End-of-term evaluation
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ContentsAcronyms 5 Acknowledgements 7 Executive Summary 8 Introduction 11 Background 13 Methodology 15 Utilization-Focused Evaluation 15 Results-Based Monitoring and Evaluation 15 Appropriateness of Approach 16 Learning by Doing Approach 16 Data Collection Methods 17 Limitations 19 Evaluation Findings 20 Programme Area 1: Prevention and Control of HIV Transmission 23 Programme Area 2: Diagnosis, Treatment and care of PLHIV 33 Programme Area 3: Impact Mitigation and Support of PLHIV 44 Programme Area 4: Programme Management and Institutional Performance 51 Programme Area 5: Surveillance, Monitoring, Evaluation and Research 63 Conclusion 71 Appendices 73 Appendix 1 – Evaluation Protocol and Matrix 0 ACRONYMS 3 INTRODUCTION 4 EVALUATION PURPOSE 5 EVALUATION OBJECTIVES 5 EVALUATION QUESTION 6 EVALUATION DESIGN 6 Theoretical Framework 6 Learn by Doing Approach 7 Local Evaluation Team 7 External Evaluation Team 8 Evaluation Matrix 8 Evaluation Protocol 9 METHODOLOGY 10 Data Collection & Analysis 10 Proposed Timetable 11 Final Report 12 Dissemination of Findings 12 Barbados HIV/AIDS NSP EVALUATION MATRIX 13 Appendix 2 – External Evaluation Team Biographies 1 1 Appendix 3 – Focus Group Discussion Study 1 CARPHA EVALUATION OF BARBADOS NATIONAL HIV STRATEGIC PLAN 1 2008-2013 1 FINDINGS FROM FOCUS GROUPS DISCUSSIONS 1 Acknowledgments 2 List of Acronyms 4 Executive Summary 4 Overview 6 Methods 6 Limitations 7 FINDINGS FROM FOCUS GROUPS DISCUSSIONS AND INTERVIEWS 8 People Living With HIV 8 People with Disabilities 11 Sex Workers 14 Men who Have Sex with Men 15 Transgender People 17 Adolescents 19 Discussion 20 Programme Design 21 IEC versus BCC 21 The Role of Civil Society 22 Enabling Environment and Stigma and Discrimination 22 On the Outside Looking In 23 Conclusion and Recommendations 23 Recommendations 24 1. Background to Barbados National Strategic Plan 2008-2013 Qualitative Evaluation- Focus Group Discussion Protocol 28 2. Aims and Objectives 28 3. Consent and Ethics 29 4. Methodology and Approach 30 5. Data Analysis Plan 34 6. Activity Timetable 35 APPENDIX I-CONSENT FORMS 36 APPENDIX II-DRAFT FGD GUIDES 41 Appendix 4 – List of Documents Reviewed 0 Appendix 5 – List of Persons Interviewed 1 AcronymsAIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ARV Antiretroviral (drugs) BDF Barbados Defence Force BFPA Barbados Family Planning Association BGLAD Barbados Gays, Lesbians and All-Sexuals against Discrimination CARPHA Caribbean Public Health Agency CEED Community Education Empowerment and Development CHAA Caribbean HIV AIDS Alliance CSO Civil Society Organisation CSW Commercial Sex Workers EET External Evaluation Team EQUALS Empowerment Quality Unity Acceptance Love Strength GIPA Greater Involvement of Persons Living with HIV/AIDS HIV Human Immunodeficiency Virus HOPEN Helping Our Peers Effectively Now IEC Information Education Communication KABP Knowledge, Attitudes, Beliefs, and Practices KAP Key Affect Populations LET Local Evaluation Team LRU Lady Meade Reference Unit M&E Monitoring and Evaluation MOH Ministry of Health MOVADAC Movement against Discrimination Action Coalition NCSA National Council for Substance Abuse NHAC National HIV/AIDS Commission NSP National Strategic Plan OVC Orphans and Vulnerable Children PAHO Pan-American Health Organisation PANCAP Pan-Caribbean Partnership against HIV and AIDS PLHIV Person Living with HIV RBM&E Results-Based Monitoring and Evaluation RePDU Research, Training and Policy Development Unit SOP Standard Operating Procedure STI Sexually Transmitted Infection TB Tuberculosis UGLAAB United Gays and Lesbians against AIDS, Barbados UNDP United Nations Development Programme VCT Voluntary Counselling and Testing AcknowledgementsThis evaluation was possible with the support of several agencies and individuals. The Caribbean Public Health Agency (CARPHA) and the External Evaluation Team (EET) would like to extend its appreciation to all involved. Firstly, we would like to thank the Pan Caribbean Partnership against HIV and AIDS (PANCAP) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for their generous support for this evaluation. This support is allocated to CARPHA as a sub-recipient of the Round 9 Agreement ‘Fighting HIV in the Caribbean: a Strategic Regional Approach’ between PANCAP and GFATM, numbered MAC-910-G02-H. We extend our thanks the Barbados National HIV/AIDS Commission (NHAC) and the Barbados Ministry of Health (MOH) who were critical partners in facilitating and guiding the evaluation. Recognition must be extended to all the national stakeholders, including HIV/AIDS Coordinators, HIV/AIDS Focal Points and Civil Society Representatives who acted as members of the Local Evaluation Team (LET) and thus played an essential role in the design and execution of the evaluation. Special thanks are extended to Ms. Nicole Drakes and Ms. Rhonda Greenidge for playing a leading role in coordinating the evaluation. Thanks are proffered to the Ministries of Health in Trinidad and Tobago and Jamaica, who released their technical staff to participate as members of the External Evaluation Team (EET). These staff were Dr. Ayanna Sebro and Mrs. Sannia Sutherland. We would like to thank Ms. Audrey Brown, Focus Group Consultant, who successfully organised and facilitated focus group discussions with key populations for the evaluation. We extend our warm thanks and gratitude to all the individuals and organisation that generously provided information or who participated in interviews and focus groups as a part of this evaluation. A complete list of persons interviewed is presented in Appendix 5. Executive SummaryThis end-of-term evaluation sought to assess the outcomes of the ‘Government of Barbados NSP for the Prevention and Control of HIV 2008-2013’ in terms of relevance, efficiency, effectiveness, coordination, and implementation. In doing so, the evaluation closely followed the Strategic Objectives stated in the NSP. There were four evaluation objectives: Determine the relevance of the programmatic response to the NSP; Assess the extent to which the Strategic Objectives of the NSP were achieved; Determine whether the programme objectives of the national response were achieved; and, Assess the extent to which programme resources were utilised to achieve programme objectives. The findings and recommendations for the evaluation were developed and grounded in the Utilization-Focused Evaluation approach and a Results-Based Monitoring and Evaluation (RBM&E) framework. An EET of regional experts worked in partnership with a LET to review the outcomes of the NSP, with a view to creating practical recommendations to strengthen the national response. The evaluation found that, in general, the national response moved closer to achieving key targets over the NSP period. Several of the strategies employed during implementation of the NSP appear to be yielding positive results. Notable outcomes include a downward trend in transmission rates; an increased age for sexual initiation; and, increased condom use. Additionally the evaluation team found that the Lady Meade Reference Unit (LRU) may be a best practice for the region. Thus, the LRU could be used to develop a model for replication or adaption within the country and regionally. The Food Bank was a sustainable model for supporting Persons Living with HIV (PLHIV), especially those of a lower socio-economic status. The team approach to securing housing support for PLHIV was functioning well and a commendable approach to addressing the needs of a highly vulnerable population. There was considerable goodwill among the HIV/AIDS Focal Points and Coordinators from the partner Ministries that could be leveraged for further programming. That empirical data was being used in some areas to improve programming, most notably the use of evaluation to improve the treatment response. There are also several challenges facing the national response that require attention. The challenge of addressing stigma and discrimination, the challenge of addressing the sexual and health behaviour among males, and the limited availability of data remain major hurdles. This limitation made it difficult for the evaluation team to draw detailed conclusions about the effectiveness of some strategies employed during the period under review. It is a missed opportunity for the national response, undermining its ability to identify successes and challenges clearly. In addition to this, the evaluation team noted that there was the need to strengthen the relationship between the NHAC and MOH. With expected changes in the level of external funding support available for the programme, stronger country level coordination between the ‘health’ and ‘multi-sectoral’ aspects of the response is critical going forward. Further challenges include the economic climate in Barbados and the closure of the Caribbean HIV AIDS Alliance (CHAA). The national response will need to adapt to the evolving economic situation facing the country and in doing so will need to ensure the internal governance structure and working arrangements are consolidated and streamline. In addition, it will need to ensure that partnerships are more targeted and effective to address the needs of those populations most vulnerable to HIV and AIDS. Meanwhile, CHAA’s closure has created an immediate gap in the national response in terms of support for civil society organisations and outreach to key populations. To deal with this, the national response will need to support the development and sustainability of the nascent CSOs whose capacity for project development and execution were being strengthened by CHAA to ensure greater community level implementation and ownership. Figure 1, below, provides a ‘Traffic Light’ overview of the evaluation team’s findings aligned to the Goal and Strategic Objectives of the NSP. Figure 1: Summary of Achievements against NSP Goal and Strategic Objectives
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Largely Achieved 
Partially Achieved 