GOVERNMENT OF MALAWI

                             MID-TERM REVIEW
                     FOR THE NATIONAL MANAGEMENT
                         OF THE HIV/AIDS RESPONSE

                                    FINAL REPORT

                                      Prepared by:

Namulondo Joyce Kadowe                &              Rogers T. E. Kamanga
International Lead Consultant                        Local Consultant                        

                                      March 2005

We wish to acknowledge National AIDS Commission and United Nations
Development Programme Malawi for the financial support extended to enable the
review to be undertaken. Special thanks go to Ms. Chimwemwe Mablekisi Planning
Officer, National Aids Commission and Mr. Fred Mwathengere Programme Analyst
(HIV/AIDS), United Nations Development Programme who assisted in mobilisation
and making appointments with the various respondents.

We are similarly grateful to staff of Ministries, Districts and other government
institutions, Non-Governmental and Community Based Organisations including Faith
Based Organisations and Development Partners for readily providing the team with
valuable information needed and for their assistance during our stay in their
respective districts and organisations.

We further pay gratitude to all stakeholders who participated in the key informant and
individual interviews.

The review team also registers sincere appreciation to all stakeholders who
participated in the Mid Term Review Draft Report Dissemination Meeting; your
valuable contributions informed and shaped the final report.

Finally we thank everybody who participated in and supported the review exercise

                           List of Acronyms

AIDS      Acquired Immune Deficiency Syndrome
ARVs      Anti-retroviral drugs
ASOs      AIDS Service Organisations
CBO       Community Based Organisation
CHAM      Christian Hospital Association of Malawi
CSOs      Civil Society Organisations
CSR       Centre for Social Research
DACC(s)   District AIDS Coordinating Committee(s)
DHACs     District HIV/AIDS Coordinators
DHRMD     Department for Human Resource Management and
EP&D      Economic Planning and Development
FBOs      Faith Based Organisations
GIPA      Greater Involvement of People Living with HIV/AIDS
GoM       Government of Malawi
HIV       Human Immunodeficiency Virus
HR        Human Resources
IGAs      Income Generating Activities
MANASO    Malawi Network of AIDS Support Organisations
MANET+    Malawi Network of People Living with HIV/AIDS
MBCA      Malawi Business Coalition Association
MGSF      Malawi Government Scholarship Fund
MIM       Malawi Institute of Management
M&E       Monitoring and Evaluation
MPRSP     Malawi Poverty Reduction Strategy Paper
MTR       Mid Term Review
NAC       National AIDS Commission
NAPHAM    Network of People with HIV and AIDS in Malawi
NAF       National Action Framework
NSF       National Strategic Framework
NVP       National Volunteer Programme
OPC       Office of the President and Cabinet
PLWA      Persons Living with AIDS
PSC       Programme Steering Committee
PSD       Programme Support Document
SASO      Salima AIDS Support Organisation
ToRs      Terms of Reference
UNDP      United Nations Development Programme
UNICEF    United Nations Children Fund
UNV       United Nations Volunteers
USAID     United States Agency for International Development
WFP       World Food Programme
WHO       World Health Organisation

Table of Contents
Acknowledgementi ........................................................................................................ i
List of Acronyms .......................................................................................................... ii
Executive Summary ..................................................................................................... iv
CHAPTER ONE ........................................................................................................... 1
CAPACITY DEVELOPMENT PROGRAMME ......................................................... 1
1.1 Introduction ............................................................................................................. 1
1.2 Background to the Study......................................................................................... 1
1.3 Objectives of the Mid Term Review ....................................................................... 2
1.4 Scope of the Mid Term Review .............................................................................. 2
1.5 Review Process ....................................................................................................... 2
1.6 Report Structure ...................................................................................................... 3
CHAPTER TWO .......................................................................................................... 4
2.1 Introduction ............................................................................................................. 4
2.2 Programme Objectives ............................................................................................ 4
2.3 Programme Components …………………………………………………………5
2.4 Collaboration with Regional Programme ……………………………………….8
2.5 Key Strategies for Programme Implementation ..................................................... 8
2.6 Institutional Arrangements...................................................................................... 8
2.7 Programme Monitoring and Evaluation.................................................................. 9
CHAPTER THREE .................................................................................................... 10
3.0 FINDINGS ............................................................................................................ 10
3.1 Introduction ........................................................................................................... 10
3.2 Capacity Development for Planning and Management of National Response ..... 10
3.3 Capacity Building for the Strategic Integration of HIV/AIDS                                                              22
3.4 Conclusions on Findings…………………………………………………………27
CHAPTER FOUR ....................................................................................................... 28
4.1 Introduction. …………………………………………………………………… 28
4.2 Understanding of Key Terms…………………………………………………… 28
4.3 Assessment of Relevance, Appropriateness, Effectiveness, Adequacy,
    Sustainability and Timeliness………………………………………………....... 29
4.4 Conclusions on Assessment of Relevancy and Effectiveness ……………… ….34
CHAPTER FIVE.........................................................................................................35
5.1 Introduction……………………………………………………………………....35
5.2 Key Recommendations ......................................................................................... 35
5.3 Conclusions ........................................................................................................... 39
5.4 The Way Forward ................................................................................................. 39

                            EXECUTIVE SUMMARY

The Mid Term Review of the United Nations Development Programme, Capacity
Development for the National Management of HIV and AIDS Response Programme
(2002 to 2006), which is executed by the National AIDS Commission, was conducted
between December 2004 and March 2005 by an external consultant with the
assistance of a local consultant.

Programme Design
The programme was designed to directly assist Government’s poverty reduction
strategy as outlined in the Malawi Poverty Reduction Strategy Paper. HIV/AIDS was
identified as a major threat to national development initiatives particularly through
weakening the productive and managerial capacity of the country. In response, a
Capacity Development Programme for the National Management of HIV and AIDS
Response was formulated, to focus specifically on developing institutional support,
appropriate systems and mechanisms for effective and timely management of national
HIV/AIDS response.

Objectives and Scope of the Mid Term Review
The main objectives of the Mid Term Review were to assess the achievements,
relevance and focus, performance and management of the Programme Support
Document in the management of HIV/AIDS national response.
In terms of scope, the programme broadly focussed on (i) relevance of the objectives,
intended outputs and components to the management of the HIV and AIDS for the
national response and how they are contributing to the intended outcomes and (ii) the
appropriateness and focus of the programme in view of the increased number of
players in the domain of HIV and AIDS in the national response, and its
appropriateness to achieve the intended outcomes.

The specific focus of the review was to assess the:
 Effectiveness of the National Executing Agency to manage the programme
 Adequacy of monitoring and evaluation mechanisms for the programme
 Achievements of intended outputs that could lead to the realization of intended
 Timeliness of inputs and results
 Contribution of the programme to the development of the national capacity for the
   management of the HIV/AIDS response
 Sustainability of the programme results
 Capacities developed at the national and sub-national levels in enhancing national
   ownership of the development initiatives.

Review Process
A combination of data collection methods was used in the review. Secondary data
were collected from literature including policy documents, programme documents,
reports and work plans. Key informant interviews conducted for selected respondents

from line ministries, national government institutions, UN agencies and Civil Society
Organisations constituted primary data. Content analysis was used to manage and
analyse the information collected.

The review found that the design of the programme was focused on the capacity gaps
within the national response. The programme focussed on two dimensions of
capacity building viz. enhancement of capacity for planning and timely management
of the national response to HIV/AIDS as well as development of the capacity of
public sector to mainstream HIV/AIDS in the national policies, plans and sector

The Programme Support Document had a well developed results and resource
requirement framework with targeted indicators for clearly defined activities, outputs
and outcomes that guided the executing agency. The inputs and the implementers for
specific activities were identified and spelt out.

The implementation arrangements were found to be adequate with exception of
procedures that required the implementing partners to develop new proposals
altogether in a situation where budgets and activities had already been approved.
This was found to have led to unnecessary delays in implementation of activities and
subsequently, realisation of expected outputs. To this effect, the review team
recommended the active participation of would be implementers in subsequent efforts
geared at programme formulation.

The strategy to entrust the execution of the programme with the National AIDS
Commission was commendable given that the programme was multi sectoral and
designed to develop capacity for the national response and mainstream HIV and
AIDS in the national agenda. The National AIDS Commission is strategically
positioned and mandated to take a lead in the National Response. In addition to
recognising the role of the National AIDS Commission, the programme was
instrumental in enhancing the capacity of the national executing agency to manage
the national response through human resource development support such as staff
remuneration and training as well as logistical support.

From the findings, the review noted significant achievements have been made. It
further observed that despite some implementation shortcomings, the programme
objectives, output, and resultant outcomes were found to be relevant, appropriate and
adequate. However, the success of the national response can not be exclusively
attributed to the capacity development programme of UNDP.

The review identified a number of issues, challenges and opportunities and made
several recommendations focusing on:
    increased participation of key actors in programme formulation and

    Enhanced role of UNDP in areas of comparative advantage
    Focused capacity building
    Improved coordination
    Promoting HIV/AIDS research and development
    Mainstreaming gender and human rights into HIV/AIDS programming
    The importance of and need to promote the GIPA Principle
    The need for strong linkages at district level
    Urgency and importance of ‘Partnership’ development
    Monitoring and Evaluation and
    Resource Management.

Conclusion and Way Forward
The capacity development programme was found to be relevant and appropriate. It
has attempted to effectively contribute to the Malawi’s poverty reduction strategy.
The programme was found to be flexible and innovative. For example, Private Sector
which was inter alia outside the programme was brought aboard.

The programme has played a catalytic role in preparing implementers for HIV and
Aids management and mainstreaming in the different development agenda.
Therefore, it should be continued to consolidate and sustain the gains so far made,
during the initial phase of implementation.

In this connection, implementation steps have been suggested as a way forward which
has included consideration and adoption of this report, reconstitution and
operationalisation of the Programme Steering Committee, Programme publicity and
revision of the PSD.

                                  CHAPTER ONE


This report presents the results of a Mid Term Review (MTR) of the Capacity
Development for National Management of the HIV/AIDS Response (2002 to 2006),
which the United Nations Development Programme (UNDP) is implementing
through the National AIDS Commission (NAC). The Programme is part of national
response to HIV/AIDS adopted by the Government of Malawi. The Review was
carried out by Ms Namulondo Joyce Kadowe, International Consultant, and Mr.
Rogers T. E. Kamanga, Local Consultant between December 2004 and March 2005.

The report briefly outlines the background to the study, and discusses the findings and
challenges of programme implementation. It also makes recommendations and
suggests the way forward for enhanced programme implementation and realization of
the capacity building and HIV/AIDS objectives.

UNDP in collaboration with the Government of Malawi formulated a Programme
Support Document (PSD) for a five-year programme from 2002 to 2006 for Capacity
Development for National Management of the HIV/AIDS Response. The programme
was designed to directly assist Government’s poverty reduction strategy as outlined in
the Malawi Poverty Reduction Strategy Paper (MPRSP). Within the MPRSP
HIV/AIDS is identified as one of the major cross cutting issues that is seriously
undermining all attempts to reduce poverty and develop the country. In particular,
HIV/AIDS has negative effects and impacts on Malawi’s development agenda and
her productive and managerial capacity.

In this regard, the formulation of the Capacity Development for National
Management of the HIV/AIDS Response Programme focused on developing capacity
to address the development dimensions of the HIV/AIDS epidemic. Specifically, the
programme focused on developing institutional support, appropriate systems and
mechanisms for effective and timely management of national HIV/AIDS response.
The programme also advocates for HIV/AIDS mainstreaming in the public and
private sectors, as well as District Assemblies; skills development and provision of
equipment, among other things.

To ensure the programme effectively contributes to the realization of the stated
objectives, the PSD provided for mid-term review in order to determine achievements
of the programme half way the implementation period, and to make recommendations
for subsequent implementation.

The main objective of the MTR as provided for in the terms of reference was to
assess the achievements, relevance and focus, performance and management of the
PSD in the management of HIV/AIDS national response.

The MTR focussed on:
     Assessing the relevance of the objectives, intended outputs and components to
      the management of the HIV and AIDS for the national response and how they
      are contributing to the intended outcomes.

      Reviewing the appropriateness and focus of the programme in view of the
       increased number of players in the domain of HIV and AIDS in the national
       response, and its appropriateness to achieve the intended outcomes.

In specific terms, the review has focused on the performance and success of the

In terms of performance, the evaluation focused on (i) effectiveness of the national
executing agency to manage the programme; (ii) adequacy of monitoring and
evaluation mechanisms for the programme; (iii) achievements of intended output that
could lead to the realization of intended outcomes and; (iv) timeliness of inputs and

In order to determine the scope of success the team evaluated the (i) contribution of
the programme to the development of the national capacity for the management of the
HIV/AIDS response (ii) sustainability of the programme results and; (iii) capacities
developed at the national and sub-national levels in enhancing national ownership of
the development initiatives.

The review was also expected to revise the PSD, based on its findings. However,
given the scope and volume of work involved in the revision and the fact that it was a
distinct activity that would logically follow the formal adoption of the report, it was
found necessary to exclude it. This was mutually agreed with both clients (NAC and

Detailed terms of reference of the review are as outlined in Appendix 1.

A combination of methods was used in collecting data for the MTR.

1.5.1 Documentation Review
Documentation review was undertaken of: PSD on Capacity Development for the
National Management of the HIV and AIDS response, Workshop report on
mainstreaming HIV and AIDS into sector programmes and the workplace, review and
selected quarterly activity progress reports as well as National HIV/AIDS major

documents such as the National Strategic Framework (NSF), Integrated Annual
Workplan 2003-2008 and National HIV/AIDS Policy.

1.5.2 Interviews
Primary data included interviews with selected key informants representing line
ministries, national government institutions, CSOs that are categorised as AIDS
Service Organisations (ASOs) and Faith Based Organisations (FBOs), associations
and networks of People Living with HIV/AIDS (PLWA) and selected UN agencies
(see Annex 2) for details of persons met). Field visits were made to four selected
focus districts, namely; Mchinji, Dedza, Blantyre City and Mwanza to get first hand

Maintaining its independence, the review team held several interactive meetings with
the UNDP HIV/AIDS programme staff responsible for the programme and also
benefited immensely from the information and proposals by the staff of NAC and the
Department of Human Resource Management and Development (DHRMD). This
was useful in ensuring practical outcomes and commitment.

1.5.3 Draft Report Dissemination Meeting
In order to check for errors and validate information collected and analysed, the draft
report was disseminated and discussed with key stakeholders. A list of participants is
attached as Annex 3.

The report is divided into five chapters as follows:

      Chapter one presents the Background of the MTR, the Review Objectives and
      Chapter Two presents the Programme Design

      Chapter three outlines the Findings: Achievements and Challenges as well as
       observations made by the review team

      Chapter Four       presents   Assessment        of   Programme   Relevance   and

      Chapter Five presents Recommendations, Conclusions and Way Forward

                                  CHAPTER TWO


HIV/AIDS was identified in the Malawi Poverty Reduction Strategy Paper (MPRSP)
as a major cross cutting issue which undermines all attempts to reduce poverty and
develop the country; HIV/AIDS has negative effects on the country’s development,
and its productive and managerial capacity. The PSD on Capacity Development for
the National Management of the HIV and AIDS response is designed within the
GoM/UNDP Country Co-operation Framework for 2002 to 2006.

The overall objective of this programme was to address the HIV/AIDS dimensions of
poverty by strengthening the capacity of national and sub-national coordinating,
implementing and monitoring institutions to effectively carry out their roles and
functions in the national response to the HIV/AIDS epidemic. The programme further
sought to reduce the incidence of HIV/AIDS through positive behavioral change.

Specifically, the programme was aimed at (i) improving the national capacity for an
effective and timely response to HIV/AIDS; (ii) supporting government to undertake
advocacy and policy dialogue activities, applied social research and policy analysis
on the impact of HIV/AIDS on development and governance, and assist public and
private sector, and civil society including the faith communities to mainstream
HIV/AIDS in their core activities; (iii) supporting activities that encourage positive
behavioral change through social mobilization and IEC; and (iv) promoting PLWA
involvement in all HIV/AIDS and development activities in Malawi.

The major expected outcome of the PSD is enhanced institutional capacity to plan
multi-sector strategies at both national and sub-national levels in order to limit the
spread of HIV/AIDS and mitigate its social and economic impact on the poor.

The PSD underscores gender and human rights dimensions of HIV/AIDS as major
guiding principles in the program implementation. Notwithstanding the emphasis the
PSD put on the principle of gender, it is worth noting at this stage that the PSD results
framework and resource requirement matrix did not have gender specific or gender
related outputs, indicators, activities and resource indication. Similarly regarding
human rights aspects, the activities in the PSD do not clearly demonstrate outputs
leading to capacity building for promotion of the rights of PLWA. Hence gender and
human rights issues were mentioned only superficially and left to the interpretation of

The Capacity Development Programme had two broad intended outcomes namely (i)
institutional capacity development to manage the national response to HIV/AIDS and
(ii) integration of HIV/AIDS in national and sectoral plans. The programme
components are discussed below:

2.3.1 Capacity Development
The expected outcome for the capacity development component of the programme
was to strengthen institutional capacity to plan and implement multi-sectoral
strategies at both national and sub national levels to limit the spread of HIV/AIDS
and mitigate its social and economic impact on the poor, including women and the
girl child.

The objective of capacity development is to strengthen national capacity for
coordination of the national response and the implementation of HIV/AIDS activities
at national, sector, district and community levels. The component activities focused
on institutional development through training, and development of systems and
mechanisms for effective management of the epidemic at both the national and sub-
national levels. Within some organizations such as NAC and District Assemblies the
capacity development support through institutional development included staffing
support in terms of meeting remuneration for key staff and provision and maintenance
of office facilities such as telephone, computers and vehicles as well as systems

Institutions that benefited from this component include; NAC, Department of Human
Resource Management and Development (DHRMD), District Assemblies, Malawi
Network of AIDS Service Organisations (MANASO), Malawi Network of people
living with HIV/AIDS (MANET++), Malawi Business Coalition Association
(MBCA) and ASOs like Salima AIDS Support Organization (SASO). The intended
programme outputs and activities to develop and strengthen capacity of identified
institutions as stipulated in the PSD are summarized in the table below:

Table 1: Expected Outputs and Activities for institutions benefiting from the
Capacity Development Programme

Programme Outputs             Programme Activities per Output
NAC to manage, coordinate,      Develop and implement mechanisms for coordinating
advocate,            mobilize    national response.
resources, and monitor and      Develop and implement day to day financial
evaluate gender sensitive        administrative logistical system.
and ethically sound, a multi-   Conduct training needs assessment for management and
sector national response         coordination.
                                Train staff in management and coordination
                                Provide institutional support
Ministries     of     Health,   Assess capacity of ministries, districts and ASOs for
Defence, Agriculture and         mainstreaming HIV/AIDS.

Programme Outputs             Programme Activities per Output
Home Affairs; Office of the      Review systems and mechanisms for mainstreaming
President particularly the        HIV/AIDS.
DHRMD;               District    Review and develop district planning that provides
Assemblies     and     AIDS       guidance for the integration of HIV/AIDS in the district
Support Organizations to          development plans.
mainstream HIV/AIDS.             Develop mechanisms for coordination.
                                 Train staff of ministries, District Assemblies and ASOs.
Central Planning Agencies        Conduct participatory capacity assessment of central
to integrate HIV/AIDS in          planning agencies for integrating HIV/AIDS into
national development plans,       national development plans, poverty reduction
sector plans, and budget          strategies and budget processes
processes.                       Train members of staff on integrating HIV/AIDS in
                                  budget processes, policies, plans and strategies.
Centre for Social Research       Assess and develop capacity of research institutions to
(CSR), Malawi Institute of        carry out applied social and economic research on HIV
Management (MIM) and              and development
Department of Economics at       Train members of staff in research methodology.
Chancellor College to carry
out applied and social
research on HIV and
HIV/AIDS mainstreamed in  Develop conceptual linkages between HIV/AIDS with
all    UNDP        supported       UNDP supported programmes and administrative
programme activities and           processes.
administrative processes        Assess AIDS mainstreaming into UNDP supported
                                   programmes and administrative processes.
                                Revise UNDP programs and UNDP administrative
                                   processes based on activity 2.
                                 Review effectiveness of mainstreamed AIDS

2.3.2 Strategic Integration of HIV/AIDS
The expected outcome for the above component of the Programme was the developed
strategies for mainstreaming HIV and AIDS in national development plans, poverty
reduction strategy and budgetary allocations to address the impact of AIDS on
development and poverty eradication.

The component activities for mainstreaming targeted on: engagement of national
leadership, advocacy, and creation of alliances with the civil military, improvement of
food security of PLWA, integration of PLWA in the national responses and provision
of ARVs. The intended programme outputs and activities for integration of
HIV/AIDS as stipulated in the PSD are summarized in the table below:

Table 2: Expected Outputs and Activities for Integration

Programme Outputs              Programme Activities per Output
National           leadership,  Conduct 4 HIV and Development workshops.
debate and exchange of  Facilitate study tours to countries with promising roles for
experiences enhanced              national leadership.
                                 Assist members of parliament to integrate HIV/AIDS in
                                  their party manifesto
                                 Review effectiveness of intervention
Advocacy and social  Advocate and mobilize people to protect the human rights
mobilization on human             of HIV/AIDS infected and affected persons.
rights,      stigma       and  Organize meeting between local and international
discrimination sensitive to       institutions to exchange of experiences.
gender promoted.                 Advocate for law reforms that do not discriminate against
                                  HIV/AIDS infected and affected persons.
Developed                 and  Jointly identify areas of collaboration between civil
implemented              Civil    society and disciplined forces.
Military Alliance against  Develop mechanisms for partnership in areas identified
AIDS                              above
                                 Implement the joint activities
Improved capacity of  Jointly with WFP, UNAIDS and NAC assess and select
CBOs, HBOs and NGOs               NGOs and CBOs to deliver nutrition supplements to
involved         in      food     AIDS affected households.
distribution              and  In collaboration with WFP and selected NGOs, CBOS
empowernment of PLWAs             develop criteria and logistical system for supplying
through IGAs.                     nutrition supplements.
                                 Develop and implement nutrition program
                                 Review effectiveness.
People      infected      and  Train 12 PLWA to form a pool of GIPA workers and
affected by HIV/AIDS              facilitate a phased recruitment, placement and
fully integrated in the HIV       participation/involvement in institutions, communities.
national response                Assist GIPA workers to create support groups at
                                  workplace and communities linked Malawi network of
                                  people living with HIV/AIDS.
                                 Develop a monitoring and evaluation system for assessing
                                  impact of GIPA.
                                 Review effectiveness of GIPA initiative.
Assessment of Ministry of  Assess the Ministry of Finance, Health and communities
Finance, Private Hospital         preparedness to introduce ARVs.
Association, Health and  Develop strategic plan for system’s preparedness to
communities preparedness          introduce ARVs at national and community level
for ARVs implementation           (including negotiations of price reductions).
                                 Implement strategic plans for system’s preparedness to
                                  introduce ARVs at national and community level.
                                 Review effectiveness of the program

It was expected that in strengthening the management of the national response, the
programme would work closely with the UNDP HIV/AIDS and Development
Regional Programme. In this connection, it was expected the programme would seek
to build trans-national and regional linkages to address issues of cross border nature
falling under the aegis of the programme. The Regional Programme objectives aimed
      Strengthening policy measures, institutional arrangements and strategic plans
       aimed at reducing the consequences of HIV infection on human and social
       capital formation and utilization.
      Developing methodologies, tools, and approaches for assessing the impact of
       HIV on development efforts and integrating HIV policies and strategies into
       development agendas.
      Strengthening capacities of regional institutions and UNDP Country offices to
       provide technical and advisory assistance on HIV and development to countries,
      Formulating regional long-term strategic action plan based on regional
       consensus on managing the HIV epidemic for sustained human development.

The main strategies that were adopted for implementing the programme included:
     Strengthening the capacity of sub-national structures that support them to
      respond in an integrated and effective manner sensitive to gender and human
     Strengthening the national institutional capacity to manage the adverse impact
      of the epidemic on human and social capital, productivity and their core
     Strengthening the capacities of central planning agencies to integrate HIV/AIDS
      in national policies, strategies and budgetary allocation processes.
     Supporting Government to undertake applied social research and policy analysis
      on the impact of HIV/AIDS on development and governance, and assist public
      and private sector, ASOs, and civil society including faith communities to
      mainstream HIV/AIDS in their core activities.
     Supporting activities that encourage positive behavioural change through social
      mobilization and IEC.

The PSD spelt out implementation arrangements, coordination, financial management
and programme Monitoring and Evaluation structures and mechanisms described

2.6.1 Implementation Arrangement
The overall execution of the programme is at the national level by the NAC
Secretariat. Implementation of the programme is undertaken by Government
ministries/departments, international NGOs, local NGOs and CBOs, including FBOs.

To ensure effectiveness of programme delivery, arrangements were made to assess
the capacity of implementing agencies prior to implementation and where necessary,
training in aspects such as financial management and reporting would be carried out
by NAC through an organizational development NGO that was identified during the
process of preparing the PSD. In addition, UN Volunteers (UNV) were to be
recruited to supplement the capacity requirements for the programme implementation.

2.6.2 Programme Coordination
For programme coordination, a Programme Steering Committee (PSC) was proposed
to provide guidance on programme management and implementation. The committee
was expected to meet on a six monthly basis. Its main responsibility was to assess the
effectiveness and efficiency of the work undertaken by the implementing agencies
and select new implementing partners. The Chairperson of the National AIDS
Commission was designated to chair the PSC which constituted of selected
implementing partners of the program, including the NGO executing agency, the
Executive Director of the NAC and the UNDP Resident Representative.

2.6.3 Financial Management
As regards financial management, it was arranged that UNDP would make quarterly
financial disbursements to the NAC and or directly to implementing partners based on
the work plan approved by the PSC. This arrangement did not foresee a basket
funding mechanism which was later adopted by Government of Malawi and enhanced
resources for national HIV and AIDS response.

2.7     Programme Monitoring and Evaluation
The evaluation of the previous programme observed that monitoring and evaluation
(M&E) was not given deserving prominence. The design of the current PSD made
attempts to address the M&E gaps by identifying and stating indicators, proposing
monitoring related activities viz. assessments, reviews and evaluations as well as
clarifying institutional arrangements and mechanisms. M&E operational activities
were planned to be conducted by the NAC as the national execution agency as
enumerated below:
     Submission of six-monthly consolidated performance reports for transmission
        to the Program Steering Committee and UNDP;
     Production of annual program reports for submission to the Tripartite Review
        Meeting for review once a year;
     Preparation of quarterly financial reports for UNDP as a basis for the quarterly
     Organising for annual programme and financial audits;
     Conducting regular support supervision visits and;
     Mid term Review.

                                CHAPTER THREE


This chapter presents and discusses the findings of the MTR. The discussion has
focused on implementation of respective components, achievement of intended
outputs and challenges met in implementation. Two dimensions of the capacity
building programme are identified: (i) enhancement of capacity for planning and
timely management of the national response to HIV/AIDS and (ii) development of the
capacity of public sector to mainstream HIV/AIDS in their policies, plans and sector

The findings are discussed based on the above identified programme dimensions.
Within each programme dimension, the discussion of findings is focused on
achievement of outputs as stipulated in the PSD.

3.2      CAPACITY            DEVELOPMENT           FOR        PLANNING          AND
The major expected programme outcome is the developed institutional capacity to
plan and implement multisectoral strategies at the national and sub national levels to
limit the spread of HIV/AIDS and mitigate the social and economic impact on the
poor including women and the girl child. Therefore, capacity development targeted
institutions at all levels including NAC as the coordinating body in the management
of the HIV/AIDS national response in Malawi as well as executing agency for the
programme; government ministries, Office of the President and Cabinet (OPC),
District Assemblies and ASOs including Private Sector. Ministries specifically
targeted are those of Health, Agriculture, Defence, Home Affairs; Central Planning
Agencies; Socio-economic Research Institutions and UNDP.

A key observation of the review relates to the lack of guided consensus on what
constitutes capacity building, the major focus of the programme under review.
Capacity development as a concept is broad and amorphous that may target
individuals, institutions, communities as well as government. Capacity development
approaches are multidimensional and range from life skills training, technical
competences to staffing, infrastructure development including modelling and
renovations; social and economic empowerment, among others, depending on the
identified need and circumstances. Thus there should be no criticisms about what
constitutes capacity development. What is critical is to identify and agree on areas of
priority for capacity development based on given mandate.

Overall, capacity development activities were implemented in most targeted
institutions with varying experiences and lessons revealed in the process. The
experiences of selected institutions that were covered by the review are presented

3.2.1 National AIDS Commission (NAC)
NAC was established to foster an independent and broad-based mechanism to achieve
an expanded multisectoral response. Given its pivotal role, NAC is the executing
agency of the capacity development programme.

The programme has been instrumental in supporting the activities of NAC and
strengthening its capacity. Activities at this level included:
    (i)    supporting remuneration of key staff within NAC;
    (ii)   reviewing and improving conditions of service to enhance retention of
    (iii) developing monitoring and evaluation systems; and
    (iv)   supporting the evaluation of the National Strategic Framework (NSF) and
           the subsequent development the National Action Framework (NAF)
    (v)    developing the National HIV and AIDS Policy.

The above activities are briefly discussed below: Supporting Remuneration of Key Staff
The programme has supported remuneration for four NAC staff members, namely;
Executive Director, Director Planning, Programme Officer for Public and Private
Sector and Data Officer. Other members of staff are supported from pool resources.
The programme support assisted NAC to take off from the critical formative phase
and has contributed to retention of high calibre personnel that are mostly from within
the top management and leadership cadre. Reviewing and Improving Conditions of Service to Enhance Retention of Staff
NAC embarked on a very important activity of restructuring the organisation. The
structure was rationalised and new positions were recommended based on the defined
functions and roles for effective programme delivery. New and additional members
of staff with required skills and competences were recruited to fill the positions.
The restructuring necessitated a Review of Resources Management Practices and
Systems which included: Review of Conditions of Service, Development of
Performance Management System, Training Policy and other relevant management
instruments. Developing the Monitoring and Evaluation System
With the support from UNDP, NAC’s capacity has been strengthened. The
remuneration support facilitated an establishment of a Planning and Monitoring
Department that has effectively enabled NAC to take a lead in developing M&E
systems and mechanisms as well as operational manuals and guidelines. Among the
key outputs are: the M&E System, the National M&E Operational Plan and many
Planning and Operational Guidelines that are facilitating a harmonised approach in
the management of a multi-sectoral national response.

The development of the National HIV and AIDS Policy is a milestone in the
management of the national response against the AIDS epidemic. UNDP participated
and supported the process. Supporting the Review and subsequent Revision of the NSF
UNDP supported the development of the first NSF. At the time of this MTR, the
development of a NAF was in progress and towards completion. The MTR noted that
the process of evaluation of the NSF has afforded NAC to make improvement in the
design of NAF. This has also enabled NAC to prioritise and refocus the national
response in view of the global and national trends. The NAF identified coordination
as a major component for scaling up prevention, care and treatment and mitigation of
the impact of HIV and AIDS.

On the whole, although implementation of activities outlined above may not have
been fully or directly supported by the Capacity Development for the National
Management of the HIV and AIDS Response Programme, their successful
implementation is as a result of UNDP’s initial support to NAC that formed a strong
foundation for NAC’s growth. In particular, the programme support to NAC has
brought capacity improvement that has led to donor confidence to invest in the
national response as well as for NAC to put in place effective coordination
mechanisms. NAC’s image has increasingly improved as it has become more
credible and accountable in its leading role of the national response and within the
context of the “three ones” (or “four ones” in case of Malawi).

Resulting from the institutional capacity building support extended to NAC, the
Commission has been able to subsequently help in the development of the capacity of
other national and sub national actors in the fight against HIV/AIDS to appreciate key
issues and components of the response. For instance, in October 2003, NAC
organised a workshop on mainstreaming HIV and AIDS into sector programmes and
the workplace. The workshop aimed at sharing the understanding of the linkage
between HIV and poverty reduction strategies, plans and core businesses. This
initiative was building on the skills gained during regional HIV and development
training programs on HIV and mainstreaming in poverty reduction strategies and
governance. Human Resource Development and Logistical Capacity
The implementation of key activities, namely; support for remuneration of key staff,
review and improvement of conditions of service and development of monitoring and
evaluation system have added value to the functioning of NAC. In particular they
have brought capacity improvement necessary for NAC’s coordination role of the
national HIV/AIDS response. The programme supported NAC with human and non
human resources development- through recruitment and remuneration of key staff at
the headquarters and facilitation of staff from Umbrella Organisations at district
levels. The programme also offered logistical support through procurement of
vehicles and equipments such as computers that have eased the work and improved
efficiency at NAC. Although rent for NAC’s office is paid from other sources,
UNDP’s initial role formed a foundation for the image NAC portrays today.

The Human Resource Development and Logistical Capacity activities have been
instrumental in enhancing the capacity of NAC to manage, coordinate, advocate and
mobilise resources for the national response. What would seem to be critical is,
however, to sustain the initial gains made by the implementation of these activities.
In this connection, an immediate dilemma confronts NAC to make a balance in
providing a high quality harmonised leadership without being seen to spend a greater
part of the resources available at its disposal on issues of human resource capacity
and particularly on administrative costs.

In terms of supporting the remuneration of staff and improvement of the terms and
conditions of service, which constitute motivation of human resource, it is critical to
note that remuneration and conditions of service are dynamic and therefore need to be
competitive to retain the best within NAC.

The review further noted that in addition to improvement of remuneration and terms
of service, the programme supported the training of NAC staff in various areas related
to their work. To complement the formal staff training, the programme also provided
opportunities for participation in excursions and exchange visits outside Malawi, and
in regional and international conferences, which were important in exposing NAC
staff to lessons, experiences and ‘best practices’ of other countries which have made
major strides in the fight against HIV and AIDS, in comparison to Malawi.

Countries visited by NAC staff include South Africa, Thailand, Kenya, and Spain,
etc. Discussions with staff and other stakeholders revealed that visits to other
countries offered important lessons for learning and several lessons were especially
important in helping them conceptualise and improve on their coordination and
adapting innovations while some lessons were adapted to Malawi’s situation. One
key informant said,

“I brought the idea of having an AIDS Focal Officer in every ministry here in
Malawi. I got the idea from Uganda when UNDP sponsored us to learn from
Uganda in 2001. Every ministry now has an officer responsible for AIDS” Rt.
Colonel Gondwe- Ministry of Defence, Malawi. Resource Mobilisation and Tracking Capacity
To steer the program, UNDP committed itself to providing both logistical and
financial support. For instance, UNDP committed to provide USD3.8 million of the
USD14.3 million which is the estimated total cost of the program. Logistical and
financial support is being extended to agencies with initiatives aimed at attaining the
objectives of the Capacity Development Programme for the national management of
the response. One such organisation which is benefiting from the support is NAC.
With regard to logistical support, the program has provided equipment in form of
computers and vehicles to NAC to facilitate its activities.

In regard to the creation of capacity for mobilisation of resources, NAC has in place a
mechanism for tracking donor resources by way of basket fund. With the creation of
NAC, donors and partners in HIV/AIDS gained interest and confidence and began to
focus on the newly created body. The donors facilitated the basket funding initiative
to support the implementation of the NSF. The basket fund is a pool in which most
donors supporting national HIV/AIDS activities put their contributions. As a result of
the successful resource mobilisation through a pooling system, it was learnt that NAC
has adequate funds to facilitate its coordination, institutional support and mobilisation

The basket fund managed by NAC is a best practice in terms of coordination,
minimizing duplication and significantly reducing administrative and reporting
burdens. The centralised unitary financial mechanism under NAC ensures proper
planning, monitoring and facilitates resource allocation to priority areas. However,
the system has encountered disbursement bottlenecks due to limited capacity among
implementing agencies in writing comprehensive project proposals and failure to
submit timely accountabilities. Efforts have been made to help build the required
capacity among ASOs and other stakeholders but more needs to be done. On the other
hand, NAC has been perceived not to respond timely to requests due to bureaucratic
procedures even after engaging the FMA.

It was also learnt that despite indications about the advantages of the basket fund,
some donors are bent on their traditional programme approaches, design and
implementation; and appear unwilling to make exceptions based on the
circumstances. As such, some development partners do not pool their monies into the
national basket. The review noted that UNDP, the first biggest partner in the
HIV/AIDS struggle in the country, is one such partner that has continued to follow an
old disbursement modality of quarterly releases.

In conclusion, the resource mobilisation and tracking capacity has been developed in
the country. Resources are mobilised from within and without as illustrated by a
policy requirement that Government institutions have to provide specific votes in
their budgets for prevention and mitigation activities of the epidemic. Specifically,
the policy stipulates that 2% of their budgets in addition to resources from
development partners is set aside specifically for HIV and AIDS activities. This also
illustrates the extent to which Government is committed to addressing AIDS in its
development agenda. However, ministries and departments have not fully complied
with this requirement as the budget line is used up to meet “other perceived priority
demands”. The mechanism for monitoring and ensuring accountability for the use of
the 2% seems to be lacking. Enhancement of Coordination Capacity
A number of strategies were proposed to ensure the success of programme
implementation through systematic coordination at various levels:

        (i). Programme Coordination Arrangements

Although the PSD provided for (PSC) to provide guidance on programme
management and implementation through quarterly meetings, it never functioned.
Yet, the review learnt that other coordinating mechanisms adopted by NAC and
various stakeholders such as the TWG meet regularly.

        (ii). NAC’s Coordination Capacity
With the support of the programme, NAC was able to realign its role of coordination,
which had hitherto been confused with implementation. NAC developed a number of
national documents and guidelines to steer the national response. A National
HIV/AIDS Policy was developed, published and launched. The policy is a key tool in
giving direction to the national response in the areas of prevention, care and support,
treatment and mitigation of the impact of HIV and AIDS and also providing
guidelines for responding to HIV/AIDS in the work place, participation and
involvement of vulnerable groups and PLWA. The policy also guides HIV/AIDS
research and monitoring and evaluation. Although the policy development process
was supported by several partners, UNDP provided the lead role and made significant
contributions towards the publication and dissemination of the Policy Document. In
addition, many guidelines were developed to guide policy, programme planning and

In general, mechanisms for the coordination of the national response to HIV and
AIDS have been developed by NAC and other stakeholders. In particular,
mechanisms for the coordination exist at different levels and respective sectors; viz.
the UN Theme Group, Technical Working Group (TWG) at national level, DACCS at
district level and networks and associations of PLWA and ASOs. These mechanisms
are implemented through regular meetings and some are fully supported by secretariat
staff, e.g. MANET+, MANASO, NAPHAM, MBCA and Interfaith. Nonetheless,
intra coordination especially at sectoral level has not been considered as necessary.

However, the review noted that the effectiveness of coordination has been doubted
because some partners fail to attend coordination meetings due to lack of staffing,
given too many regular meetings besides their regular schedules. While the capacity
issue is appreciated, failure to attend meetings denies institutional representation and
contribution to the national response.

On the other hand it has been noted that some coordination mechanism meetings such
as the TWG attract too many participants since its membership is open to every
stakeholder involved in the national response. The large representation makes it
difficult for effective participation, contribution and follow-up. It also questions the
value of representation.

On the whole, it should be pointed out that ‘Partnership’ is an innovative coordination
mechanism that eases coordination where numerous actors exist with vested interest.
It has been adapted and has proved to work well in many countries. The PSD

attempted to propose this type of partnership arrangement but the review noted that
existing similar mechanisms are still lacking and not well defined.

3.2.2  Capacity Development in Selected Ministries, District Assemblies and
       AIDS Service Organisations
Capacity development was a major component of the programme under review.
Therefore, Capacity Assessment was one of the planned activities intended to provide
baseline information to inform the programme what capacity strengths and capacity
gaps existed among identified implementing agencies for management of activities
and mainstreaming. The following sub sections briefly outline the findings. Capacity Assessment for Implementing Agencies
The review found that the capacity assessment was not done as planned. Hence,
capacity development activities that have been carried out through training, study
tours, conferences and workshops were not systematically targeted. It is, therefore,
difficult to measure the contribution of the programme towards capacity building in
form of skills, infrastructure and institutional development. Capacity development
that is not based on identified needs more than often leads to resources wastage and
frustrations due lack of focus and defined targets.

Since the capacity assessment was not done and most activities targeting capacity
development are not yet done in most institutions, other than NAC, it is
recommended that the assessment should still be carried out to identify gaps for
prioritisation and appropriate focusing. Results from such an assessment would
particularly help in identifying key competences and development of relevant and
responsive competence framework required not only for the capacity development
programme of the UNDP but also for the successful implementation of NAF. Capacity Development within the Public Sector
The Public Sector constitutes the biggest labour force in Malawi. AIDS has
significantly impacted on the public sector in various ways, hence the need for work
place policies and interventions as well as capacity development initiatives. The
programme therefore targeted to support capacity development activities for the
public sector through the DHRMD under the OPC. This was in cognisant that the
department’s main role and responsibility is to provide HR policies and strategies for
ensuring that the public service has the required human resource capacity and systems
for the implementation of government programmes and delivery of services at all
levels. Institutional support to the department was proposed to include:
    (i)     Assessment of the Impact of HIV/AIDS in the Public Sector,
    (ii)    Assessment of Critical Areas for Capacity Replenishment
    (iii) Development of Programme Document for Capacity Improvement and
            Development in the Malawi Public Service and,
    (iv)    Development of work place HIV/AIDS Policy for the Public Sector.

    (i)    Assessment of the Impact of HIV/AIDS in the Public Sector,
HIV/AIDS has undermined Government’s efforts to achieve desired goals and
objectives. Therefore, the programme supported DHRMD to conduct an impact
assessment to establish the magnitude of the problem of the HIV/AIDS on the sector.
The study was carried out by the MIM.

The findings and recommendations of the HIV/AIDS Impact Assessment Study in the
public service resulted in tremendous effort to improve the sectoral response to
HIV/AIDS epidemic. It is out of the recommendations of the study that led to the
establishment of the Public Sector Steering Committee and Technical Committee to
coordinate the response within the public sector. At the time of this review the two
committees were not operational following changes and movements among Principal
Secretaries after general elections in 2004. It was noted that the two committees only
functioned for a short while after their establishment and therefore it was not clear to
understand fully how those committees work and how they relate to NAC. There
were, however, indications that the committees were being reconstituted and would
soon be operational.

    (ii)   Assessment of Critical Areas for Capacity Replenishment
Following an impact study as outlined above, the programme supported the
assessment of critical areas for capacity replenishment within the public service. The
study covered ten ministries including the DHRMD and confirmed that the public
sector was experiencing high levels of vacancies on its institutional establishments
largely due to the effects of HIV/AIDS and weak or inadequate human resource
policies and strategies. The immediate and long term implications of the study
suggested that urgent interventions were required to arrest the attrition of human
capital necessary for delivery of public services and implementation of various
development programmes.

   (iii)   Development of Programme Document for Capacity Improvement and
           Development in the Malawi Public Service

Following the two studies on the HIV and AIDS Impact in the Public Sector and the
Assessment of the Critical Needs, the programme supported the formulation of a
Programme Support Document on Capacity Improvement and Development for the
Public Sector, which has focused on three interrelated components, namely: (i) Policy
Support, (ii) Capacity development, (iii) Capacity maintenance and HIV and AIDS
Mainstreaming. This PSD was developed to actualise recommendations of the study
of HIV/AIDS Impact Assessment in the public sector and Assessment of Critical of
Areas for Capacity Replenishment as well as in recognition that there was dire need
to improve service delivery in the public as the scale of human trauma wrought by the
epidemic, required a response that mobilizes the leadership in the public service, the
civil society and the community at large to be able to respond to dysfunctional aspects
that are created by epidemics such HIV and AIDS, Disasters and malnutrition.
Today’s public sector decision-makers must lead, plan, own, and manage the
development processes in a more systematic and strategic manner. This programme,

which has been developed in line with the Southern African Capacity Initiative, is,
therefore, an impeccable achievement. The Southern Africa Capacity Initiative
(SACI) is UNDP’s flagship response to the capacity challenge brought to the fore by
the crisis as highlighted by the reports of the Special Envoys to the Secretary General
on HIV/AIDS and on the Food Crisis, respectively1. Specifically, SACI is UNDP’s
response and contribution to the CEB2 High level Committee on Programmes
(HLCP)3 policy paper, which draws attention to the impact of HIV and AIDS on the
overall governance capacity at all levels. It responds to Actions 1, 6, 7 and 11 of the
HLCP document which call for, inter alia, research to improve decision making,
urgent capacity building to deal with the impact of AIDS, studies on the impact of
HIV/AIDS on local government and assisting in developing national systems for
monitoring the epidemic. SACI also represents the core of UNDP’s strategic response
to creating conditions for the attainment of MDGs and for supporting governments of
affected countries to plan for and manage development activities, taking into account
challenges created by HIV/AIDS.

    (iv)  Development of work place HIV/AIDS Policy for the Public Sector.
The development of the policy will help to provide guidance on how the various
public sector institutions should mange and respond through institutionalised
arrangements. In this respect, the review noted that the four activities highlighted
above were implemented and sprouted into initiatives to mainstream HIV/AIDS at the
workplace and in human resources (HR) policies, regulations and procedures.

The review team further noted that the DHRMD had written and submitted a proposal
to NAC for implementation of activities pertaining to the above capacity development
programme. However, given the observed delays in disbursements, it was not
possible to project when funds would be released from NAC as DHRMD had pending
accountability from previous funding. Given that the department is fully staffed with
an established finance department, issues of accountability should not arise and
disbursement delays on accountability grounds should not exist. Volunteers
It was anticipated that the programme would provide resources for UN Volunteer
(UNV) experts in HIV and AIDS to provide advisory services to national experts and
transfer skills to national counterparts.

Although there seems to be significant evidence for the need for HIV and AIDS
experts among the ASOs, there is only one UNV, attached to MANET+. It was not
clear why the facility was not fully utilised. It is possible that agencies were not
aware of the facility and how to access it since its availability was on demand driven

    January report of SE’s
  Chief Executives Board – former Administrative Committee on Coordination (ACC)
  The High Level Committee on Programmes (HLCP) ‘s mandate is to serve as the senior-level
preparatory body of the CEB sessions. It is responsible for promoting programme coordination
throughout the UN System, foster collaboration with civil society, including the private sector; and, as
requested, provide guidance to inter-agency arrangements in the programme areas.

basis. For one thing most of the beneficiaries did not benefit in the programme
formulation and NAC may not have publicised the details of the programme. District Level Capacity Building
At district level capacity development for enhanced management of HIV/AIDS
response has focused on a multi-sector approach through the District Assembly which
is the vehicle for coordination of administrative and development activities.

         (i). District AIDS Coordination Committees
To ensure a more effective coordinated district and community response, the
programme has established District AIDS Coordinating Committees (DACCs) which
comprise of members from various stakeholders at the district level. The review
gathered information that DACCs were initially serviced through the health sector but
the results were negative as the arrangement linked them to the health sector,
defeating the multi-sectoral approach. Another challenge that faced the DACCs at
that time was that staff who provided secretariat services were not fully committed to
DACCs as they were committed to full time responsibilities and HIV/AIDS
responsibility was an added extra burden which did not contribute to ones
remuneration and performance appraisal. Subsequently, DACCs were weak and
ineffective. NAC has addressed this by recruiting District HIV and AIDS
Coordinators (DHACs), recruiting Umbrella Organisations; and redefining the
composition, role and institutional linkages of the DACCs under the District

        (ii). District HIV and AIDS Coordinators
With time, however, NAC has learnt that AIDS is a district concern just as it is
national given the decentralised governance. Therefore, coordination at district level
has been identified as very important if desired action is to happen. Hence, full time
positions of District HIV/AIDS Coordinators (DHACs) were established to take
charge of the management and coordination functions of the response at district and
lower levels. At the time of the review it was reported that 28 DHACs had been
recruited for 28 districts but only a few had effectively assumed their new
responsibilities as the majority were still serving notices of resignation within their
former employments. The review team had fears that many could miss an orientation
NAC had planned for all the DHACs in a near future. It is also not very clear how the
Assemblies may effectively retain these officers given the existing human resource
challenges that seem to persistently erode their capacity base.

        (iii). Coordination Linkages at the District Level
Current institutional arrangements under the District Assembly have placed the
District HIV/AIDS Coordinator under the Director of Planning and Development
given the fact that the issues cut across and are development oriented. However,
there appears to be less uniformity in the operations and status of DACC. In some
districts as is the case in Mchinji, DACC is a sub-committee of the Planning and
Development Committee while in others it is a fully fledged Committee, for example
in Mwanza. While guidelines have been given and members of the DACC have been

oriented in their work, there still appears to be some variations in how they operate.
The confusion was noted with regard to the number of members to constitute the
DACC and in reporting lines at Assembly level and in relation to Umbrella
Organizations. Whereas this could provide opportunity for Districts Assemblies to
diversify and innovations in harnessing resources, it could also be an indicator of lack
of clarity of the guidelines or the need for informed and regular orientation on roles,
responsibilities and processes. This is particularly significant as PSD for the
programme did not provide for the utilization of umbrella organizations for capacity
building interventions. Their use on the programme in not part of the formal
arrangement and it is an irregularity. AIDS Service Organisations Capacity Building
The ASOs that benefited from the capacity building programme included NGOs,
CBOs, FBOs, MANASO, Malawi Business Coalition Association (MBCA), SASO
and MANET+.

        (i). Malawi Network of AIDS Service Organisations (MANASO)
Capacity building activities under MANASO included workshops for networking
among CBOs including proposal writing and financial management, development of
AIDS Service Organizations and provision of administrative services such as the
procurement of a computer and a vehicle as well as stationery. Activities
implemented were reported to have been successful but required more resources to
obtain desired outcome. There is need for NAC to support the capacity building for
such ASOs in the areas of resource mobilisation for scaling up activities and
sustainability of impact.

         (ii). Malawi Business Coalition Association (MBCA)
The Private Sector was not specifically targeted in the PSD. However, MBCA
benefited from the programme through training. Capacity development activities
included leadership training for the private sector, development of a training manual,
and a handbook for Chief Executives and Focal Points. Discussions revealed that not
all activities have been implemented as planned due primarily delays in sourcing of
funds from NAC. Activities that were undertaken included participation in regional
training and workshops on networking. Four staff went to Kenya and four went to
South Africa during 2003/5 and 2004/5 financial years respectively. A Training
Manual and a Handbook for Chief Executives were planned but by the time of the
review, they were not yet developed due to lack of resources. It was, however,
reported that arrangements have been made to source consultants to facilitate the
process once resources are made available.

3.2.3 Central Planning Agencies
The development of the capacity of Central Planning Agencies specifically, the
Ministry of Finance and Economic Planning, National Economic Council and
National Statistical Council to integrate HIV/AIDS in national development plans,

sectoral plans and budget processes was undertaken as a key strategy for the

The team noted that while central planning agencies benefited from interventions led
by the DHRMD, which have included appointments of HIV/AIDS Coordinators and
establishment of HIV Committees in every Government Ministry and Department,
there was no notable deliberate attempt to meaningfully integrate HIV and AIDS
responses in development policies, strategies and programmes. There was no
integration of HIV/AIDS responses into development plans of central and or line
institutions to combat poverty through specific methodologies. This still remains a
key challenge of the programme and the whole national response since this is yet to
be effectively addressed. The only attempt to integrate HIV and AIDS responses in
development policies and strategies was during the MPRSP process. However, in the
document HIV and AIDS responses merited only one paragraph, as a cross – cutting

It is worthy noting that while work place programmes are essential to ensure that the
supply of quality human resources is not impaired, the services demanded by clients
tend to change with the onset of the HIV and AIDS epidemic. For instance the type of
extension messages to the farming community cannot remain the same as before the
epidemic because both the composition of the farming community has also changed
with teenagers being household heads. The same is true with education where a good
proportion of pupils are now orphans implying that there would be need to design
appropriate teaching methods.

It is anticipated that the Public Sector Work Place Policy and guidelines will further
assist in promoting the integration of development plans, poverty reduction strategies
of HIV and AIDS issues into core business of central planning agencies and line
ministries. What so far has been done is a healthy trend towards the processes of
developing capacity for mainstreaming and the eventual actual integration of
HIV/AIDS in budget processes, policies, plans and strategies.

3.2.4 Socio-economic Research Institutions
The programme aimed at strengthening HIV and AIDS related research at various
levels, strengthening capacity of researchers and supporting actual research. To
pursue this, the programme involved three national socio-economic research
institutions, namely; MIM, CSR and Department of Economics at the Chancellor

The review learnt that staff of MIM participated in facilitating capacity development
workshops for HIV Coordinators and Mainstreaming and Proposal writing for the
development of project proposals.     One MIM staff member participated in the
regional workshop in South Africa. Similarly four staff from CSR are benefiting

from a tailor made capacity development research training with a South African
Research Institute. Besides, CSR has embarked on a comprehensive interactive
review of HIV/AIDS research since the onset of the epidemic in Malawi. The
programme has also provided equipment such as computers and printers to enhance
CSR capacity.

3.2.5 UNDP Supported Programmes and Administrative Processes
Planned activities for UNDP in the programme focused on development of
conceptual linkages between HIV/AIDS with UNDP supported programs and
administrative processes, assessment of AIDS mainstreaming into UNDP supported
programs and administrative processes as well as revision of the UNDP supported
programs and UNDP administrative process.

It was noted that almost all the UNDP supported programmes have mainstreamed
HIV and AIDS responses in their activities. For instance, the Democracy
Consolidation, Decentralisation, and Public Sector Reform programme have activities
that deal with issues of HIV and AIDS. The Democracy Consolidation Programme
has even produced a booklet on democracy.

The review also noted that currently there are capacity limitations for programme
coordination, supervision and monitoring within UNDP. The section that is
responsible for this programme has only one officer. The effect of this is that many
times the officer tends to be inundated with a number of assignments including the
Southern Africa Capacity Initiative that is focusing mainly on HIV and AIDS and
development, which call for undivided attention.

The programme focus for this component was on developing the capacity of public
sector to mainstream HIV/AIDS in their policies, plans and sector strategies.
Integration of HIV/AIDS activities and components in national development plans,
poverty reduction strategy and the budgetary allocations to address the impact of
AIDS on development and poverty reduction was an expected outcome of the
capacity development programme. Integration activities were implemented in the
areas of policy and leadership, PLWA, advocacy, and networking and were mainly
limited to work place. This was because of lack of general consensus on what
constitutes mainstreaming and how to mainstream.
What should be noted is that mainstreaming as a concept includes conception and
perception of the internal and external effects of HIV and AIDS on a given sector and
vice versa. It therefore follows that much needs to be done in this area.

3.3.1 Policy and Leadership
The policy and leadership development component focused on interrelated activities
which included policies and guidelines for mainstreaming HIV/AIDS at the work

place and core functions and training for managers and focal point personnel to
appreciate and own the challenge of the epidemic and to effectively manage the
national response at central, sub-sector, district and community levels.

The programme targeted national leaders including cabinet ministers, Members of
Parliament (MPs) and leaders of key faith institutions. Workshops focusing on
HIV/AIDS and development were held for the leaders. The workshops sensitising
leaders on their roles to appreciate and mainstream AIDS in their leadership were

Study tours were also conducted for different leaderships. The tours were useful in
exposing participants to new experiences, best practices and lessons for enhancement
of their leadership roles in the fight against HIV and AIDS and integration of relevant
activities in the various plans. Resulting from the study tours, some leaders were able
to take the challenge to participate in HIV and AIDS activities in their communities.
The civil-military alliance concentrated on leaders from the faith, local government
and NGOs/CBOs.

Members of parliament were sensitised on HIV/AIDS issues. However, it is not clear
whether the respective parties were able to integrate HIV/AIDS in their party
manifestos. Considering the role MPs and Political Parties play, there is need to
support members of parliament in translating knowledge into tangible actions in their
interaction with the grassroots communities (in their constituencies) and ensure that
the legislative processes is responsive to HIV and AIDS. Aware of the political
dynamism, MPs change with change of government. It is therefore recommended
that sensitisation and capacity development for leaders especially MPS should be a
continuous process.

3.3.2 Advocacy for Rights of People Living with HIV and AIDS
The programme recognised the effects phenomena of stigma and discrimination and
lack of sensitivity on HIV and AIDS work. Thus advocacy and social mobilisation
on human rights, stigma and discrimination was on of the highlighted outputs.

The review noted that a vibrant campaign against campaign was implemented in 2002
and 2003 within the global AIDS campaign. Many organisations were involved in
the local campaign against Stigma and Discrimination and PLWA played a
significant visible role under the guidance and leadership of NAC.

A multi-media campaign was launched which facilitated the development of IEC
materials and their publications and disseminated. IEC materials included T-shirts,
posters, billboards, leaflets/flyers, panel discussions, drama episodes, etc. The
campaign against stigma, discrimination and advocacy for human rights offered
strength and courage to PLWA and other people. It was the campaign that gave
MANSO and MANET+ the impetus to organise a public observance of Candlelight
event, where issues of stigma, discrimination and human rights were discussed
openly. Despite those efforts, MANET+ expressed a concern where stigma still

prevails especially among the elite and people of higher strata. This calls for
continued programming and continuous sensitisations targeting individuals on these
issues as change is a process that happens over time.

3.3.3 Formation of Civil Military Alliances
Civil-military alliance against AIDS was one of the major outputs of the programme
under review. The programme expected to have established an operational alliance
by the forth year of programme implementation. One key informant from the military
confirmed that civil-military alliance exists, where the alliance was explained to mean
existing collaborative activities between military and civil population. For example:
     military has trained and sensitised civil leadership including chiefs, opinion
        leaders, chaplaincy, members of parliament, etc.
     the military clinic is open to civilians who may want to access medical care
        and treatment;
     military and civilians had joint training in counselling and sensitisation;
     both civilians and military organise joint drama performances; and
     military participate in collaboration with civilians in national advocacy fora,
        e.g. world Aids Day.
The key informant however attributed the establishment of the alliance to military
innovativeness, not the Capacity Development Programme. He acknowledged
UNDP’s support to facilitate him and others to visit Uganda in 2001, but thereafter no
additional support have gone to the military from UNDP. He further stated,

       “We know there are funds from UNDP but we do not know how to access
       those funds”.

This statement was a pointer to the review team that the intended beneficiaries were
not involved in project formulation and there were no deliberate efforts to inform and
prepare them for the programme implementing. The executing agency should
organise a forum for programme implementers to be oriented to the document.

3.3.4 Improvement of Food Security
This was jointly implemented with UNDP, UNAIDS and WFP. UNDP supported
training activities for capacity building for selected ASOs and FBOs to deliver
nutrition supplements to AIDS affected households; UNAIDS offered technical
support while WFP handled the food distribution. The programme was successfully
implemented in four out of the planned six districts and criteria and logistical systems
were developed.

Other aspects of capacity development included economic empowerment of affected
households and creation of HIV/AIDS nutritional awareness. The implementation
was affected by delays in disbursement of funds by NAC to support the capacity
component of food distribution.

3.3.5   Integration of People Living with HIV and AIDS into the National
PLWA are not only recipients of support but are critical partners in prevention and
mitigation programmes. PLWA were mobilised through their networks and PLWA
organisations to take a lead role in the national response. PLWA are participating in
the national response through organised agencies and associations such as MANET+,
MANASO, NAPHAM, SASO, among others. MANET+ and GIPA
MANET+ was established in 1997 as a local NGO to bring together associations and
support groups of PLWA. The NGO thus coordinates member organisations and also
advocates for promotion of rights of PLWA. It offers counselling services, promotes
voluntary counselling and HIV testing and as well as positive living.

Since it was founded, MANET+ has depended on several development partners
particularly UNDP and USAID through Umoyo Project which was reported to be
coming to its conclusion soon. UNDP support through NAC was being used in
recruitment and placement of National AIDS Volunteers in institutions for a period of
two years under the Greater Involvement of People Living with HIV/AIDS (GIPA).

GIPA is a global principle that advocates for greater involvement and participation of
HIV positive persons in policy development, planning, implementation and
monitoring activities that affect their well being. The Principle is very important and
critical in every national response to HIV and AIDS. To operationalise and
implement the GIPA principle, the PSD planned to recruit local PLWA as volunteers
and place them in different public and private institutions to give HIV and AIDS ‘a
human face’. This was seen as a strategy to fight stigma and promote positive living
and good behaviour as it relates to HIV prevention, AIDS care and mitigation of the
socio-economic impact.

At the time of the review the National Volunteer Programme had the 12 persons on
board as planned in the PSD. These had been trained essentially in skills for
communication on HIV/AIDS issues and counselling. The scheme was so far
reported to be successful although majority of employers both in the public and
private are yet to take full advantage to support the scheme to their advantage. It was
noted that MANET+ was faced with several challenges that were also cited in the
MANET+ study report including difficulties in attracting people with high profile and
skills. Consequently, the GIPA project remains weak with volunteers of limited skills
who have not done much to demystify HIV/AIDS and give it a human face especially
among the elite.

From the various discussions, it was clear that GIPA was not well publicized and is
only known to a few individuals and agencies. Thus, lack of publicity kept the GIPA
silent and key agencies such as schools that would have benefited from the volunteers

lost the opportunity. It should be noted that information is a prerequisite to demand
creation. Salima AIDS Service Organization (SASO)
SASO is an NGO that was founded in 1994 by an HIV/AIDS activist. SASO’s
mission is to increase and strengthen awareness of HIV/AIDS and mitigation. A
number of development partners such as UNDP, UNICEF, Southern Africa AIDS
Trust and ActionAid have been supporting its activities but of late its performance
has been put to question. UNDP support to SASO has included capacity building
activities such as management training, provision of UNVs for short term human
resource replenishment and computers. It was also noted that SASO had been a
beneficiary of the GIPA programme way back in 1990s although the present
leadership had no details on how the programme operates and did not seem to
understand the GIPA principle. They could only recall the former SASO Executive
Director (rip Catherine Phiri) involvement with GIPA activities. The review team’s
educated opinion is that the GIPA Programme is not well publicized among
However, by the review time, it was observed that SASO was faced with internal
management crisis which had even led to suspension of funding from NAC.

3.3.6 United Nations Volunteers (UNVs)
The project design aimed at enhancing capacity of institutions through employment
of United Nations Volunteers (UNVs). The review found out that UNVs were
recruited by UNDP under a different programme. They are deployed in places of
work including hospitals and health centres and ministries. The recruitment of
UNVs was timely as Malawi has experienced a high attrition rate of medical
personnel who have moved to Europe and other places in search of better
employment terms. It should however be noted that the HIV and AIDS capacity
development programme has only one external UNV, who is attached to MANET+.
This is a diversion from the initial programme design and this could have been due
to lack of awareness among institutions that were supposed to proactively demand
for the volunteers.

Overall the UNV component for HIV and AIDS has not performed. While in other
sectors where UNVs have been deployed, the initiative has played an important role
in addressing HR gaps, considering the high cost of UNVs, HRMD should address
the HR issues to attain ‘permanent capacity’ through training/recruiting and
retaining local staff should be designed and implemented to address sustainability as
a matter of urgency.

3.3.7 Preparation for ARV Programme
By the year 2002 when the programme was conceived, the antiretroviral drugs
(ARVs) were accessible to an insignificant number of Malawians because of the
exorbitant cost. At that time, the Government of Malawi could not consider
providing free or highly subsidized ARV drugs. The very few who had access to the
drugs were meeting their own costs and or were being supported by charities and or

friends abroad. Today, at the time of the MTR, the prices of ARVs have
considerably reduced and are affordable by a bigger number of Malawians within
the middle and upper classes, although the majority who are the ordinary persons in
Malawi can not afford to procure ARVs. However, a programme for free ARVs in
selected hospitals is in place but accessibility still remains a problem.

Malawi subscribes to the current globe principle of three ones, i.e. “One
Coordination Authority, One Action Plan and One Monitoring and Evaluation
System”. The country further contributes to the United Nations General Assembly
(UNGASS) indicators. Within the global context, Malawi is expected to meet
certain targets that contribute to the World Health Organisation (WHO) “three by
2005” target.

The programme was supposed to assist ministries of Finance and Health as well as
CHAM to prepare for procurement, storage and distribution of ARVs.          The
programme, in collaboration with WHO, has since supported NAC to develop
Guidelines for ARVs. What remains is to prepare communities for VCT and
uptake and to make ARVs easily accessible. This is a continuous process.

Although from the findings, significant achievements have been reported, it was
observed that implementers were not clear of the source of funding and some
agencies were not aware of UNDP support. To most implementers, NAC is the donor.
This made it difficult to attribute all the success to the programme.

                      CHAPTER FOUR:

The ToRs required the review to assess the relevance of the programme objectives,
intended outputs and components to the management of HIV and AIDS response and
how they contributed to the intended outcomes; and review the appropriateness and
focus in view of the increased number of actors in the domain of HIV and AIDS
national response.

In terms of performance, the review was specifically to evaluate the effectiveness of
the national executing agency, adequacy of monitoring and evaluation mechanisms,
achievement of intended outputs and timeliness of inputs and results. In terms of
success, the evaluation focused on contribution of the programme to the development
on the national capacity for the management of HIV and AIDS response,
sustainability of the programme results and capacities developed.

Under this chapter the review has, therefore, presented an overall impression of the
programme based on the above. In this connection, an attempt has been made to
define key terms which have guided the conduct of the review in order to provide
consensus of understanding within the context of the assessment.

The terms that the review contextualised and tried define were; relevance,
appropriateness, effectiveness, adequacy and sustainability. These terms were to be
understood as follows:

4.2.1 Relevance:
In the context of the assignment, the term relevance was taken to refer to the
significance and application of the programme in contributing to the national
response in Malawi. In other words, it implies importance and applicability of the
programme objectives, activities, outputs, targets and indicators. It also addressed the
feasibility of the intended outputs and how they link to outcomes throughout the
entire span of the programme (2002 to 2006).

4.2.2 Appropriateness:
Appropriateness within the given context is quite similar to relevance. Specifically, it
measures whether the programme and its components, outputs as well as activities
were suitable to address HIV and AIDS in the country.

4.2.3 Effectiveness:
Ordinarily, effective refers to doing the right things. For this particular assignment,
effectiveness of the national executing agency focused on NAC’s ability to coordinate
and manage the national response.

4.2.4 Adequacy:
Adequacy was interpreted as the M&E systems and mechanisms in place as well as
the scope or degree of satisfaction with the quality of monitoring applied during the
implementation of the programme. The difference between what is required and has
taken place would help to determine the level of inadequacy or gap in order to take
required corrective action or behaviour to address the situation.

4.2.5 Sustainability:
This was perceived to refer to viability, ownership and evidence for continuity with
achieved results and experiences and replication of results during and beyond the
implementation of the programme. Sustainability in this context was about
capabilities developed for the programme to deliver services and benefits beyond the
implementation period.

4.2.6 Timeliness
Timeliness in terms of inputs and results refers to efficiency and effectiveness; the
cost effectiveness of the programme and correctness of activities as well as number of
beneficiaries. In other words it is about responsiveness of planned activities.

Based on the above interpretation of those key words, the review assessed the
feasibility, applicability, appropriateness of the programme outputs, activities, and
targeting in relation to expected outputs. It further assessed abilities and capabilities
of NAC to execute the programme as well as availability of systems and mechanisms
to monitor the programme.
An overall informed impression of the programme in terms of the above prescribed
context is summarised below:

4.3.1 Relevance and Appropriateness of Objectives, Outputs and Components:
Given the similarity between relevance and appropriateness, the two have been used

(a)     The PSD Design
 It was generally noted and agreed that the PSD identified the key issues that remain
valid to the development and implementation of an expanded national response to the
epidemic, even after the programme. The key components viz. capacity development
for HIV and AIDS management and mainstreaming were well articulated and this
was very relevant and appropriate. In this respect, the PSD was prepared in a
multisectoral perspective that was far beyond but inclusive of health; and recognised
the importance of social mobilization of various stakeholders including the
government, civil society including the faith based entity and PLWA, all of whom
have critical roles in ensuring a comprehensive and effective multi-sectoral response
to HIV/AIDS. It was noted that the Private Sector was the only critical sector that
was not pronounced in the PSD and targeted.

Despite the right direction the PSD took, some anomalies were noted. For example,
one of the programme outputs stipulated in the PSD was “AIDS mainstreamed in all
UNDP supported programme activities and administrative processes”. Although this
particular output is relevant and contributes to the overall goal of the capacity
development programme, was misplaced. It would have been better placed under the
outcome that seeks to integrate HIV and AIDS in development plans and
agendas. Similarly, the output on “Nutritional status of people infected and affected
by AIDS in six selected districts improved” is misplaced. Emphasis that relates to the
programme is the capacity and systems required of NGOs/CBOs to deliver food and
not food delivery. Nutritional improvement is at another level outcome as a result of
capacity developed or as a result of food distribution by the WFP.

(b)      Gender
The review further noted that the gender aspect was emphasised as one of the key
principles that would guide the programme to appropriately target men and women
for prevention and mitigation. Nonetheless, the PSD did not offer guidelines on how
to effectively perform this very difficult task of mainstreaming gender into planned
activities to achieve the desired gender sensitive response. As a result, the review
found that the element of gender was totally lost through implementation. Structural
factors such as issues of gender need to be seen as integral to effective programming
and central to any effective response to HIV/AIDS. The programme design would
have exploited synergies through collaborative and joint programming with the
gender department within UNDP and with the Ministry of Gender to come up with
clear guidelines for gender sensitive planning.

(c)     Focus
The capacity building programme is national and multi-sectoral. However, it was
noted that much as some work was planned and done at district level, activities were
concentrated at the centre. In view of the decentralisation governance and
recognition that the HIV and AIDS impact is more pronounced among the grassroots
communities, the programme would have had more focus at district and community
levels where action is most needed. This would call for new modalities to strengthen
CBOs and local NGOs with additional skills, resources and information and power.
It would also require strong links between NAC and other key sectors whose
mandates link them to communities; such as Local Government, Ministry of Gender
and Community Development, and the Decentralisation Secretariat.

Similarly, assessment of Ministry of Finance, private hospital association, Health and
communities preparedness for ARV implementation-output was relevant. This is
because the Ministry of Finance was strategic in providing resources for procurement
as Health and hospitals are important for storage and distribution while communities
were also necessary to mobilise beneficiaries.

(d)     Targeting
While a good attempt was done to target appropriately, several instances were cited
where there were omissions and where target numbers were insignificant. Omissions
were noted where activities targeting districts and never considered key institutions
like Local Government, Decentralisation Secretariat, etc. Also noted were the 12
PLWA earmarked for training under GIPA. Training of only 12 people in a country
where HIV/AIDS threatens all the gains in development is grossly inadequate. It
would make more sense it were a training of trainers, who would later train others to
create a multiplier effect.

4.3.2   Effectiveness of the National Executing Agency to Manage the
As regards NAC’s effectiveness to manage the programme, it was noted that NAC is
the only neutral agency suitable to execute and manage a programme that is multi-
sectoral in nature. Therefore, NAC was well positioned as a lead agency for the
capacity building programme. Much as NAC’s capacity could be put to question at
the time of programme formulation, the capacity development targeted NAC as a
beneficiary and the review noted that the capacity of NAC has been enhanced and is
in a better position to manage and lead the national response for prevention and
mitigation. Nonetheless, there is need to continuously engage those agencies whose
capacity is built including NAC for sustenance and there is also more need to reach
out to other organisations, especially those with coordination roles and
responsibilities at district and community levels. This is especially so as currently
NAC is perceived to be highly centralised in its operations and inhibit responsiveness
in programme delivery, more so with regards to disbursements of resources and
programme supervision.

4.3.3 Adequacy of Monitoring and Evaluation Mechanisms for the Programme
On this aspect, the review established that systems and mechanisms for the M&E
have been put in place for the national programme. A monitoring conceptual
framework and a national operational plan as well as M&E Guidelines were
developed. The national operational M&E Plan defines all indicators and data
sources while the Guidelines outline steps; define roles and responsibilities and spell
out clearly who does what, how, where and when. In terms of monitoring the
financial inputs, the programme is audited annually by independent auditors. The
audit is carried out on schedule and has been instrumental in enhancing financial and
administrative management.

In addition, the joint monitoring team i.e. NAC, UNDP, UNAIDS and WFP was
found to be working well. What is critical for NAC is to expand the national
monitoring team to include other key players such as the Local Government, the
Decentralization Secretariat and other ministries responsible for Gender and
Community Development. NAC could also consider instituting lower level joint
monitoring teams to augment the national level monitoring.

In spite of the apparent adequacy of the system above, actual monitoring was found
weak and a source of complaint by many stakeholders who look to NAC for

4.3.4 Achievements of Programme Outputs
The programme has made tremendous strides in the achievement of intended outputs
as noted in the preceding chapter above. In particular, it has helped to direct and
strengthen the capacity for the management of the national response at various levels
despite lapses in activity implementation. In summary key achievements are noted as

(a)    The capacity of NAC to manage, coordinate, advocate, mobilise resources and
monitor and evaluate a multi sectoral national response, not withstanding challenges,
has been greatly enhanced.

(b)    Capacity of research institutions to carry out applied and social research on
HIV and development and writing funding proposals was strengthened for staff from
MIM and CSR who participated in the various training. The training has challenged
research institutions to take stock of what studies have been done since the onset of
the epidemic in Malawi. To this, the research institutions are engaged into a
comprehensive document review and CRS has embarked on a process to compile an
inventory of HIV and AIDS related research in the country.

(c)     UNDP has made initial strides to ensure that HIV/AIDS mainstreaming for
UNDP supported programmes and administrative processes succeeds. To achieve
this, so far 43 people from different sectors and organisations participated in phase
one of the regional training on mainstreaming, although a follow up was noted to be

(d)      Different leaders were introduced to HIV and AIDS as a development concern
in form of orientation workshops and exchange of experiences. Through exchange
visits to countries like Kenya, Uganda, South Africa, etc., Malawi’s national response
has been able to adopt best practices in their response. What is important to note is
that leadership is dynamic with a high turnover. Targeting the leadership cadre
should thus be a continuous process.

(e)    A lot of work was noted around advocacy for social mobilisation and fighting
against stigma and discrimination and benefited from the World AIDS Campaign
2002 and 2003 framework. Through the AIDS campaign, MANET+ and MANASO
organised the first public open candlelight event, an action that is reflective of
reduced stigma. There is however no evidence noted regarding advocacy for law
reforms. Advocacy and social mobilisation of human rights and the fight against
stigma and discrimination may require collaborative efforts with law institutions e.g.
Ministry of Justice

(f)     Alliance with civil society and the military were reported to exist although not
as a result of the current capacity building programme but on the basis of history and
individual ingenuity. What is important for NAC is to nurture those alliances and
sustain them.

(g)     As already observed, nutritional status of PLWA improved was not
appropriate as an output for this programme. Similarly, criteria developed for food
distribution and training in income generating activities were noted as positive
outputs. However, the programme benefited NGOs and ASOs as their capacities
were built in preparation for food distribution in four districts. .

(h)     Preparedness of Ministry of Finance, Private Hospitals Association, Ministry
of Health and communities for ARVs implementation assessed was articulated when
free ARVs were not available. The Ministry of Finance was targeted to provide a
budget for ARVs and thus Government needed to be ready for procurement,
distribution and storage of drugs. Given the funding dynamics, the Government has
donor resources to procure ARVs. Consequently, UNDP and WHO have supported
the health sector to prepare for distribution and NAC to develop Guidelines for

 4.3.5 Timeliness of Inputs and Results
In terms of timeliness of inputs and results, implementers in the different sectors
echoed concerns over delayed disbursements of funds. The delays were attributed to
NAC, Implementers, and UNDP. Delays attributed to NAC were of a technical
nature. Although implementing partners were identified during the drafting of the
PSD, NAC required the partners to submit proposals for funding. The proposals from
the various partners were reviewed and approved by NAC. The process of review
and approval of proposals turned out to be elaborate, requiring a lot of time and
thorough scrutiny. Some of the proposals had irregular implementation plans while
others had unrealistic budgets. The process of improving the proposals to satisfy
NAC standards, mainly through training workshops further contributed to the delays
in approval and disbursement of resources.

Often times, even after the training, submitted proposals and budgets did not meet
NAC’s expectations and were repeatedly reviewed, leading to loss of valuable time.
This was contrary to the PSD which specified budgetary allocations and clearly
indicated the different implementers in every sector. It would have therefore, been
sufficient to orient all identified departments and institutions on their roles in the
programme and guide them in phasing the activities and not necessary to subject them
to the rigour of developing comprehensive proposals for an already approved and
funded programme. This illustrates the shortcomings of programmes that are
developed without the involvement and participation of the would be implementers
and the need for the involvement of all stakeholders in future planning processes that
lead to the development of programmes.

On the other hand, delays on the part of implementers were attributed to their weak
technical and financial competences and outstanding accountabilities. Some of the
proposals submitted by the implementing partners did not satisfy the NAC criteria.
The review noted a need for NAC to re-examine the PSD in order to accelerate

Although the programme objectives, outputs and the resultant outcomes have
remained relevant and appropriate, the implementation processes have revealed
institutional bottlenecks relating to visibility of the programme. Beneficiary
institutions other than NAC are not aware of the UNDP support through the
programme. This is because of the way NAC has chosen to manage the programme
following the adoption of the “Basket Funding”. The implication of this as a result is
that UNDP may not directly supervise and or track the programme without going
through NAC.        While this may be appropriate for NAC, it is not healthy for
stakeholders to know the source of funding and the related requirements.

                                  CHAPTER FIVE


From what has been established in the preceding discussion it is clear that the
HIV/AIDS epidemic continues to threaten the development gains of the developing
economies. Despite all efforts made to control the scourge, new more cases continue
to appear among critical population groups such as youth and women who are the
lifeline of society.

Given the trend and situation, governments need to address specific political, social
and economic challenges that bar individuals from changing behaviour and families
from playing their traditional extended family obligations. The challenges include
Capacity in terms of resources; information, knowledge and skills; employment with
the associated motivational packages; gender socialisation as well as quality and
comprehensive care.

The review identified a number of issues, challenges and opportunities as discussed
the preceding chapter. Based on the identified issues and challenges the following
recommendations are proposed.

5.2.1. Participation of key Actors in Programme Formulation and
While the programme offered a strategic opportunity in strengthening the capacity for
the management of the national response, UNDP did not adequately involve various
partners targeted for capacity development and or those to support the initiative with
the required resources at the time it was being prepared. In terms of beneficiaries they
have had to learn of what was planned for them during the implementation stage. In
some respects this led to delays in implementation of activities. Participation of key
actors is associated with the effectiveness of achieving programme objectives and
efficiency in the utilization of resources.
It is recommended that for all programme development, UNDP as the capacity
development lead agency and NAC as the overall coordinating and executing
agency should enlist the effective participation of strategic partners in planning
and developing future programmes.

5.2.2. Role of NAC
NAC was strategically identified as the executing agency given its mandate and
relationship with HIV and Aids stakeholders. NAC has grown over the past few
years and its roles have expanded to include being a donor, through the basket
funding mechanism. This additional responsibility calls for more personnel and more
skills. Although the programme has facilitated training of NAC staff through
workshops, conferences and exposure visits, a needs assessment should be done to
assess the level of capacity needs that exists for Malawi’s scale up.

Similarly, the programme support towards remuneration was underscored as strength.
The challenge of sustainability of the responsibility for compensation of NAC human
resource should be passed to the GoM to ensure that even after the phase out and
termination of UNDP or any other external funding, NAC would continue to afford
the cost of its personnel. This is especially pertinent given the amount of investment
made in developing the present human resource capacity.
In conformity with the capacity development programme, deliberate advocacy
and lobbying targeting OPC and the Ministry of Finance should be initiated to
include all NAC human resource salary requirements in the government budget.

5.2.3 Role of UNDP and its comparative advantage
UNDP has a leadership role among UN agencies. It is also mandated as a coordinator
within the UN family. It is recognised and respected by Government as a genuine
historical partner that has always spearheaded support for HIV and Aids activities
from the start of the response. UNDP was also noted as taking a lead on issues
pertaining to good governance at district levels and capacity building for central level
institutions. In the exercise of these roles and provision of technical services, UNDP
has gained considerable experience and institutional capacity that are respected by
other development agencies. Since AIDS is a leadership challenge, given the
comparative advantage and longstanding experience, UNDP has a comparative
advantage in the area of capacity development, it is recommended that capacity
development remains a focus for UNDP in the support of an expanded response
to HIV and AIDS and UNDP should continue to mobilise more resources to
expand in scope, scale and space.

In view of the above recommendation, the need to strengthen UNDP HIV/AIDS unit
to coordinate other UN agencies and to supervise and monitor the programme, to
ensure efficiency and effectiveness cannot be overemphasised. The current staff
position of one officer is not adequate. It is therefore recommended to consider
enhancing capacity of the section through the engagement of one additional staff
initially on short term contracts subject to review.

5.2.4 Capacity Development
In view of the modest achievements, planning for capacity development for an
effective national response requires commitment in both resources allocation and
preparedness for a long and continuous process. It is recommended that capacity
assessment be done as had been planned in the PSD to inform and form a
baseline for subsequent capacity development activities. Such capacity
assessment should aim at addressing accountability problems among
implementers and disbursement challenges.

The establishment of the District AIDS Co-ordinators is not a panacea to existing
capacity challenges at sub-national level. It is recommended that through the
capacity building programme, training, inter and intra district visits should be
facilitated to promote and nurture critical learning. Such lessons learnt should

be disseminated for various actors at different levels to benefit and improve their

5.2.5. Coordination Mechanisms
The review has underscored the significance of coordination and noted progress made
at different levels. It has also identified gaps that have affected the implementation of
the programme. It further observed that the Partnership Development initiative that
was recommended in the PSD was not operationalised. Given that “Partnership
mechanism” has worked in some African countries such as Uganda, it is
recommended that NAC revisits the concept of Partnership and explores the
possibility of establishing a clearly defined Partnership to augment existing
coordination efforts.

In addition, to minimize coordination challenges and confusion currently experienced
at the sub-national level, it is strongly recommended that linkages between Local
Government and the Decentralisation Structures should be explored and
exploited by NAC to effect a multi-sectoral streamlined response at sub-national
and community levels. This should be accompanied by defined roles and
responsibilities through documented and disseminated Guidelines that promote
the development and implementation of integrated district development plans.

5.2.6 HIV/AIDS Research and Development
It was learnt that staff from research institutions were trained in proposal writing and
were also given a tailor made training in research but no actual research was done.
Given the importance of research in relation to HIV and development, it is
recommended that CSR expedites the compilation of the Research Inventory to
provide a basis for NAC to prioritise and commission relevant socio-economic

5.2.7 Gender and Human Rights
Policy makers, planners and implementers are aware of the unfolding new global
trend where new HIV infections are occurring more in women, particularly
adolescents and young adults. Some of the major factors influencing this trend
include cultural practices upheld through socialisation, lack of economic
empowerment, limited information, low levels of education and domestic violence,
among others.

Since AIDS is threatening the lifeline of society through affecting young women who
procreate and youth who constitute a whole generation that propels society’s
continuity, effective HIV and AIDS interventions need to be gender responsive and
innovative to target and challenge the different factors that increase vulnerability of
women and girls. It is proposed that programme implementers are supported to
sustain the momentum and impetus created from last year’s Aids campaign to
advocate for human rights and practical gender responsive interventions. These
should be supported by budgetary allocations.

5.2.8 Monitoring and Evaluation
While systems and mechanisms were noted to have been developed, failure of NAC
to carry out regular support supervision and the absence of an effective M&E
mechanism at district and community levels as well as failure to establish the PSC
expected to track direction and guide the programme were noted as big challenges
and significant omissions respectively.      The review thus recommends a
reconstitution of the PSC and replication of joint monitoring teams at district
and lower levels to enhance monitoring at programme policy level and as well as
at programme implementation units to promote ownership and NAC should
improve on the monitoring.

At setoral level, it is also recommended that composition of membership for
coordination mechanisms should be reviewed, taking into account the need for
efficiency and effectiveness in d3ealing with issues of HIV and AIDS.

5.2.9. Resource Management
The review observed a number of weaknesses pertaining to coordination at the centre,
district and community levels. NAC that is technically and politically empowered to
coordinate all HIV and AIDS activities in the country is overwhelmed by the
numerous actors spread over the country. Parallel structures to basket funding within
NAC also create extra work and unnecessary bureaucracy and consequently
contribute to delays in financial releases which in turn affect programme
implementation. It is thus recommended that UNDP pools the capacity
development support into the national basket. This should, however, not
jeopardise UNDP’s visibility and identity.

5.2.10 The GIPA Principle
Based on the findings discussed in chapter three under GIPA and PLWA, the
principle is important and plays a major role in addressing stigma. It is also critical
that successful HIV and AIDS programming, implementation and monitoring
involves PLWA as critical partners. It is, therefore, recommended that the GIPA
Principle be accorded prominence and widely advertised with modifications.
The current approach could be diversified to placing PLWA in their usual work
places to demystify HIV and AIDS among their fellow workers.

5.2.11 HIV and AIDS Mainstreaming
It has been noted that the selected sectors made tremendous strides in mainstreaming
HIV and AIDS in their agenda. These efforts have been limited to work place
interventions. It is therefore recommended that mainstreaming of HIV and AIDS
should go beyond work place interventions to include holist integration of the
concerns of the epidemic into all core functions and activities of the respective

While the review has made the above recommendations, it would be necessary that
the recommendations are critically examined in a holistic manner in the interest of
improving the management of the national response.

Overall, in spite of process obstacles during implementation the programme was
relevant and responsive to the MPRS. Specifically, the capacity building objective of
the programme has succeeded in building the capacity of NAC to consolidate its
ability to manage an effective harmonised national HIV and AIDS response and give
leadership and guidance to partners participating in and contributing to the national
efforts against the epidemic. What would be required is for NAC to ensure it remains
relevant in championing the response and creating the necessary leadership capacity
in the public and private sector, districts, CSOs and community levels. Therefore, it
would be necessary for NAC to champion the creation of the Partnership Framework
as a matter of urgency.

Finally, the key factors of success of this programme have been observed to be
relevant, appropriate and effective. In addition, the programme incorporated the
principles of flexibility and innovativeness. In particular, support to the Private sector
was not originally provided for but the sector was brought aboard. This was on the
realisation that the sector was strategic in complementing Government’s commitment
to scale up the national response.

The way forward is to continue with the programme as designed. However, it is
envisaged that issues raised in this report will attract the attention of NAC, UNDP
and other stakeholders. In particular, effort should be made to prioritise the issues
and recommendations for implementation within the remaining period.

In this respect, the following immediate steps are proposed as part of Way Forward
for consideration:

NO     TASKS                                    RESPONSIBLE            TIME FRAME
1.     Consider and adopt the MTR Report          NAC/UNDP                 Immediate

2.     Disseminate the MTR Report                   NAC/UNDP                  April

3.     Review        and     prioritise   the           NAC                   April
       recommendations of the MTR
       (This calls for revision/update of the
4.     Organize stakeholders’ meeting to                NAC                April/May
       gain consensus over Results
       Framework          and        Resource
       Requirements at:
       a) Central level, and
       b) District level
5.     a)Reconstitute PSC to champion the           NAC/UNDP               April/May
       programme implementation for the

NO   TASKS                          RESPONSIBLE   TIME FRAME
     remaining period

     b)Develop ToRs for PSC
6.   Implement the Programme             All        May plus


Appendix 1: Terms of Reference

Appendix 2: List of People Met For Key Informant Interviews

Appendix 3: List of Participants at the MTR Draft Report
            Dissemination Meeting

Appendix 4: List of Documents Reviewed

                                            APPENDIX 1:


P.O. BOX 30135
Lilongwe 3

26 August 2004


UNDP in collaboration with Government formulated a programme support document
for a five – year programme starting from 2002 to 2006, which is focusing on
developing capacity to address the development dimensions of the HIV and AIDS
epidemic, to understand and respond to the interconnectedness of poverty, good
governance, and social cohesion, and productivity, protection from infection and
survival. Specifically, the programme support document will focus on development
of institutional support; development of appropriate systems and mechanisms for an
effective and timely management of the national HIV/AIDS response including HIV
and AIDS mainstreaming the public sector and Districts assemblies; skills
development; and provision of equipment among other things.

UNDP support would contribute tit he integration of HIV/AIDS in national
development plans, poverty reduction strategies and budgetary allocations to address
the impact of AIDS on development and poverty eradication; and improved
institutional capacity to plan, coordinate, advocate, mobilize resources and implement
multi – sectoral strategies at both national and sub national levels to limit the spread
of HIV/AIDS and mitigate its social and economic impact on poor people and

The programme support document will work closely with the UNDP HIV and
Development Regional Programme and will seek to build trans-national and regional
linkages to address issues of a cross border nature falling under the aegis of the
Programme. The regional program objectives aim to (i) strengthen policy measures,
institutional arrangements and strategic plans aimed at reducing the consequences of
HIV infection on human and social capital formation and utilization; (ii) develop
methodologies, tools and approaches for assessing the impact of HIV on development
efforts and for integrating HIV policies and strategies into development agendas; (iii)
strengthen capacities of regional institutions and UNDP Country offices to provide
technical and advisory assistance on HIV and development to countries; and (iv)
formulate regional long-term strategic action plan based on a regional consensus on
managing the HIV epidemic for sustained human development.

Some of the areas, which will require collaboration with the Regional Programme
    The development of conceptual frameworks that link HIV/AIDS to UNDP into
     supported country programs and key sectors.
    The development of methods and tools for mainstreaming HIV/AIDS into
     UNDP supported programs and key sectors.
    The development of methods and tools for monitoring and evaluating
     mainstreaming HIV/AIDS program.
    The training of public and private sector officers in the use of the above
     mentioned methods and tools.
    The promotion of exchange of experiences among countries in the Region.

    The assessment of system’s preparedness for the implementation of ARV
     (including negotiation of prices, potential for bulk purchasing)

According to the program support document, this programme would be subject to a
mid – term review in 2004. This mid – review is, therefore, in line with the
requirements of the programme support document.

The main objectives of this mid – term is to assess the achievement, relevance and
focus, performance, and management of the programme support document in the
management of the HIV and AIDS national response.

The evaluation will focus on:
    Assessing the relevance of the programme objectives, intended outputs and
     components to the management of the HIV and AIDS national response and
     how they are contributing to the intended outcomes.

    Reviewing the appropriateness and focus of the programme in view of the
     increased number of players in the domain of HIV and AIDS national response,
     and its appropriateness to achieve the intended outcomes.

In terms of performance the evaluation should evaluate:
     Effectiveness of the national executing agency to manage the programme
     Adequacy of monitoring and evaluation mechanisms for the programme.
     Achievement of intended output that could lead to the realization of intended
     Timelines of inputs and results.

In terms of success the evaluation should evaluate the:
     Contribute of the programme to the development of national capacity for the
      management of the HIV and AIDS response.
     Sustainability of the programme results; and
     Capacities developed at the national and sub – national levels in enhancing
      national ownership of development initiatives.

The evaluation mission would produce an evaluation report, which should determine:
    Make proposals for the further improvement of programme output delivery to
     achieve intended outcomes.
    Make recommendations for formulating follow – up actions including
     refocusing the programme objectives/components/outputs to enhance the
     capacity development efforts of the national response.
    Draw lessons learned concerning best and worst practices in enhancing national
     capacities for the management of the national HIV and AIDS response.

    Revise the PSD based on agreed the recommendations and focus of the

The evaluation methodology and approach will include:
    Desk review of relevant documents;
    Questionnaires if necessary to obtain views of key persons involved in the
     programme implementation.
    Interviews and field visits to obtain views of key stakeholders, particularly on
     their assessment of the programme implementation.

An independent team of consultants will undertake the evaluation. The team will be
composed of an international development specialist with experience in capacity
development for HIV and AIDS management at national and sub – national levels,
preferably in sub – Saharan Africa; and two local consultants: a public health expert
with vast experience in capacity development for District and HIV and AIDS
mainstreaming; and an economist with experience in HIV and development issues.
At least one of the consultants should have worked extensively with the United
Nations system and be familiar with HIV and development issues.

The National AIDS Commission in close collaboration with the United Nations
Development Programme will be primarily responsible for organizing and managing
the evaluation in consultation with all the stakeholders. The estimated duration of the
evaluation is three weeks as per the following timetable:
    Briefing of evaluaToRs by UNDP & National AIDS Commission and desk
     review (3 days).
    Visits to project sites to conduct interviews on the application of NEX modality
     (1 week)
    Preparation of an issues report and validation of preliminary findings with
     stakeholders through circulation of initial reports for comments, meetings, and
     other types of feedback mechanisms and drafting of the evaluation report and
     formal debriefings (1 week)
    Stakeholders workshop to validate/critique the report (1 day)
    Preparation of final report (3 days)

Fees for both the local and international consultants will be negotiable, and will be
paid on the basis of each day worked.

                                                  APPENDIX 2:

             LIST OF PEOPLE MET

1.    Dr. Biswick Mwale              NAC
2.    Mr. Roy Hauya                  NAC
3.    Ms. Doreen Sanje               NAC
4.    Mr. Fred Mwathengere           UNDP
5.    Mr. David Chitate              UNAIDS
6.    Ms. Kara                       WFP
7.    Dr Grace. Malindi              Ministry of Agriculture
8.    Mr. Dickson E. Chunga          DHRMD
9.    Mr. Sobuso D. Jere             DHRMD
10.   Mr. Joseph Kalirangwe          DHRMD
11.   Mr. Anock Kapira               MANET+
12.   Mr. John Onen                  MANET+
13.   Ms. Helen Huynh                MANET+
14.   Ms. Mwandida Mvuma             MANET+
15.   Ms. Elsie Makawa               MANET+
16.   Ms. Grenda Winga               MANET+
17.   Ms. Janet Kathyola             MIM
18.   Mr. F. Mzamu                   Dedza District Assembly
19.   Ms. Matewere                   Dedza Distrct Assembly
20.   Ms. Rose Kumwenda Ngoma        MBCA
21.   Mrs. Francina Nyirenda         MANASO
22.   Mr. H. K. Chatepa              Mwanza District Assembly
23.   Mr. Francis Phiri              Blantyre City Assembly
24.   Ms. M. Ngwira Phiri            Mchinji District Assembly
25.   Mr. Steve Mfune                SASO
26.   Mr. Paul Duncan                SASO
27.   Ms. Memory Baluwa              SASO
28.   Mr. L. Robert                  SASO

                                                            APENDIX 3:


NO    NAME                                ORGANISATION
1     Mr. Richard Chakhame                Local Government
2.    Ms. Priscilla Amir                  WFP
3.    Mr. John Kadzandira                 CSR
4.    Mr. Anock Kapira                    MANET++
5.    Mr. Steve Mfune                     SASO
6.    Ms. Haneih Khataee                  UNDP
7.    Mr. Bill Chanza                     UNCDF/UNDP
8.    Mr. Fred Mwathengere                UNDP
9.    Mr. Cosby Nkhwanzi                  NAC
10.   Ms. Chimwemwe Mablekisi             NAC
11.   Ms Doreen Sanje                     NAC
12.   Mr. Subuso D.Jere                   DHRMD
13.   Mr. Trevor Mtenje                   DHRMD
14.   Mr. Moses Chirwa                    Min. of Finance
15.   Ms. Namulondo Joyce Kadowe          International Lead Consultant
16.   Mr. Rogers T.E. Kamanga             Local Consultant

                                                                    APPENDIX 4:

                      LIST OF DOCUMENTS REVIEWED

1. National AIDS Commission, Integrated Annual Workplan 2003 – 2008
2. PSD Capacity Development for National Management of the HIV and AIDS
   Response Programme (2002-2006), Government of Malawi, UNDP
3. AIDS-Joint Government-Donor AIDS Mainstreaming (Draft for Discussion)
4. Assessing the impact of HIV/AIDS in the public service
5. Responding to the HIV/AIDS Epidemic Through a Multi-Sectoral Approach:
   UNDP Support to the HIV/AIDS Response in Malawi
6. National AIDS Commission Report on the Study tour to Botswana, Kenya and
7. NAC Quarterly Progress Reports to UNDP (2004)
8. NAC/UNDP Programme Annual Audit Reports
9. Advocacy Implementation Plan For Working With Six Key Social Groups in
   Malawi on Behaviour Change
10. Draft Report Strategy for the Expansion of Greater Involvement of People Living
   with HIV and AIDS
11. National AIDS Commission, The National Operational Monitoring and
   Evaluation Plan
12. Evaluation Report of the UNDP Assisted Project on Capacity Building for HIV
   and Development
13. UNDP Report on the Identification of Critical areas for Capacity Replenishment
   in the Public Sector
14. PSD on Capacity Development and Improvement in the Public Service (UNDP)


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