A Framework for the Evaluation of National Aids Programmes

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Author(s): Boerma T, Pisani E, Schwartlander B, Mertens T

Year: 1999

At present, UNAIDS, WHO, and USAID are co-ordinating a global initiative to improve monitoring and evaluation of national programmes (UNAIDS/WHO/MEASURE Evaluation, 1999). This initiative builds upon the experience in monitoring and evaluation of a wide range of developing countries and aims to develop guidelines for a sound monitoring and evaluation system. Experience in countries such as Thailand and Uganda has shown that there is a great need to demonstrate the overall impact of national AIDS programmes. Showing that programmes change behaviour and consequently reduce new infections is an essential component of building public support to sustain or expand the current budget and activity level of the national AIDS programme. One of the shortcomings of existing monitoring and evaluation efforts by national AIDS programmes is that they exist independently of a clear framework which links programme efforts and behavioural trends to HIV-related outcomes in a logical way. This paper proposes a simple conceptual framework for monitoring and evaluation of AIDS programs, using the intermediate or proximate determinants conceptual framework used in the study of fertility and child survival. By specifying the programme outcomes as proximate determinants based on epidemiological theory the conventional input-output-outcome-impact monitoring and evaluation framework becomes conceptually clearer. The framework underscores the need for selection of indicators at different levels of the framework, ranging from context and programme inputs to health impact and mortality and emphasises the central role of the proximate determinants. The combination of monitoring data at different levels of the framework with disease surveillance data provides the most practical basis for the evaluation of national programmes.