Presented by Roger Drew

Riga29th January 2009

Findings of Mid-Term Evaluation

HIV/AIDS PREVENTION AND CARE AMONG INJECTING DRUG USERS AND IN PRISON

SETTINGS IN ESTONIA, LATVIA AND LITHUANIA

� Baltic countries have significant HIV epidemics

� HIV continues to spread mainly through injecting drug use

� There are relatively high HIV prevalence rates in Baltic prisons

Introduction

� Four year project started in 2006

� $5m

� From Dutch government

� Managed by UNODC project office in Vilnius

Background

� To learn lessons from project implementation to improve future project planning, design and management

Purpose of Evaluation

� Review of available literature

� Semi-structured interviews with key informants during three country visits

� … and also with a few regional/international bodies and international experts

� Limitations

Method

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Fit with UNAIDS Division of Labour

� Convening power of UN agency

� Credibility with criminal justice system

� Approach

� Collaborative

� Neutral, professional and evidence-based

� Long-term, diplomatic, incremental, persuasive

� Flexible and country-driven approach to financing

UNODC Priority and Comparative Advantage

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Highly relevant

� Difficulties of working on HIV and AIDS in prison system

Objectives: Relevance and Attainability

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Growing consensus on importance of harm reduction approaches

� Increasing coverage… but need for agreed measures

� Increasing availability of strategic information

� Strong focus on capacity building activities

� Support to development of new national programmes in Latvia and Lithuania

Progress towards Objectives and Results

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Yes… because of relevance of objectives

Usefulness of Results

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� On HIV transmission…

� But issues of attribution

� Differences between countries

Likely Impact

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

Political Commitment

Environment for harm red (prisons)

Environment for harm red (comm)

Focus based on epidemiology

National coordination capacity

National coordination mechanism

Roles and responsibilities defined

Financing

Political continuity

Recognition as political priority

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

Funding Mechanisms

Level 4: In addition to levels 1-3, funding flows

through identified sustainable mechanism

Level 3: In addition to levels 1-2, sustainable funder is involved in project management and supervision

Level 2: In addition to level 1, sustainable funder

gives in-principle commitment to continue funding activities

Level 1: Sustainable source of future funding clearly

identified and agreed

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

Risks

NGO services

Prisons

Low Threshold Centres

MMT

� Government responsibility

� Political commitment

� Coordination function

� Financing mechanisms

� Risks

� Advocacy

� NGO capacity and fundraising

Sustainability

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Adverse economic environment

� Prison settings

� Capacity issues in small countries

� Also country-specific issues

Problems and Constraints

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Initial project implementation

� Management structures

� M&E framework

� Staffing levels

� Flow of information

� Financial management

� UN coordination

Planning, Implementation and Management

� Initial project implementation

� Management structures

� M&E framework

� Staffing levels

� Flow of information

� Financial management

� UN coordination

Planning, Implementation and Management

Initial Project Implementation

0

200000

400000

600000

800000

1000000

1200000

1400000

2006 2007 2008 2009 2010

$

Budget Expenditure

� Initial project implementation

� Management structures

� M&E framework

� Staffing levels

� Flow of information

� Financial management

� UN coordination

Planning, Implementation and Management

� UNODC priority and comparative advantage

� Objectives: relevance and attainability

� Progress towards objectives and results

� Usefulness of results

� Likely impact

� Sustainability

� Problems and constraints

� Planning, implementation and management

� Role of UNODC

Findings

� Overall positive

� Role of regional coordinator

� Relations with UNODC HQ

� Technical expertise

� Expanding role

Role of UNODC

� Prison settings

� NGOs

� Demands of managing a small grants programme

� M&E framework

Lessons Learned

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� Maintain and strengthen focus on activities among IDUs and in prison settings

� Ensure the equivalence of the provision of health services in communities, arrest houses and in prison settings

� Build bridges between services

General

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� Rapidly adopt M&E framework

� Support organisational development of NGOs

� Make project coordination mechanisms more sustainable

� Introduce ‘sustainability assessments’ for small grants

� Retain flexible approach to financing

� Review management role

� Provide training on ethics for health professionals

� Mapping range and quality of services at LTCs

� Improve information flow

� Resolve issues of financial management with UNDP

� Consider adopting a ‘light’ joint UN team on AIDS

UNODC

� Rapidly adopt M&E framework

� Support organisational development of NGOs

� Make project coordination mechanisms more sustainable

� Introduce ‘sustainability assessments’ for small grants

� Retain flexible approach to financing

� Review management role

� Provide training on ethics for health professionals

� Mapping range and quality of services at LTCs

� Improve information flow

� Resolve issues of financial management with UNDP

� Consider adopting a ‘light’ joint UN team on AIDS

UNODC

Funding Mechanisms

Level 4: In addition to levels 1-3, funding flows

through identified sustainable mechanism

Level 3: In addition to levels 1-2, sustainable funder is involved in project management and supervision

Level 2: In addition to level 1, sustainable funder

gives in-principle commitment to continue funding activities

Level 1: Sustainable source of future funding clearly

identified and agreed

� Rapidly adopt M&E framework

� Support organisational development of NGOs

� Make project coordination mechanisms more sustainable

� Introduce ‘sustainability assessments’ for small grants

� Retain flexible approach to financing

� Review management role

� Provide training on ethics for health professionals

� Mapping range and quality of services at LTCs

� Improve information flow

� Resolve issues of financial management with UNDP

� Consider adopting a ‘light’ joint UN team on AIDS

UNODC

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� National guidelines for MMT

� Study reasons for slow take-up of MMT in Tartu

Estonia

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� Establish task force for expansion of MMT

� Commit to pilot MMT in one prison

� Review provision of ART

� Adopt new AIDS programme

Latvia

� General

� UNODC

� Estonia

� Latvia

� Lithuania

Recommendations

� Review and revise new national AIDS programmebased on ASAP comments

� Commit to piloting MMT in one prison

� Explore ways of financing ART in prison

Lithuania

Presented by Roger Drew

Riga29th January 2009

Findings of Mid-Term Evaluation

HIV/AIDS PREVENTION AND CARE AMONG INJECTING DRUG USERS AND IN PRISON

SETTINGS IN ESTONIA, LATVIA AND LITHUANIA