External evaluation of NCA’s HIV and AIDS programme in West Africa (Mali, Mauritania, Guinea and Sierra Leone)

Background

NCA's regional HIV and AIDS programme in West Africa was initiated with the funds collected from the TV campaign in 2001. As 2006 was the last year with these funds, NCA wanted to have an external evaluation done in order to collect lessons learned for a possible new phase of the HIV/AIDS programme in two of the countries (Mali and Mauritania).

Purpose/objective

The purpose of the evaluation was to evaluate the intervention strategies, the results that have been achieved and lessons learned for a new phase of the programme.

Methodology

For Mali and Mauritania, a combined qualitative/quantitative study was done, whereas for Guinea and Sierra Leone, only a qualitative study was made.

Key findings

Mali:
It is especially on the level of local engagement and enthusiasm among the beneficiary groups that this programme has had success. Also, it is encouraging to note that the subject of HIV and AIDS is no longer a tabou, not even in Kidal, where there are traditionally the most restrictions when talking about sexuality. A quite large proportion of the population in the North knows at least two ways of contagion by the HIV virus, according to the evaluation report. This is of course the results of not only NCA's partners' interventions, but knowing that very few actors work in this area, especially Kidal, one might think that our interventions have had a certain impact at this level. One major obstacle to evaluating the achievement of NCA's partners' programmes is that there were not done baseline studies in a systematic way before the start of the programme, which makes it difficult to measure the impact. Also, the expected results were not always clearly stated in the partner's programme documents. Another challenge in Northern Mali is the fact that many religious leaders continue talking about HIV/AIDS as a result of sin and divine punishment.
Mauritania:
The evaluation report shows that good results have been achieved by the programme: A large number of both women and men know that the disease exists, and a fair number of people is aware of two ways of transmission of the virus (by sexual relations and blood transmission).
EVALUATION SUMMARY
However, the third main mode of transmission, from mother to child, is not well known, as is the case in NCA's intervention areas in Mali as well. The evaluators also find LWF's way of working with one of the most vulnerable groups, the (female and male) sex workers, interesting and path-breaking. This group, with which no other actors work due to their stigmatization in the Mauritanian society, has clearly changed its behaviour thanks to LWF and local partners' interventions (condoms are now used, tests are taken, additional information is searched for regarding STI's, etc.). The weakest part of LWF's programme on HIV and AIDS seems to be the one carried out as an integrated part of the rural development programme. According to the recommendations of the evaluation, this part of the programme needs to be further developed. Another recommendation is to strengthen and further develop the Muslim leaders' support to the programme, a component which seems to play an important role in order to convey the messages on HIV and AIDS in the strongly Muslim Mauritanian society.
For both Mali and Mauritania, the evaluation shows that the results are good when it comes to the level of knowledge about the disease and also on how to protect oneself. However, in the area of behaviour change, there still seems to be a lot to do.
Sierra Leone and Guinea:
The qualitative study has shown that good results have been made by Lutheran World Federation (LWF) in SL and by TWIN in Guinea, while LWF in Guinea seems to have achieved less during the programme period. Both LWF in SL and TWIN in Guinea are praised for their creativity and warmth with which they have approached the beneficiaries when talking about HIV and AIDS. Most of the people the evaluation team talked to knew about the disease and ways of protecting themselves. As in Mali in Mauritania, however, the critical point for the future seems to lie in the challenge linked to behaviour change.

Recommendations

Recommendations:
Mali:
- Further strengthening of partners' capacity for local response, problem analysis and programme planning
- Develop strategies to phase out from certain areas and transfer the responsibility to piloting committees with members from the local community
- In order not to contribute to further stigmatization of the persons living with HIV and AIDS it is urgent that NCA and partners elaborate a strategy to further sensitize the religious leaders regarding the transmission of the HIV virus
- NCA and partners need to reflect further on how to make people living with AIDS disclose and also how to sensitize their communities to take care of people living with HIV and AIDS
Mauritania:
- Strengthen the part of the HIV and AIDS programmes in the rural areas, by giving more responsibility to the local employees in these zones.
- Revisit the training guide to make sure the information is up to date.
- Use the statistics in the quantitative part of this evaluation to redefine the objectives for the period after 2007.
SL / Guinea:
- As NCA can no longer finance the HIV and AIDS work there, search for new partners or possible ways of continuing the efforts with only a minimum of funding.

Comments from the organisation

NCA will continue its HIV/AIDS programme only in Mali and Mauritania from 2007 on. A workshop has been held in first part of June with representatives from Mali and Mauritania in order to discuss ways of capitalizing the successes and the weaknesses and learn from each other for the conception of a new HIV/AIDS programme.