| Monitoring and Evaluation
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| 1. | We welcome the innovative approach which DFID used in drawing up the Monitoring and Evaluation Framework for its HIV/AIDS Strategy. We look forward to the publication of the first biennial report on World Aids Day 2010, and expect it to provide valuable information on progress made by DFID against its commitments in the Strategy. To further enhance transparency and accountability, we recommend that DFID publishes, in full, the completed biennial country overviews of progress against its priorities for action. This will assist all stakeholders, including ourselves, in assessing whether DFID is achieving its objectives for its HIV/AIDS activities. (Paragraph 14)
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| 2. | A challenge remains, however, in disaggregating DFID's contribution from that of other partners in the global AIDS effort. This is necessary to demonstrate to UK taxpayers what the UK's substantial funding for HIV/AIDS is achieving. We recommend that, in response to this Report, DFID provides us with further information on its plans for measuring the specific contribution its funding is making to tackling HIV/AIDS. (Paragraph 15)
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| Health system strengthening
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| 3. | We strongly support the substantial funding which DFID is providing to strengthen health systems in developing countries and fully accept that capable and well-resourced health services are an integral part of an effective HIV/AIDS strategy. We remain seriously concerned, however, that DFID has no mechanisms in place to track the impact which its £6 billion funding for health systems will have specifically on HIV/AIDS care, despite this being one of the key elements of its Strategy. We reject DFID's assertion that it is not "feasible, practical or desirable" to specify how its £6 billion in health systems funding will be allocated. We recommend that, in response to this Report, the Department provide us with a meaningful breakdown of its spending plans for this funding package, at least over the next two to three years, including an indication of how HIV/AIDS programmes are likely to benefit. (Paragraph 25)
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| 4. | The focus on health systems also ignores that fact that some of the essential components of universal access, particularly prevention and long-term care in the community, may not benefit from health systems funding. We recommend that, in response to this Report, DFID sets out how it will ensure that its HIV/AIDS Strategy promotes an holistic approach which includes prevention, treatment, care and support for all people living with HIV/AIDS, including those vulnerable to discrimination and stigmatisation. This approach must also recognise that prevention and care services are frequently provided outside the public health sector, by family members and community groups, and that targeted prevention programmes aimed at marginalised groups are often one of the most effective HIV interventions. (Paragraph 26)
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| Integration of HIV/AIDS with other disease programmes
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| 5. | We were disappointed that no measures for monitoring the integration of HIV/AIDS, TB and malaria programmes were included in the Monitoring and Evaluation Framework. An integrated approach to tackling these diseases is a key element in an effective AIDS strategy, given that so many people with HIV die from TB and malaria and that people with TB and malaria are more vulnerable to HIV. More resources are needed to promote early detection of TB, including funding for new diagnostic tools, as well as support for research into new drug treatment regimes. Greater attention must also be given to interaction with other diseases, particularly hepatitis C. We recommend that, in response to this Report, DFID provides us with information on its plans for developing programmes and funding research into co-infections between HIV/AIDS and other diseases, beyond TB and malaria. (Paragraph 33)
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| 6. | We welcome DFID's acknowledgement of the close links between promoting sexual and reproductive health and tackling HIV/AIDS. We were, however, disappointed to learn that DFID had postponed indefinitely the publication of its Maternal Health and Sexual and Reproductive Health and Rights Strategy, initially planned for mid-2009. We urge DFID to publish this important document as soon as possible and to ensure that it takes full account of the need for the integration of HIV/AIDS programmes with sexual, reproductive and maternal health services. (Paragraph 36)
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| Social protection programmes
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| 7. | We remain concerned that many of the most vulnerable people affected by HIV/AIDS, particularly children, may be excluded from social protection programmes. Cash transfers, while very effective in some situations, are not a sufficient mechanism for reaching those most in need because marginalised people, particularly those engaged in activities deemed to be illegal, are often unwilling or unable to access services. We are not convinced that DFID has the necessary mechanisms in place to enable it to measure the impact which its funding for social protection is achieving and to assess whether it is reaching the priority groups affected by HIV/AIDS. We recommend that, in response to this Report, DFID provides us with detailed information on how it plans to track its social protection funding and sets out the mechanisms it will use to measure its impact. (Paragraph 42)
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| Marginalised and vulnerable groups
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| 8. | Reaching the most marginalised people and those excluded from society with effective HIV/AIDS interventions can often best be achieved by small civil society organisations who understand the needs of specific groups of disadvantaged people. Engaging with such organisations requires adequate staff time and expertise. We remain concerned that DFID staff reductions mean that the Department is less well-equipped to do this necessary work than previously. (Paragraph 51)
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| 9. | DFID has given us some impressive examples of how it is using Challenge Funds channelled through umbrella organisations to support community-based organisations. We are not, however, convinced that DFID yet has a comprehensive strategy for working through civil society and community groups to reach the people most in need of HIV/AIDS services. We recommend that DFID, in response to this Report, provide us with further information on how it will use its monitoring and evaluation mechanisms to measure the effectiveness of its funding for HIV/AIDS civil society groups. (Paragraph 52)
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| 10. | Gender-based violence is an abuse of women's human rights and is a significant contributory factor in the spread of HIV. In its new White Paper, DFID has given a commitment to support women and girls affected by violence and its HIV/AIDS Monitoring and Evaluation Framework includes a provision for gender analysis of AIDS programmes. Although welcome, neither of these measures directly tackles the impact of gender-based violence on women and its links with HIV. DFID told us last year that it was reviewing its work on violence against women to assess where and how it could do more to tackle it. We recommend that it shares the results of that review with us, in response to this Report. (Paragraph 55)
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| Access to treatment |
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| 11. | Although we welcome the increase in access to anti-retroviral treatment which has been achieved, it is a serious concern to us that the global commitment to provide universal access to treatment by 2010 will not be met. We urge DFID to expand its programmes to increase access to anti-retroviral treatment. (Paragraph 57)
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| 12. | We are seriously concerned that the number of women receiving prevention of mother-to-child transmission treatment (PMTCT) remains well below target levels. DFID and its donor partners should prioritise treatment to women and children and use the opportunities presented by antenatal care to promote the take-up of HIV/AIDS treatment by women. DFID should also ensure that the PMTCT services which it supports recognise the wider health needs and potential vulnerability of women living with HIV/AIDS. (Paragraph 63)
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| 13. | A growing number of people living with HIV and AIDS will require access to anti-retroviral treatment (ART) if the target of universal access is to be reached. The number of people requiring ART is increasing because more people are being infected; the increased rate of testing is leading to more diagnoses; and people with HIV are now living longer due to successful treatment. We welcome DFID's co-operation with pharmaceutical companies to reduce the cost of first-line drugs for developing countries and to increase their accessibility. Wider availability of second-line drugs is now needed. We recommend that DFID provide us with more details, in response to this Report, of its plans to increase availability and reduce the cost of vital HIV/AIDS treatments through its co-operation with UNITAID and use of patent pools. (Paragraph 68)
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| Funding for HIV/AIDS programmes
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| 14. | The Government has reiterated its commitment to meet the target of allocating 0.7% of Gross National Income to Official Development Assistance, despite the impact of the global economic downturn. However, other countries are reneging on the pledges they have made. HIV/AIDS remains a serious development challenge and we are concerned about the impact that reduced development assistance funding will have on HIV/AIDS programmes. It is very disappointing that the 2010 target for universal access will be missed by a wide margin. This must not be compounded by failure to maintain the levels of support for HIV/AIDS programmes agreed by the international community. (Paragraph 73)
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| 15. | We support the Government's intention to work with Canada, when it holds the G8 presidency in 2010, to press donor countries to specify and publicise their targets for HIV/AIDS funding. We recommend that the Government sets an example to its G8 partners by specifying, in response to this Report, what the UK's HIV/AIDS annual expenditure targets will be from 2010 and how this funding will be allocated. (Paragraph 74)
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| 16. | The US$3 billion funding shortfall announced by the Global Fund to fight AIDS, TB and Malaria will affect its ability to deliver vital HIV/AIDS programmes. The UK's long-term funding commitment is commendable but, as a leading contributor to the Fund, the UK also has a responsibility to press other countries properly to support the Fund. The UK should take every opportunity to convey to international partners the importance of substantial and predictable allocations to the Fund and the serious consequences, including deaths, which will result from countries reneging on their funding pledges. (Paragraph 77)
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| 17. | We welcome the prospect of closer collaboration between the UK and the US on HIV/AIDS work which the relaxation of some of the restrictions on the operation of the President's Emergency Plan for AIDS Relief (PEPFAR) offers. The two countries are leading donors in this area and joint working, which includes developing country governments, is an effective approach to tackling HIV/AIDS which we recommend DFID pursues wherever possible. (Paragraph 82)
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| 18. | The focus in the DFID White Paper on fragile states provides an opportunity for the Department to strengthen its HIV/AIDS programmes in those countries and to work with others to ensure that effective prevention and treatment programmes are available to those affected by conflict, particularly women who are often the victims of sexual violence. It is vital, however, that this change of emphasis in DFID's priorities does not affect future funding for core HIV/AIDS activities in other developing countries. We recommend that DFID, in response to this Report, provide us with information on how HIV/AIDS funding will be broken down between fragile and conflict-affected states and other country programmes. (Paragraph 86)
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| Cross-Whitehall working on HIV/AIDS
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| 19. | The evidence we received from the Government has not persuaded us that the Foreign and Commonwealth Office has either the resources or the expertise to take lead responsibility for HIV/AIDS programmes in middle-income countries where DFID no longer has a presence. We remain concerned about the lack of clarity on how the FCO will perform this role. Yet it is in many middle-income countries that HIV infections are spreading most rapidly. We recommend that, in response to this Report, the Government provides us with specific examples of HIV/AIDS programmes which the FCO is pursuing in high-prevalence middle-income countries, including those aimed specifically at vulnerable and marginalised groups, together with the criteria which it has developed for selecting the countries where it will undertake this work. (Paragraph 90)
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| 20. | We have not been provided with enough evidence to convince us that the Cross-Whitehall Working Group has sufficient authority or capacity to act as the main mechanism for monitoring the implementation of the UK's HIV/AIDS Strategy. Its terms of reference are vague; it involves officials rather than ministers; and its administrative support does not appear to be adequate. One small step which would improve its transparency and accountability would be to publish the Group's meeting papers. Putting this information in the public domain may also help to persuade stakeholders that the Group is taking its monitoring task seriously and that it is capable of making a meaningful contribution to the biennial reporting process for the AIDS Strategy. (Paragraph 93)
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