Written evidence submitted by UNICEF
1. The UK National Committee for UNICEF
welcomes the opportunity to make a submission to the International
Development Committee's inquiry into progress being made in the
implementation of the Government's strategy for fighting HIV in
the developing world "Achieving Universal Access—the
UK's strategy for halting and reversing the spread of HIV in the
developing world".
2. UNICEF, the United Nations Children's
Fund, is mandated by the United Nations General Assembly to advocate
for the protection of children's rights, to help meet their basic
needs and to expand their opportunities to reach their full potential.
UNICEF is guided by the United Nations Convention on the Rights
of the Child and strives to establish children's rights as enduring
ethical principles and international standards of behaviour towards
children.
KEY POINTS
— It is too early to state how far progress
has been made in implementing the Government's 2008 strategy as
a full detailed appraisal of current activities is yet to be made
public.
— DFID must ensure that children's rights
are placed at the centre of the implementation of the HIV strategy.
— While UNICEF UK welcomed the £6
billion commitment to strengthening health systems and fully supports
the needs to improve health systems in developing countries as
the backbone of the HIV response; it remains unclear which specific
activities and initiatives this money will fund.
— It currently remains unclear how critical
programmes that address the underlying dirvers of HIV infection,
such as gender norms, multiple concurrent partnerships and age
disparate relationships which increase young people's vulnerability
to HIV infection will be addressed within the implementation of
the strategy.
3. 2009 marks the 20th anniversary of the
United Nations Convention on the Rights of the Child (UNCRC),
which the UK Government ratified in 1991. Ratification committed
the UK Government to protecting and ensuring children's rights
both within the UK and through its international development policy.
It is therefore important that in evaluating the implementation
of the HIV Strategy the extent to which it uses a rights based
framework, as well as how it contributes to the fulfilment of
children's rights around the world is addressed.
4. It is becoming increasingly clear that
without a massive scale up of resources we will miss our Universal
Access targets in 2010. New statistics show that despite some
remarkable gains in other areas, much work is still needed to
reach the global target of universal access by 2010. For example
in 2008, only approximately 38% of children in developing countries
in need of treatment for HIV received it. Pregnant women and children
are still accessing treatment at lower rates than the general
adult population (38% of children in need of treatment receiving
it, compared to over 43% of adults in need).[84]
It is unclear what will happen to the HIV and AIDS agenda after
this. Therefore, the comprehensive implementation of this HIV
Strategy must ensure that the UK, as global frontrunners in the
international HIV response, maintains the momentum and efforts
invested in tackling HIV.
5. As the UN prepares to review the MDGs
in 2010, thoughts will turn to what the post 2015 framework should
be. The question is important and the UK expects to engage in
a debate over a range of options. But this should not distract
us or others from the primary task—over the next five years,
to pursue the delivery of the MDGs, including Goal 6 to reverse
the rate of HIV infections, as quickly as we can.
6. This submission covers several of the
questions posed by the Committee in their enquiry; responses on
our experience are detailed below.
The process established by DFID for monitoring
the performance and evaluating the impact of the Strategy
7. As the first baseline report from the
Government on the implementation of the HIV strategy is yet to
be made public, it is difficult to analyse in detail the process
established to monitor and evaluate its impact. However, the monitoring
and evaluation framework published on 1 December 2008 to accompany
the strategy did not provide a demanding framework for evaluation
with the use of quantitative indicators.
8. We hope that this framework for evaluation
will capture and monitor the broad intent of the strategy, beyond
the specific priorities for action, and ensure action across all
areas highlighted as important.
9. It also remains difficult to track UK
financial resources available for HIV and, within this, how much
is allocated to prevention, treatment and care and support activities.
While we welcomed the significant financial commitment made within
the strategy for health systems strengthening a breakdown for
how this has been, and will be, spent is yet to be provided. Without
clearer information on actual and intended spending on HIV activities
it will remain challenging to monitor the performance and impact
of the HIV strategy.
10. As part of monitoring the effective
implementation of the HIV Strategy there is an urgent need to
prioritize high quality data. Quantitative and qualitative data
is a prerequisite to identifying both those most at risk, including
young people, and evaluating programmes. Data must be disaggregated
by factors such as sex, age, marital status, wealth quintile and
geographical location can drive better programming. As part of
monitoring the performance and impact of the Strategy more emphasis
should be given to improving the quality of available data. As
a world leader in international development and a key player in
international fora DFID plays an important role in improving the
collection of data on HIV and AIDS both for its programmes and
for ensuring this inputs into improved HIV programming at all
levels.
Progress on health systems strengthening and on
an integrated approach to HIV/AIDS funding
11. While UNICEF UK welcomed the £6
billion commitment to strengthening health systems and fully supports
the need to improve health systems in developing countries as
the backbone of the HIV response; it remains unclear which specific
activities and initiatives this money will fund.
12. HIV and AIDS has a cross cutting impact
on the development agenda. In many countries, especially in the
high prevalence countries, HIV remains an emergency and in these
areas the response to HIV requires activities beyond the health
system. It currently remains unclear as to how these programmes
will be funded. For example, programmes to improve life skills
education for in and out of school youth and initiatives to address
the underlying drivers of HIV infection, such as gender norms,
multiple concurrent partnerships and age disparate relationships,
which increase young people's vulnerability to HIV infection.
13. While five people are infected with
HIV for every two that are placed on antiretroviral treatment
there is an urgent need to scale up action on preventing HIV infections.
With 45% of new infections taking place in young people, addressing
new infections within the 15-24 year age group is critical to
addressing the HIV epidemic.[85]
Yet to do this young people need access to information on how
to protect themselves against HIV infection and they need access
to youth friendly HIV services that are integrated within existing
health provision. In addition, to this young people also need
a safe and supportive environment that enables them to use both
the knowledge and access to health services to reduce their risk
and vulnerability to HIV infection. While the financial commitment
to health systems is crucial in providing aspects of this spectrum
of service provision it remains unclear where financing for the
creation of safe and supportive environments will be provided.
As evidence from Tanzania and Zimbabwe demonstrates without access
to this kind of environment HIV prevention efforts will continue
to have a limited long term impact.[86]
Integration of HIV/AIDS prevention, treatment and
care with other disease programmes, particularly tuberculosis
and malaria
14. It is as yet too early to say how much
progress has been made in improving the integration of HIV programmes
with other disease programmes. However, as mentioned above the
provision of integrated youth friendly services is critical in
improving the HIV and AIDS response for young people.
15. HIV prevention, diagnosis, treatment
and care should be integrated within existing health infrastructures,
which must be youth friendly. Young people need to receive appropriate
prevention counselling as part of voluntary testing and prevention
of mother to child transmission services. Those living with HIV
need information about how to live a positive and healthy lifestyle,
how they can influence the progression of the disease, what their
treatment and care options are, and how to prevent transmission
to others.
The effectiveness of social protection programmes
within the Strategy
16. UNICEF UK welcomed DFID's continued
support for social protection within the HIV Strategy. Social
protection remains a key way to reduced vulnerabilities to global
challenges, such as the global recession, climate change and HIV
and AIDS.
17. In the implementation of this support
it is essential that social protection programmes are child sensitive
and AIDS inclusive, as is outlined in the June 2009 statement
supported by DFID, UNICEF and other partners.[87]
This recognises those children's experiences of poverty and vulnerabilities
are multidimensional and differ from that of adults. Thus, social
protection should be focused on addressing the inherent social
disadvantages, risks and vulnerabilities that children may be
born into as well as those acquired later in childhood due to
external shocks. This is therefore best achieved through integrated
child protection approaches.
18. While it is too early to evaluate the
progress made in implementing these commitments within the Strategy
in order to reduce vulnerabilities DFID should review the design
and implementation of social protection policies to ensure they
are child sensitive and AIDS inclusive in order to maximise impact.
84 Towards Universal Access: Scaling Up Priority
HIV/AIDS Interventions in the Health Sector, 2009 WHO, UNAIDS
and UNICEF. Back
85
UNICEF UK 2009, Preventing HIV with Young People: The Key to
Tackling the Epidemic. Back
86
Mema Kwa Vijana and Regai Dzive Shiri. Rethinking how to prevent
in young people: Evidence from two large randomised controlled
trials in Tanzania and Zimbabwe. Policy Briefing Paper No.
10 Nov 2008. Back
87
DFID, Help Age International, Hope and Homes for Children, Institute
for Development Studies, International Labour Organisation, Overseas
Development Institute, Save the Children UK, UNICEF and UNDP.
Advancing Child Sensitive Social Protection, June 2009. Back
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