HIV/AIDS thematic area level: • Positive aspects: legal framework in place; Three Ones principle is being implemented with solid coordination and a promising M&E unit • Challenges: weak enforcement of human rights and anti-discriminatory laws; lack of transparency; weak capacity of the health care system with respect to surveillance, prevention, VCT, treatment coverage, and rehabilitation and social services for IDUs; while general awareness of the existence of the epidemic, there are still many misconceptions and taboos regarding modes of transmission and vulnerable groups

  14. EnablingEnvironment Score PoliticalLeadership 6.6 FinancialResources 3.3 Human RightsViolations 1.88 Social and Cultural Practices as they Relate to the Implementation of HIV Prevention Strategies 3.75 I l legal Drug Trafficking 6.0 Human Resources 3.75 Constraints Produced by Donor Policies and Practices 5.0 TOTAL SCORE Enabling Environment 4.3 HIV/AIDS Thematic Area Legal Framework 4.2 Policy Framework 10.0 HIV/AIDS Thematic Area Management 6.0 Transparency of the Decision Making Process W ithin the HIV/AIDS Thematic Area 6.0 Access to Knowledge and Information 2.1 TOTAL SCORE HIV/AIDS Thematic Area Level 5.6 OVERAL SCORE FOR Kyrgyzstan 4.8 KYRGYZSTAN - Overview of Scores

  15. Lessons Learnt • Buy-in for the assessment is essential from all counterparts. In the case of Russia, not only UNDP but all the UN agencies • Sufficient involvement of the focal point in the HIV/AIDS area and his/her access to most of the relevant documents • One standard questionnaire for all stakeholders was most suitable • The questions that appear under each section have been revised after every single country visit with a team of HIV/AIDS experts with the aim to have questions that are: • Simple (both for the interviewer and the interviewee) • Without a double meaning • Equally easy to understand in different countries which are at different stages of development • Precise in asking what is meant to be asked • Consistent in respecting the people being interviewed

  16. Lessons learnt - 2 • In some countries the questionnaire proved to be difficult to use because the questions were too general and similar assessments have already been carried out. Therefore, the scoring exercise was not applied either (Russia). • Balance between external and local consultants • Meet with 1 representative of the organization or if more people, clarify who will be the principal person answering the questions and how the others should participate. • Usefulness of the organizational level assessment as a case study. In future assessments, it may prove valuable to have several in depth organizational assessments • The assessment was carried out in the capital city only but can equally be carried out in one/all region/s

  17. Next Steps – Use of Methodology and Findings • Advocacy tool in itself • Review recommendations with country stakeholders and take necessary follow up actions/projects: SHORT vs. LONG term • Carry out the same capacity assessment in other countries • Adapt capacity assessment to the specific needs of a country and conduct it periodically to enable countries to assess and monitor their performance over time • Adapt capacity assessment methodology and tools to allow international agencies/stakeholders monitor and evaluate their activities in the area of HIV/AIDS (enabling environment, HIV/AIDS thematic) and their contribution to the country HIV/AIDS response

  18. THANK YOU FOR YOUR ATTENTION!!!!

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