Annex 1: Lessons learnt from under-spendof
The "PREVENTING HIV/AIDS Project" (PHP)
These lessons are drawn from the independent mid-term
project review and the recent Country Programme Review carried
out by DFID's Evaluation Department.
Lesson 1: Government ownership and leadership
is important for good project implementation.
During the first two years, 2004-2005, PHP was co-managed
by Ministry of Health [MOH] and the World Health Organization
[WHO]. Division of responsibility and accountability was not clear,
resulting in delays in decision-making, project implementation
and expenditure. A key lesson is that WHO lacks the delegated
authority to effectively manage large-scale programmes.
In response, in 2006, DFID transferred sole management
to MOH, retaining WHO's technical assistance role. Under Government
management, the project is expanding coverage of activities and
disbursement is starting to increase. In 2005, the project reached
40.4% of street-based sex workers, increasing to 96.8% in 2006.
In 2005, the project distributed 200,000 needles and syringes,
increasing to 1.5 million in 2006 and still rising. Decentralizing
implementation to provinces is helping accelerate disbursement,
with more attention focused on strengthening provincial implementation
capacity.
Lesson 2: An enabling policy and legal environment
is important for effective delivery of HIV prevention programmes
for at risk groups
PHP targets harm-reduction and high-risk groups —
sex-workers and intravenous drug-users. This sensitive pilot work
outside the law led to slow disbursement as peer educators faced
police harassment while distributing condoms and clean needles
and syringes.
The Government of Vietnam passed the Law on HIV/AIDS
in 2006, legalising harm-reduction and institutionalizing coordination
among health, police and social affairs in combating HIV/AIDS.
This enabling policy environment facilitates the work of PHP.
PHP instantly scaled up needle and syringe distribution from 1.5
million in 2006 to 10 million [planned] in 2007. It demonstrates
how DFID can be a catalyst to support pioneering prevention work
that lays the foundation for scaling up.
Lesson 3: Flexible staffing is important to ensure
adequate DFID capacity to tackle implementation difficulties.
Initially, DFID Bangkok provided advisory support
to PHP. In response to rising implementation challenges, DFID
allocated dedicated in-country advisory capacity in 2006 to support
hands-on management demands. This has improved project delivery
and disbursement, supported and strengthened government leadership
and enhanced working with other donors.
Department for International Development
17 September 2007
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