BURKINA FASO

Monitoting and Evaluation of HIV/AIDS programs

Nicolas Meda

Background

Burkina Faso is a West African country of nearly 11 million people, 80% of whom reside in rural areas. The majority of the population (50%) is under the age of 15; 70% is under 30 and 52% of is female. More than 60 major ethnic groups coexist in Burk ina Faso, with three main ethnic groups dominating. Over 50% of the population is Muslim; 29% is Christian. The GNP per capita in Burkina Faso is around $230. One of the key factors for both the economic development of Burkina and the nature of HIV/AID S/STDs is the substantial labor migration of youth and men to more economically productive regions. Labor migrants generally move to either urban areas, the fertile regions in the south of the country or to neighboring countries.

The first AIDS cases were reported in 1986. From 1987-1990, HIV prevalence was about 4%. Burkina Faso has a generalized population epidemic with an estimated HIV prevalence in the general adult population exceeding 7%. The national response to the epi demic was limited until 1996. From 1996 on, programme efforts at the national level were scaled up significantly.

National response

A national AIDS programme (PNLS) was established in 1987, beginning with a short-term plan in the first years followed by three mid-term plans. In 1990 a national AIDS committee was created. Initially funding was small, but has increased to $18 million for the third mid-term plan covering 1996-2000. The government contribution has increased to 15% of the overall AIDS budget when the Population and AIDS control project was set up within the national AIDS programme in 1996.

The syndromic approach to STD control was introduced in 1996-97 in three STD control pilot projects. Programmes were extended to cover the whole country in late 1997. Voluntary counseling and testing facilities are only available in the towns of Bobo- Dioulasso, as the facility in Ouagadougou was closed following the withdrawal of donor support.

With regard to AIDS care, anti-retroviral treatment is available to a very small proportion of economically privileged persons living with HIV/AIDS, as costs are too high to expand to the general population. Anti-retroviral therapy (AZT) is on the nati onal list of essential drugs, though not widely used. There is no national anti-discriminatory legislation for people living with HIV/AIDS.

Monitoring and evaluation

The main monitoring and evaluation data collection efforts include an urban KAP survey among pregnant women, truckers and commercial sex workers in 1994, a nationally representative KAP survey in 1996 (3261 respondents) and HIV surveillance data from n ine antenatal clinic sites in 1994 (including more than 2,000 women). In addition, HIV data are available from commercial sex workers in the two largest towns at five points in time between 1989 and 1998.

The link between monitoring and evaluation and policymaking, programme planning and implementation has been weak. The subcommittees dealing with M&E had very limited resources, and have not been able to implement surveillance or evaluation activiti es according to plan.

Input, output and context

Data about the programme inputs can only be found in unpublished documents. There is no systematic monitoring of inputs or documents such as annual reports, which might summarize all activities. It is possible, however, to obtain data on government an d donor contributions to the AIDS programme and HIV prevention and AIDS care activities, numbers of health workers and others trained in IEC and the syndromic approach to STD treatment. Almost 10% of facilities now have personnel with STD treatment traini ng. Detailed data on condom distribution are available for the period 1986-1998, when numbers increased from 16,000 to 2.2 million in 1991 (with the launching of the social marketing programme) and to 4.7 million in 1998.

AIDS knowledge and attitudes have been the subject of many smaller and larger studies, which were reviewed in 1996-1997 (Desclaux et al., 1997). Surveys in 1994 (selected urban areas), 1996 (nationally representative sample on 3200 respondents) and 19 97 (selected rural areas) allow analysis of aspects of the trends in knowledge and attitudes.

There is no national blood safety policy and there are no national guidelines for blood transfusion practices. UNAIDS estimated that 80% of the blood transfusions were safe from HIV. VCT is not popular with less than 0.1% of the population using the s ervices in Bobo-Dioulasso. Eight organizations are concerned with AIDS care in the two largest towns.

Proximate determinants

Surveys focusing in knowledge and attitudes also included questions on ever use and recent use of condoms questions. This included a national survey in 1996. There are no data on prevention indicators 4 and 5 (non-regular partners and condom use during the last act with a non-regular partner).

In 1997 two surveys were conducted to evaluate the quality of STD services, using the WHO protocol. In both surveys – one in the North and one in the two regions with the two major towns the scores on prevention indicators 6 and 7 were well below 10%.< /p>

HIV/AIDS and STD

HIV surveillance has not worked according to plan. With the exception of 1997 the number of antenatal clinics with HIV prevalence data has been 3 or less during 1991-97. A review in 1997 concluded that resources were lacking, supervision was weak and q uality control procedures for the laboratories were not adequate. There is only one small population-based survey in a rural area, conducted in 1990. STD control is based on the national health information system, but urban studies have shown that underr eporting is a serious problem in the HIS data.

AIDS impact mitigation

AIDS cases are heavily underreported. It is estimated that coverage is only 4%. In the national survey in 1996 questions were asked about the respondents' attitude concerning AIDS patients. A large number of rural and urban respondents were found to h ave discriminatory attitudes (45% and 60% respectively).

Conclusion

The national response to the AIDS epidemic in Burkina Faso was limited during 1986-96 and was only recently expanded. As a consequence, HIV monitoring has also been constrained and has not been implemented according to national plans. STD monitoring i s almost absent, data on sexual behaviour are limited and the prevention indicators have only been used marginally. The main factor inhibiting improved monitoring and evaluation efforts is that there is no unit or body with resources to carry out monitori ng and evaluation. It is recommended that a subcommittee for epidemiology, monitoring and evaluation be established within the AIDS programme, to replace the serosurveillance subcommittee.