30 April 2006

Greater Involvement of People Living with and Affected by HIV/AIDS in Cambodia – Extension Phase

Executive Summary

Brief overview of the project

The GIPA project document was developed in July 1999 by a joint project formulation mission of UNAIDS/UNDP/UNV. The first phase of the Cambodian GIPA project was implemented from June 2002 until – with extension – February 2005. The second phase of the project has been implemented from March, 2005, and the project will end in May 2006.

Objectives of the second phase of the GIPA project have been:
1. Increased understanding and enabling environment for GIPA in the target provinces and less stigma against PLHAs by the general public,
2. Capacity building of at least 50 institutions to involve PLHA in their programmes,
3. Building the capacity of GIPA Animators and PLHA in the country’s overall response,
4. Better access of women living with, and affected by HIV/AIDS, to existing care, treatment and support services and their involvement in monitoring the improvement of quality of these services.

The NAA has continued to be the Implementing Agency of the project during the second phase. There have been four (4) donors for the second phase of the project, UNV, UNAIDS, UNDP and UNIFEM. UNV, UNIFEM and UNDP have executed their own funding for the project, and the UNAIDS funding has been executed through UNDP. The total budget for the second phase has been USD 241,000. A National Project Coordinator (NPC) has been working for the project during the whole second phase. The Project Steering Committee has comprised of members from UNV, UNDP, UNAIDS, NAA and CPN+.

During the second phase, in addition to the six (6) GIPA Animators and one (1) Project Operations Assistant, who worked as NUNVs for the project since the first phase, four (4) GIPA Animators were selected for new Host Institutions (MoLVT, MoR, CPN+, WMC) and one (1) for the NCHADS to replace the GA who had resigned early during the first phase. Furthermore, three (3) GIPA Field Workers were recruited to the provinces of SRP, BMC and BTB.

Evaluation of the second phase

An external evaluation for the second phase of the Cambodian GIPA project was carried out between March 29 and April 28, 2006, in order to:
· Assess how recommendations of the project’s first evaluation have been taken into account during implementation of the second phase,
· Assess the outcome of the second phase, in relation to project objectives, with a special focus on volunteerism, gender and human rights,
· Find out a proper way for future efforts of GIPA in Cambodia, including an exit strategy for the current GIPA project and a road-map towards the future.

The evaluation was carried out by an International Consultant, with assistance of a Cambodian Translator. The evaluation included a review of the project documents and reports as well as other relevant texts and publications. In addition, individual and group interviews with people working for the GIPA project, representatives of GIPA Host Institutions (HIs), partner organizations and several UN agencies, NGOs, INGOs and donor agencies were carried out. The evaluation included also a half-day Workshop on April 25, 2006, for key agencies related to the project.

Findings

a) Recommendations of the first evaluation 2004

This evaluation started with assessment on how the recommendations of the project’s first phase have been taken into account during the planning and implementation of the second phase. The results and recommendations have been taken seriously, but in spite of conscious efforts, not all of them have been able to be implemented. The project has continued for a second phase, as recommended, and it has widened its coverage remarkably, targeting tens of new partner institutions. A qualified National PC was recruited for the project. New GIPA Animators and Field Workers have been recruited and placed to Host Institutions. The NUNVs have developed their ToRs, which has been very beneficial. “Formal” and “informal” capacity building has been carried out with and for the NUNVs, and the overall opinion of the NUNVs on their trainings and support is positive. Hundreds of PLHA have benefited from trainings and seminars.

The financial system and procedures have remained heavy and slow, however, causing postponements of implementing activities, as well as slow reimbursement of spendings. No petty cash has been available for the NUNVs, which has caused difficulties for them – for example some NUNVs report having paid gas for motorbikes as well as office equipment from their own pockets. Clarifying the roles and responsibilities of the PSC, Executing Agencies, Implementing Agency and the NPC has not really taken place. The quality of the project Work Plan and especially reporting have still left room for improvements. Less female PLHA have been recruited as NUNVs as planned, due to lack of qualified candidates. The project has not expanded to new provinces. Advocacy for high level decision makers has been difficult, at least partly due to lack of budget to attract them to attend seminars and meetings. The private sector and the general public have been reached by the project activities less than recommended.

b) Achievement towards the project objectives

Indicators that have been fully met:
· 25% of 200 target institutions who have not yet done integration of GIPA, have voluntarily mainstreamed the concept in their activities (under Objective 2)
· PLHAs participating in boards, councils, elected bodies etc. of the 50 target institutions referred above (Objective 2).
· Agencies and organizations which have participated in GIPA integration workshops have taken specific steps to integrate GIPA into their policies and programs (Objective 2).
· National UNVs’ and PLHAs’ interviews/feedback demonstrate increase in skill levels of areas in which training was received (Objective 3).
· At least 12 PLHA are participating in boards, councils and elected bodies in target institutions (Objective 3).
· Monthly NUNV reports include documentations on initiatives to empower selected PLHAs (Objective 3).
· The PWSFP has become a member of the NCHADS CoC TWG and is actively engaged in major decision making sessions (Objective 4).

Indicators that have been partially met:
· GIPA principles are reflected in the next NSP and other policy instruments through the inclusion of specific provisions related to GIPA (Objective 2).
· Strong, active and functioning sector composed of at least 5,272 women CPN+ members (Objective 4).

Indicators that have not been met
· Active exchange of communication and information exists between and among implementers of the GIPA project in the region, as measured by the number of email and information exchanges of the network (Objective 3).
· Formal agreements made reflecting linkages established between the sector and other professional organizations providing services (Objective 4).

Indicators that can not be measured due to lack of verifying data:
· At least 10% of total PLHA population in project target areas shows a better understanding of general GIPA principles (Objective 1)
· Documented cases of arbitrary discrimination in health care, employment, justice administration, school, housing and insurance are identified and quantified (Objective 1).
· Number of cases of arbitrary discrimination in health care, employment, justice, administration, school, housing and insurance decreased at least by 10% for male PLHAs and 15% for positive women (Objective 1).
· Reports of workshop evaluations reveal positive appraisal of participants on the effectiveness of NUNVs in organizing/facilitating activities (Objective 3).
· Notable improvements in the quality of specific women-friendly services in the CoC framework of key partners based on the set of indicators developed (Objective 4).
· Improvements in quality of MMMs based on the set of indicators developed by the NCHADS (Objective 4).

c) Volunteerism, gender & human rights

Volunteerism has clearly contributed to the project achievements and outcomes. The GIPA Animators and Field Workers, key people running the project activities, have been assigned as UN Volunteers. Due to the project’s lack of budget for ‘sitting allowances’, incentives and travel costs, a big part of the partner agencies and individual partners and beneficiaries have volunteered to participate the project activities and co-operation. The project has also managed to mobilize volunteers in many ways.

The gender dimension has been taken into account. Promoting women’s access to care, health and support services has been one of the project objectives. Placing a NUNV as a Positive Women Sectoral Focal Point at the CPN+ and selecting and training 28 other PWSFPs was already mentioned. Gender has been a topic during the project’s trainings, and a number of HIV+ women have benefited from the trainings. ‘Gender dimension’ in this project, however, has been understood as promoting equality between men and women. The needs and involvement of sexual and gender minorities have not been addressed.

Involvement and participation is a human right as such, and thus the whole project can be seen as a human rights initiative. The concept of rights-based programming has been addressed several times during the NUNVs’ follow-up meetings and the CoC and MMM workshops. The CHRAN, Organization on Cambodian Human Rights on HIV/AIDS Network, has been invited to present cases on HIV/AIDS, stigma and discrimination during several workshops. It is difficult to measure the project’s impact on human rights and reducing stigma and discrimination, however.

Conclusions

The project, during the second phase, has taken real effort to maximize its impact with the available resources and lessons learnt from the first phase, and achieved some concrete results to certain extent.

In addition to the fact that GIPA is now a priority area in the National Strategic Plan on HIV/AIDS 2006-2010, the overall impact of the project on the national response on HIV/AIDS in Cambodia has been limited. However, this project has proved, that a GIPA project can promote PLHA Involvement:
· In the national HIV/AIDS strategy and policy planning
· Within health care organizations
· In different line ministries
· Within the mass media
· Within PLHA networks
· Within provincial and district HIV/AIDS activities
· In the NGO sector
Furthermore, a GIPA project can benefit in establishment and strengthening PLHA groups and networks, strengthen the self-confidence and capacity of the PLHA involved and make PLHA as role models.

The Cambodian GIPA project is now in a phase of being handled over to be carried out stronger than before by Cambodian institutions, and changing its profile as a separate project into work of already existing and functioning national structures. This is the correct thing to do. Continuum of this project in the mentioned way is still needed in Cambodia.

Recommendations

The following is recommended for the future efforts of GIPA in Cambodia:

1. Continuing the GIPA initiative within existing local structures
2. Focusing the GIPA activities
3. Use and expansion of the GIPA Animator/GIPA Field Worker model
4. Inclusion of HIV/AIDS affected people to be active participants of future GIPA activities
5 Inclusion of other vulnerable groups, such as HIV/AIDS affected MSM, drug users and children

Exit Strategy

This included:
-  Ensuring the sustainability of the project’s achievements within the HIs and the partner institutions.
- Establishing a group for planning the future GIPA efforts.

Lessons learned

A number of lessons learned are presented for guidance of future GIPA projects, such as:
· Sensitization of the Host Institutions on the GIPA principle, and also their interest and willingness to host a GIPA Animator or Field Worker, are crucial factors.
· Profound and continued capacity building of the GIPA Animators and Field Workers is crucial for a GIPA project to success.
· During planning and implementing a GIPA project, all relevant stakeholders should reach a consensus on what is meant by ‘GIPA’ within this particular GIPA project.
· The roles and responsibilities of all key players, such as the PSC, the Implementing Agency, the Executing Agency, the PC and the GAs/GFWs should be made very clear
· A clear financial system should be established before starting any project activities.
· A clear M&E and reporting system should be established before starting any activities.
· Selection of the Project Coordinator (PC) is crucial for a project success.
· The fact that the GIPA project is not a funding agency, but and advocacy (and capacity building) effort should be made very clear to all HIs and partner agencies.