Mr. Erin Blake: M&E Specialist, CARPHA
Mr. Erin Blake is an Australian national with over eight years’ experience working in M&E for international development projects, and has been working in his current capacity as an M&E Specialist with CARPHA (and previously CHRC) since June 2012. Mr. Blake has a passion for working across cultures on community-based development projects and has experiences working in South Sudan, Cambodia, the Caribbean and Australia on a wide variety of projects ranging from local governance/anti-corruption to public health (especially HIV and AIDS). The main focus of his international work has been on developing and implementing M&E systems including the development and implementation of national M&E plans; designing and conducting applied research studies; designing and conducting programme evaluations; and, implementing training programs to foster greater M&E capacity. Prior to working internationally, he worked for several years in community focused roles for local government in Sydney, Australia. Mr Blake holds a Master in Social Change and Development, a Graduate Diploma in Local Government Management, and a Bachelor of Arts in Politics and History.
Mrs. Patricia Smith-Cummings: M&E Officer, CARPHA
Mrs. Patricia Smith-Cummings is a Belizean national with over four years’ experience working in M&E at the national and regional level. She has been employed as an M&E Officer with CARPHA since August 2013. Prior to this, Mrs. Smith-Cummings was working as an M&E Officer at the National AIDS Commission in Belize and as a Data Analyst at the Belize Family Planning Association. Mrs. Cummings has passion for M&E and supports the mandate of promoting sexual and reproductive health and rights without discrimination. The main focus of her work has been on monitoring and reporting on sexual and reproductive health project progress and achievements, clinical service statistics monitoring and reporting, monitoring the implementation of the Belize HIV National Strategic Plan, conducting M&E training, and supporting countries with the development, implementation and strengthening of national M&E systems to strengthen strategic decision-making. Mrs. Cummings has a management background.
Mr. Garth Watson: M&E Officer, CARPHA
Mr. Garth Watson is currently a Monitoring and Evaluation Officer with the Caribbean Public Health Agency. He is a graduate of the University of the West Indies and holds a M.Sc. in Sociology, specialising in Development. During the course of his career, Mr. Watson has taught at the University of the West Indies, as well as the Management Institute for National Development Jamaica in Sociology, Survey Design, Public Sector Management and Research Methods. Mr. Watson has worked in the areas of Sexual and Reproductive Health and HIV/STI programming for over seven years providing technical expertise to Jamaica and the wider Caribbean. During this time he completed a number of research and policy papers in the areas of social development, sexual reproductive health and at-risk groups.
Mrs Sannia Sutherland: Grants Manager, National HIV/STI Programme, MOH, Jamaica
Mrs. Sannia Sutherland joined the National HIV/STI Programme (NHP) of Jamaica's Ministry of Health in 2004. In 2008 she joined the HIV Prevention Unit as Behaviour Change Communication Coordinator and was subsequently appointed to the post of Director, Prevention in 2011 where she provided strategic management of the HIV Prevention Programme. Following the integration of the National Family Planning Board and components of the National HIV/STI Programme in April 2013, Mrs. Sutherland served as interim Executive Director of the National Family Planning Board. Currently Mrs. Sutherland is functioning as Grants Manager for the National HIV/STI Programme.
Mrs. Sutherland has also worked at UNICEF and the Planning Institute of Jamaica; through this fusion of bilateral and government experience, she has honed strong proposal writing skills. Most notably is her contribution to the development of the Global Fund Round 7 Proposal, the PEPFAR 2010-2014 Proposals, UNAIDS, UNICEF, and UNWOMEN Concept Notes, through which Jamaica has received approx. US$100 million to support a full HIV Programme inclusive of Treatment, Care and Support, Prevention and Policy Development. Her competence is buttressed by the successful completion of a BSc in Public Administration, an MSc Governance and Policy. Sutherland has over 15 years’ experience in the field of Development.
Dr. Ayanna Sebro: the Deputy Director of the HIV and AIDS Coordinating Unit, MOH, Trinidad and Tobago
Dr. Ayanna Sebro is the Deputy Director of the HIV and AIDS Coordinating Unit of the Ministry of Health of Trinidad and Tobago. Dr Sebro is a preventative medicine physician with experience in the area of HIV and its related infections. She has worked as a physician at the Medical Research Foundation under Professor Courtenay Bartholomew for five years before joining the Ministry of Health in her current post.
Her interests include overall health system strengthening and the development of the field of infectious disease medicine in the Caribbean region. Dr. Sebro earned her medical degree at the University of the West Indies Mona Campus and Master’s in Public Health in International Health and Epidemiology from Tulane School of Public Health and Tropical Medicine. A graduating member of the first cohort of the Harvard Clinical Global Scholars, she is currently a Dr PH candidate at the University of the West Indies.
Appendix 3 – Focus Group Discussion Study
CARPHA EVALUATION OF BARBADOS NATIONAL HIV STRATEGIC PLAN 2008-2013 FINDINGS FROM FOCUS GROUPS DISCUSSIONS
Prepared by Audrey Brown
October 6, 2014
Acknowledgments
The Caribbean Public Health Agency would like to thank the staff at the National HIV/AIDS Commission for their support and thank all of the respondents that gave willingly of their time, thoughts, feelings and opinions.
Table of Contents
Acronyms 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 5
INTRODUCTION 6
EVALUATION PURPOSE 7
EVALUATION OBJECTIVES 7
EVALUATION QUESTION 8
EVALUATION DESIGN 8
Theoretical Framework 8
Learn by Doing Approach 9
Local Evaluation Team 9
External Evaluation Team 10
Evaluation Matrix 10
Evaluation Protocol 11
METHODOLOGY 12
Data Collection & Analysis 12
Proposed Timetable 13
Final Report 14
Dissemination of Findings 14
Barbados HIV/AIDS NSP EVALUATION MATRIX 15
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 6
Executive Summary 6
Overview 8
Methods 8
Limitations 9
FINDINGS FROM FOCUS GROUPS DISCUSSIONS AND INTERVIEWS 10
People Living With HIV 10
People with Disabilities 13
Sex Workers 16
Men who Have Sex with Men 17
Transgender People 19
Adolescents 21
Discussion 22
Programme Design 23
IEC versus BCC 23
The Role of Civil Society 24
Enabling Environment and Stigma and Discrimination 24
On the Outside Looking In 25
Conclusion and Recommendations 25
Recommendations 26
1. Background to Barbados National Strategic Plan 2008-2013 Qualitative Evaluation- Focus Group Discussion Protocol 30
2. Aims and Objectives 30
3. Consent and Ethics 31
4. Methodology and Approach 32
5. Data Analysis Plan 36
6. Activity Timetable 37
APPENDIX I-CONSENT FORMS 38
APPENDIX II-DRAFT FGD GUIDES 43
Appendix 4 – List of Documents Reviewed 0
Appendix 5 – List of Persons Interviewed 1
Acknowledgments 2
List of Acronyms 4
CARPHA–Caribbean Public Health Agency 4
PWD-People with Disabilities 4
Executive Summary …5
Overview 7
Methods 7
Limitations 8
FINDINGS FROM FOCUS GROUPS DISCUSSIONS AND INTERVIEWS 9
People Living With HIV 9
People with Disabilities 14
Sex Workers 16
Men who Have Sex with Men 18
Transgender People 21
Adolescents 23
Discussion 25
Conclusion and Recommendations 28
List of Acronyms
AIDS –Acquired Immune Deficiency Syndrome
BCC- Behaviour Change Communication
CARPHA–Caribbean Public Health Agency
CEED- Community Education Empowerment and Development
CHAA- Caribbean HIV/AIDS Alliance
FGD- Focus Groups Discussions
HIV -Human Immunodeficiency Virus
IEC-Information Education Communication
KAP- Key Affected Population
LGBT-Lesbian Gay, Bisexual and Transsexual
LRU- Ladymeade Reference Unit
MSM-Men who have Sex with Men
MSW-Male Sex Workers
NHAC-The National HIV/AIDS Commission
NSP-National HIV Strategic Plan
OVC-Orphans and Vulnerable and Children made to HIV
PLHIV-People Living with HIV
PWD-People with Disabilities
QEH- Queen Elizabeth Hospital
SRH- Sexual and Reproductive Health
STIs –Sexually Transmitted Infections
S&D-Stigma and Discrimination
SO-Strategic Objective
SW-Sex Workers
TG- Transgender People
UGLAAB-United Gays and Lesbians against AIDS Barbados
VCT-Voluntary Counselling and Testing
Executive Summary
The Research, Evaluation and Policy Development Unit (REPDU) of the Caribbean Public Health Agency (CARPHA) in partnership with Barbados National HIV and AIDS Commission conducted a qualitative evaluation of the Barbados National Strategic Plan for the period 2008-2013 in September 2014, with key affected populations (KAP). Focus group discussions and key informant interviews were conducted with men who have sex with men (MSM) people with disabilities (PWD) people living with HIV (PLHIV) sex workers (SW) transgender people (TG) and adolescents. One of the key limitations of the study was that the majority of the focus group participants and interviewees were also volunteers, peer educators and activists in the HIV response and their views may not adequately represent the experiences of less enlightened beneficiaries.
The key findings are:
Specialist HIV services for HIV treatment and sexual and reproductive health (SRH) are highly regarded and should be considered a best practice.
There has been limited real active and ongoing engagement of KAP resulting in substantial unmet needs.
Coherent strategies and methods to engage KAP, along with behaviour change communication programmes are in need of strengthening.
The role of respected peers was deemed to be most impactful in motivating and supporting behaviour change.
There is an insufficiency with regards to civil society involvement in HIV programming to KAP, because there appears to be a lack of vibrancy, structure and leadership and capacity needs to be built in this area, particularly in relation to MSM, TG and youth.
Stigma and discrimination in the general population and in mainstream health care settings continue to be a barrier for KAP and few structural changes were made to foster an enabling environment for KAP
Human rights and gender equality programming was lacking.
KAP still view their selves as being on the outside looking in with limited power and influence to guide and shape HIV/STI programming and the allocation of resources.
They key recommendations are the need for:
An alignment of the national strategic framework for HIV/STI and activities with the expressed needs of KAP.
More prominence on BCC interventions and high impact programming
Civil society strengthening with regards to enhancing HIV programming and reach to KAP
Advancement of the human rights and gender equality agenda in HIV advocacy and programming.
A review the governance structures of HIV/STI programmes to make meaningful the participation and voices of KAP
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