SUPPORTING PUBLIC SECTOR WORKPLACE TO EXPAND ACTION AND RESPONSES AGAINST HIV/AIDS (SPEAR) MID TERM EVALUATION FINAL REPORT 23rd February 2012 i Mid Term Evaluation REPORT SUPPORTING PUBLIC SECTOR WORKPLACE TO EXPAND ACTION AND RESPONSES AGAINST HIV/AIDS (SPEAR) PROGRAM The Republic of Uganda ii Acknowledgements This work has been supported by funding from USAID. The consultants appreciate the technical advice and support from the following people and offices: USAID Project team, World Vision Inc., RTI International, SPEAR implementing team, staff and technical persons from MoIA, MoES, MoLG, headquarters and districts, officers and community members from UPS, UPF, education institutions, all persons from various INGOs, and NGOs who responded to the consultations and other beneficiaries who gave us their inputs in one way or another. Evaluation Team Team Leader : Rose Azuba (roseazuba@gmail.com Team members: Denis Nabembezi (nabembezidennis@yahoo.co.uk) Max Ddiba Bwetunge (maxbwetunge@yahoo.com) Fred Wajje (yoweriwajje@yahoo.co.uk) MULTIPLE MANAGEMENT CONSULT mmc@ymail.com iii Table of Contents Acronyms and abbreviations ................................................................................ vi EXECUTIVE SUMMARY .......................................................... VIII 2 CHAPTER ONE :- INTRODUCTION .................................. 1 1.1 BACKGROUND ............................................................................................... 1 1.2 rationale for evaluation ................................................................................. 1 1.3 scope and methodological approach ............................................................. 2 1.4 organization of the report ................................................................................ 3 2. MAIN FINDINGS ...................................................................... 5 2.1 Program Effectiveness ................................................................................... 5 2.1.1 Policy Formulation, Implementation and Monitoring ....................................... 5 2.1.2 Dissemination .................................................................................................... 6 2.1.3 Institutional capacity building ........................................................................... 7 2.1.4 Policy adoption and practice ............................................................................ 7 2.1.5 National level Partnership ................................................................................. 8 2.1.6 Key challenges and Limitations ....................................................................... 8 2.2 Access to and Utilization of Services ............................................................. 9 2.2.1 Stigma and discrimination .............................................................................. 10 2.2.2 Risk prevention and Provision of HCT Services ............................................. 10 2.3 utilization of wrap around services .............................................................. 11 2.3.1 Referral and linkage program .......................................................................... 11 2.3.2 PHAs beneficiary groups ................................................................................. 12 2.3.3 Communities and family benefits .................................................................... 13 2.4 Key concerns and challenges ....................................................................... 13 2.4.1 Access to and utilization of services ................................................................ 13 2.4.2 Existing PHAs groups formed ......................................................................... 13 2.5 Sustainability and ownership ....................................................................... 14 2.5.1 Political ownership: ......................................................................................... 15 2.5.2 Institutionally ................................................................................................... 15 2.5.3 Social, economic and financial sustainability: ................................................ 15 2.5.4 Challenges to ownership and sustainability ..................................................... 15 2.6 Efficiency ...................................................................................................... 17 2.6.1 Administrative Structure efficiency ................................................................. 17 2.6.2 design and implementation efficiency ............................................................ 17 2.6.3 Financial efficiency ......................................................................................... 19 2.7 Linkages and value addition ........................................................................ 21 2.7.1 Linkages .......................................................................................................... 21 2.7.2 UNIQUE qualities or value addition from SPEAR PROJECT ....................... 22 2.8 Key risk factors ............................................................................................. 23 iv 3.0 BEST PRACTICES, LESSONS LEARNT; AND CONCLUSIONS 24 3.1 Best practices and lessons learnt ................................................................. 24 3.1.1. Implementation approaches ............................................................................. 24 3.1.2 Policy .............................................................................................................. 24 3.1.3 Institutional capacity building ......................................................................... 25 3.1.4 Wrap around services ...................................................................................... 25 3.2 Summary and Conclusions .......................................................................... 26 3.2.1 Summary and key recommendations ............................................................... 26 3.2.2 Conclusions ..................................................................................................... 27 v Tables Table 1: Selection Criteria of Districts ……………………………………………….3 Table 2: Policy achievements …………………………………………………….. 6 Table 3: Utilization of Care and Treatment services ……………………………….11 Table 4: Costs and Expenditure structure ……………………………………………19 Tables 5: Budget Performance Summary FY 2009…………………………………..43 Tables 6: Budget Performance Summary FY 2010………………………………...43 Table 7: Budget Performance Summary FY 2011……………………………………43 BOXES Box 1: Themes for key evaluative questions …………………………………………3 Box 2: Strategic Action Points for Policy ………………………………………….....9 Box 3: Strategic Action Points – Improve Access to Services ………………………14 Box 4: Strategic Action Points – Ownership and Sustainability …………………….16 Box 5: Action Points – Financial efficiency ………………………………………...20 Annexes Annex 1: Terms of Reference ……………………………………………………....29 Annex 2: List of Respondents ……………………………………………………...33 Annex 3: Detailed Budget performance (Table 5, Table 6, Table 7)………………...43 Annex 4: Documents consulted ……………………………………………………44 vi Acronyms and Abbreviations ACP AIDS Control Program AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral Therapy ARV Anti-retrovirals BCA Behavior Change Agent BCC Behavior Change Communication BTVET Basic Training and Vocational Education Training Institute CSO Civil Society Organizations FPPs Focal Point Persons GIK Gift in Kind HCP Health Communication Partnerships HCT HIV Counseling and Testing IDI Infectious Diseases Institute IEC Information, Education and Communication IGA Income Generating Activity IGP Inspector General of Police ILO International Labor Organization IR Intermediate Result M&E Monitoring & Evaluation MJAP Mulago Mbarara Joint AIDS Project MJAP Mulago-Mbarara Joint AIDS Program MMC Medical Male Circumcision MoES Ministry of Education and Sports MOH Ministry of Health MoIA Ministry of Internal Affairs MoLG Ministry of Local Government MoPS Ministry of Public Service MoU Memorandum of Understanding NCDC National Curriculum Development Center NUMAT Northern Uganda Malaria, AIDS and TB Program PAC Project Advisory Committee PEP Post Exposure Prophylaxis PEPFAR President’s Emergency Plan for AIDS Relief POSHNET Police Support and Help Network PHA People Having AIDS PLHIV Persons Living with HIV/AIDS PSW Public Sector Workers RHSP Rakai Health Sciences Program RTI Research Training Institute International S&D Stigma and Discrimination SDS Strengthening Decentralization Systems SMC Safe Male Circumcision STAR Strengthening TB & AIDS Response TAAG Teachers Anti AIDS Group TASO The AIDS Support Organization TNA Training Needs Assessment TWG Technical Working Group UAC Uganda AIDS Commission vii UNATU Uganda National Teachers Union UNEB Uganda National Examination Board UPS Uganda Prisons Service USAID United States Agency for International Development VCT Voluntary Counseling and Testing VHT Village Health Teams WV World Vision YEAH Young Empowered and Healthy viii Executive Summary The Supporting Public sector workplaces to Expand Action and Responses against HIV/AIDS, (SPEAR) project (Agreement No.617-A-00-08-00015-00) is a five-year (June 20, 2008 to June, 19 2013), USAID/PEPFAR funded initiative to support the Ministries of Internal Affairs (MoIA), Local Government (MoLG) and Education and Sports (MoES) in Uganda to enhance HIV/AIDS prevention, care and treatment of public sector workers for selected workplaces. USAID sanctioned a Mid Term review with a rationale to evaluate and contextually assess continued relevance of the SPEAR project and its effectiveness in approach since inception and establish lessons learned and good practices that will inform implementation of ongoing and future programs by USAID and Government of Uganda. Four local consultants was hired to undertake an evaluation assignment between November 23rd 2011 and 23rd February 2012. Participatory methods took precedence against the extractive methods using both quantitative and qualitative methods. The evaluation covered 16 districts, selected in a consultative process based on an inclusion and exclusion criteria (Table 1). The respondent population included USAID, SPEAR, RTI staff, District Local Government officials, PHA groups, target ministries and autonomous departments and institutions like Uganda Prison Services (UPS) and Uganda Prison Force (UPF), Teachers’ Anti Aids Group (TAAGs), Public Sector Workers (PSWs) and key civil society partners and beneficiaries (spouses and immediate family members of PSWs). The program so far has made very significant contributions in terms of responsiveness to HIV/AIDS prevention and access to care, treatment and support at the work place for public sector workers. Generally the project is on track and on average 80% of the targets set for year 1-3 have been met with exception of providing spouses and immediate family members of PSW access to services, enhancing access to wrap around services, and disseminating policies to the lower levels of the public sector. In spite of challenges, SPEAR has established political, social and institutional sustainability through top leadership support. This was achieved by: drumming up stakeholder interest through participation in consultative dialogues and workshops at national and country wide launches of the HIV/AIDS policy at the work place; institutionalizing a training component within the curriculum of all 3 key institutions of police, prisons and PTCs; and establishing and supporting PHA networks such as TAAGS, POSHNET( Police Support and Help Network ) and Drama groups to sensitize and fight stigma about HIV/AIDS among public sector works and initiate Income Generating Activities (IGAs). SPEAR has established efficient approaches and strategies to achieve the project objectives through a well- selected project team represented by technical expertise in each of the project objective areas. Regional field hubs have been established to handle operations at the district level. The project works with National structures aligning with existing institutions like the ACPs and autonomous departments at target Ministries. SPEAR has set up performance based contracts and MOUs with select partners to solicit specialized services where an additional partner is more appropriate. By design, the project scaled down the number of target districts, a spot- ix on design efficiency given the thin staff (high staff to workload ratio) at the SPEAR office and the need to ensure direct participation and ‘buy- in’ by stakeholders despite the existing challenges. The total project overheads still lie over 30% compared to the direct costs. Although there is no agreed to benchmark or best practice with regard to the ratio of administrative costs to direct project costs, 25% is commonly accepted as a reasonable threshold and in this case, this cost is well over the reasonable thresholds. On access to HIV/AIDS prevention, care and treatment, SPEAR is synonymous with mobilizing PSW’s to undertake Voluntary Counseling and Testing (VCT) services. Although with limited success, it has attempted to link people that tested HIV positive to other HIV and AIDS care providers. Clients are referred to USG funded partners with complementary services like STAR-E, EC, SW, NUMAT, TASO, AIC, URCS, ICOBI, PACE, MJAP and JHUCCP, etc. SPEAR’s services also included capacity building of service providers to offer additional services for a complete wrap around package. The latter services include: SMC; production and dissemination of HIV/AIDS related IEC materials; condom use education; and supply of materials like HIV testing kits and condoms. SPEAR’s uniqueness stems from targeting public sector workplaces to develop and implement HIV/AIDS work place policies tailored to address concerns and issues of the unique groups of highly mobile and hard to reach professionals at risk: majorly prison officers; police; and guard services. The policies are designed to guide rules and regulations in target Ministries to ensure that their staff have access to and are encouraged to use voluntary HIV testing services and the clinical referral system for care and treatment. Though the system is not yet functioning well, the concept is appreciated. Ineffective partnership arrangements; un-signed performance based contracts; staff overloads; unexpected delays in preparing policy operational guidelines; weak monitoring and quality assurance systems; and ineffective coordination among IPs are some of the impediments that may hold up the program results if not sufficiently addressed. As short and immediate term measures, the evaluation team recommends the program to : -i) effect outstanding performance based contracts with concerned service providers and partners ii) integrate biomedical interventions like PMTCT and SMC in all prevention strategies, iii) support operationalization of HIV /AIDS policies, iv) augment support of PHAs under the linkage referral system and in their PHA groups. For long term measures, support SPEAR to work with the Ministry of Health to harmonize and establish a tracking systems for HIV and AIDS care clients nationally for easy follow up and monitoring. 1 1 CHAPTER ONE: - INTRODUCTION 1.1 BACKGROUND The Supporting Public sector workplaces to Expand Action and Responses against HIV/AIDS, (SPEAR) project (Agreement No.617-A-00-08-00015-00) is a five-year (June 20, 2008 to June, 19 2013), USAID/PEPFAR funded initiative to support the Ministries of Internal Affairs (MoIA), Local Government (MoLG) and Education and Sports (MoES) in Uganda. The project is implemented by World Vision (WV) and Research Training Institute International (RTI) in the Central, Eastern, Western, Northern and Southern regions of Uganda. With an overall strategic objective to enhance HIV/AIDS prevention, care and treatment of public sector workers for selected workplaces, the project is implemented through a multi￾dimensional HIV/AIDS workplace intervention. The 3 strategic objectives targeting policy development, institutional capacity building, behavioral change and access to and utilization of HCT and wrap around services contribute to USAID Uganda I.R 8.1 towards a final impact of effective use of social sector services through the following key results:- R1 Supported public sectors have policies, plans and activities that assure availability, integration and utilization of sustainable HIV prevention, care and treatment services for their employees  IR 1.1 Public sector workplaces supported to develop adopt/adapt disseminate policies and practices that improve employees’ access to high quality HIV-related services  IR 1.2 Target workplaces and partner service providers equipped with HIV-related technical and institutional capacity to mainstream and implement HIV/AIDS prevention, care and treatment programs R2 Increased access of quality HIV/AIDS prevention, care and treatment services by target public sector workers and their families, with a focus on identifying HIV-positive individuals and facilitating access to networked care and treatment services  IR 2.1 Demand created for utilization of HIV prevention, care and support services  IR 2.1.1. Effective stigma and discrimination reduction programs developed and implemented in target public sector workplaces  IR 2.2 Increased availability of HCT services for target public sector workers and their families  IR 2.3 Improved linkage to palliative care, treatment services, and psychosocial support services for HIV-positive public sector workers and their families R3 Improved utilization of wrap-around services by target public sector workers living with HIV/AIDS (PHA) and their families through effective partnerships with USG and non-USG supported programs  IR 3.1 Increased number of target public sector workers and their families accessing wrap￾around services through effective referrals and linkages  IR 31.1.Improved public sector worker’s awareness of wrap-around services available and accessible  IR 3.2 Effective referral and tracking system for HIV/AIDS prevention and support services in target workplaces strengthened 1.2 Rationale for Evaluation Having ended the 3rd year of implementation, USAID sanctioned a Mid Term review of the 5 yr program with a prime rationale to evaluate and contextually assess continued relevance of the SPEAR project and its effectiveness in approach since inception. This is aimed at guiding the stakeholders especially the implementing and funding agency on current status, underscoring what is working and what is not working well. The evaluation was also to document effectiveness towards the original design purpose; major achievements so far, 2 missed opportunities and good practices as well as limitations and challenges encountered. It is also designed to establish lessons learned and good practices that will inform implementation of ongoing and future program work by USAID and Government of Uganda. 1.3 scope and methodological approach The evaluation entailed a comprehensive review of the SPEAR project since inception from 2009 to 2011 assessing design, implementation and achievements so far. In the inception phase an in-depth review appraised the project objectives, strategies undertaken, implementation and monitoring through project documents and studies undertaken. The methodology, evaluation design, sampling tools and work schedule were refined with consultation of USAID task managers and SPEAR implementing agency staff. The field phase comprised the main component in which data was gathered through interface with various stakeholders at the targeted institutions of: MoIA headquarters, local police, prisons, immigration, community services, guard services; MoLG headquarters and associated institutions at the districts; MoES headquarters, and her affiliated bodies and educational institutions both nationally and at the districts. Others consulted included the different collaborators and partners at national level. Discussion and meetings were held with different project beneficiaries and local government officers. All activities were carried out in representative districts from the 5 regions (Table 1). A desk phase for in-depth analysis of the evaluation findings, interpretation, and report preparations ensued. To guarantee a high degree of stakeholder participation and emphasize a learning process, participatory rather than extractive methods were employed using USAID evaluation guidelines and applying international principles of evaluation. Both quantitative and qualitative data has been used for interpretation of the findings. A purposive multi-stage sampling procedure was adopted and used to select 16 districts. Respondents and key informants were identified in consultation with the SPEAR technical staff. The inclusion and exclusion criteria of the selected districts endeavored to attain a mix based on: regional representation, HIV/AIDS sero-prevalence rates ( high, medium, low), district accessibility for service delivery (Easy Vs Hard to Reach), monitoring performance indicators, intensity of SPEAR activities, and the intervention sector distribution (Police, Local Government, Prison Services, Immigration, Education and Private security). To maximize time and resources, following a collective consultation in the central region, the evaluation team spilt into 2 groups and carried out simultaneous activities with multiple stakeholders groups. Whereas 100 % coverage of districts and regions selected was achieved there were several instances where the persons and officials targeted especially in government were not available due to other various ongoing activities. In most cases, a representative was delegated and in a few of such cases, the officers delegated had limited information on the subject matter. Where possible, consultations by emails and telephones was undertaken to fill the gaps. The Personnel consulted included but not limited to: Directors, HIV/IADS focal persons, Community service Dept officers, Senior Immigration Officers, ACP Commissioners Personnel in the 3 key ministries. At the districts, persons consulted included Regional SPEAR Coordinators, District HIV/AIDS personnel, district leadership e.g. CAO, Chairpersons or their assistants, Members of TAAGS, Leadership and Officers from Prison and Police services and family members especially spouses. At national 3 level, members of PAC and other INGOs, and NGO partners and /or their representatives who were active in the project were also consulted. A mix of methods including reconstruction of cause and effect correlations, FGDs, KIIs, and Direct Observations, were used to gather both qualitative and quantitative data. Evaluation focused on the six evaluation questions whose themes are summarized in Box 1 below (details in Annex TORs). Interpretations employed standard evaluative criteria of relevance, effectiveness, efficiency, sustainability and responsiveness. Sample tools for data collection are included among the Annexes. 1.4 Organization of the Report Included in Chapter one of the document is an introduction that gives a brief background to the projects, the rationale and purpose for evaluation, and a brief of the methods adopted in 1 MoH  Performance Service Delivery Indicators, 2009/2010 2 Kampala is central but was selected mainly because of its centrality in administration   Table 1: Criteria for District selection Regional Districts Prevalence Reach Performance1 Data Sources Central 1.1.1 Kampala2 High Easy High Kampala Line Ministries HIV/AIDS personnel Top Management ToTs  Policy Champions  Staff (PHAs and other selected employees s) Documents Partners NGO, FBOs, Hospitals and documents People to be consulted  SPEAR and WVI Staff HIV/AIDS focal person TAAG Local Government leaders  Policy Champions  Prison , police workers  Families (police and prisons)  Private security firms Jinja High Easy High Bugiri Moderate Hard Moderate Kiboga Low Hard Low Eastern Mbale High Easy High Soroti Low Hard Moderate Katakwi Low Hard Low Northern Apac Low Hard Low Gulu High Easy High Arua Low Hard Moderate Western Hoima Low Hard Low Masindi Moderate Hard Moderate Kabarole High Moderate High Southern Masaka High Easy High Mbarara High Moderate High Kabale Low Hard Moderate Box 1: Themes for Key Evaluation Questions  Effectiveness vs. national partnership  Ownership and sustainability  Efficiency of strategies and approaches  Linkages and value addition  Risk factors 4 executing the project. Chapter two highlights all findings presented in a narrative and statistical form (tables) with information from all data sources corroborated to enhance better interpretation and understanding to the readers. Judgments and interpretation of the findings are based on data gathered against the specific performance indicators in the PMP. The findings are presented in alignment to the key evaluative questions specified in the ToRs. The lessons learnt, best practices, recommendations and a conclusion are mentioned at appropriate sections and summarized in Chapter 3. The ToRs, list of respondents and other data is annexed id the section that follow thereafter. 5 2 CHAPTER TOW: MAIN FINDINGS 2.1 Program Effectiveness How effective has the program been in achieving the planned results to date? This will include amongst others a review of the effectiveness and contribution of the partnership between World Vision Inc. and the national level partners to achieve shared program objectives and results?. The project effectiveness has been discussed in consideration of the 3 strategic objectives set out by the project namely: - to i) Develop, avail and integrate utilization of HIV/AIDS policy at work place, ii) Improve access to and utilization of Quality HIV/AIDS prevention, care and support and iii) Improve access and use of wrap around services ( nutritional, water and sanitation, Family planning, Malaria Prevention , OVC) . 2.1.1 Policy Formulation, Implementation and Monitoring The policy strategy was designed to provide a framework to guide the key actors of the selected public sector workplace to plan and implement the HIV/AIDS policy and ensure that i) there is continued integration, access and utilization of sustainable and high quality services and ii) that institutions are equipped with adequate technical and institutional development skills to integrate and utilize prevention, care and treatment services for HIV/AIDS. All the 3 Line Ministries (MOES, MoIA and MoLG) have developed their HIV/AIDS policies . Using the existing institutional establishments, efforts have been made to disseminate them for implementation by staff at different levels through training and imparting dissemination skills to policy champions. Of the three, only the Ministry of Education and Sports had developed operational guidelines for the policy by the time of this evaluation exercise. Planned Results  Employees at work place access high quality HIV/AIDS related services  Workplace and partners service providers are equipped with HIV related technical and institutional development skills to implement sustainable strategic plans and operational activities  Stigma and discrimination at workplace is reduced Key Activities  Develop HIV/AIDS policy and present it in a user friendly package to all beneficiaries  Disseminate policy widely to all beneficiaries  Training of Policy Champions to support and sustain implementation  Develop policy guidelines, and plans to customize and operationalize policy at different levels  Develop framework for monitoring policy progress 6 2.1.2 Dissemination The exercise revealed that HIV/AIDS policy is available and its existence is officially recognized in all 3 ministries. Both senior and middle officials are aware of the policy, with some in possession of the policy booklets which were printed and disseminated in large numbers. Key stakeholders at the work place (WP) and policy champions were sensitized through policy training, launches and inaugurations. The latter strategically ensured the participation of politicians and top institutional leaders. While their presence was spot on and of high impact at that moment, it was short lived. Many of these higher ranked senior officers are busy people, always with changing priorities and have therefore not been able to carry on policy championing activities as expected. Delegating the responsibility of policy championing to officers who are most strategically placed to carry out these activities, such as the HIV focal persons, District health educators and District education officers ensured buy in but was also on one hand an indication of commitment . MoES published 20,000 policy booklets and disseminated 20,000 charts, MoLG 11,000 policy booklets and disseminated 4,500 charts while MoIA only published 9,500 and no charts. Given the number of stakeholders who are direct users and beneficiaries from the policy, these numbers are insufficient. By the time of the evaluation, the policy was therefore yet to be officially adapted for practice by many of the institutions. Although reports mentioned that MoES and MoIA had prepared policy implementation guidelines, the consultations affirmed that only MoES has operational guidelines at the final drafting stage. Whereas MoES had the advantage of having initiated the policy formulation during the ESWAPI project, it is true that the policy process has been slow. It is also conceivable the process of consultation coupled with delegation to lower cadre staff that have less mandate on making key decisions, partly contributed to the delay in drafting guidelines. . Even in the absence of the guidelines, at least 14 of the 35 districts have attempted to customize and adapt the HIV/AIDS policy to their environment for practical application. These are:- Bugiri, Mayuge, Jinja, Mpigi, Masaka, Kasese, Mbarara, Apac, Nebbi, Ibanda, Soroti, Mbale and Tororo. Table 2: Policy achievements Planned LOP Targets 3 yr Targets Mid Term achievement (MTA) MTA vs. LOP 1. Policy documents ( 3 line ministries 100% 3/3 ( 3/3) 100% 100% 2. Mainstreaming HIV/AIDS workplace policy in ongoing programs 100% 40% 40% 40% 3. # of sectoral outlets/districts supported to develop HIV/AIDS at workplace 90 77 69 (90%) 85% 4. # of individuals trained workplace HIV related policy development 150 133 137 (>100%) 91% 5. # of individuals trained in operationalizing policy and plans 400 350 238 (60%) 60% 6. # of individuals trained in workplace HIV related institutional capacity building 90 105 154 (150%) 171% 7. # of points of operation supported with institutional capacity building for workplace implementation and costed work plans 150 110 86 (78% ) 57% 7 2.1.3 Institutional Capacity Building A total of 392 policy champions have been trained as part of the technical and institutional skill development. Of these, 238 were trained to operationalize the policy while 154 were equipped with capacity building skills. Having realized these large numbers, there was an agreement between SPEAR and USAID to cap further training of the policy champions and instead integrate policy issues into existing activities at the workplace instead of making it a stand-alone. MoEs has gone an extra mile to hold a policy implementation review and discuss plans and activities to integrate the policy into the education curricular, and some of the education institutions have developed customized guidelines for implementation of the policy. The capacity has thus been built to operationalize and sustain the policy. Despite the large number of Policy Champions trained (1107 BCAs, 132 policy champions and 1207 anti S&D) operationalization of the policy only lies at 60% of the planned 3 yr targets and the skills within the different policy champion categories are still fragmented, besides there being no monitoring framework to follow up progress on roll down and adoption activities. 2.1.4 Policy adoption and Practice In a few districts, the policy stipulations are already being applied even without guidelines. Although the policy booklets and communication materials were fairly well disseminated among the mentioned groups, ironically there are direct beneficiaries who have neither seen nor read the policy booklets. Whereas the element of poor reading culture is undeniable, in some it is lack of commitment and laxity to put the policy into practice.. Some junior officers mentioned that their seniors had casually referred to the contents of the policy and nothing beyond that. E.g. at one Gulu police FGD with 28 officers, only 5 attested to having knowledge of the policy, while in an Arua PHA FGD, 7 of 7 maintained that they had no knowledge of policy and had not seen the policy handbook. A similar observation applies in other districts visited like Katakwi, Soroti, Kabarole and Kabale. There was evidence however, that the policy has been adopted and is being applied by some officials even before guidelines are in place. For example, testimonies of PHA staff benefitting from the policy by having differed deployment and transfers were attested to in various police, prison and teachers’ institutions in Kibuli , Mbale, Soroti, Arua and Bugiri. The PHAs who have presented their status to their superiors and supervisors are given special consideration and not transferred to where they cannot access ARVs and/or given or posted to less stressful work in their daily routine. This specification which is an HIV.AIDS policy stipulation, is yet to be systematically applied and is still seemingly at the discretion of the supervisor. Cases are reported where senior officials or supervisors at district institutions although aware of the policy requirements have declined to give special consideration of staying or selective transfers in spite of the PHA pleas. This was often blamed on a perpetual manpower shortage, but in some cases, respondents reported that supervisors felt that as a command institution, there should be no negotiation to commands irrespective of this policy. These attitudes reflect limited knowledge or deliberate denial of the existence of policies and guidelines, and point to strong degrees of stigma and discrimination that have yet to be addressed. 8 2.1.5 National level Partnership Over the 3 years, the project has developed and nurtured partnerships with government, CSOs INGOs and PHA networks to varying degrees of engagement at planning and implementation. The partnerships were stronger with the government ministries, weaker at the districts and least functional with other NGOs and CSOs. The project held partnerships formalized by performance-based and fee-for-service contracts with key service provider institutions like AIC and MJAP while with others they were loosely structured based predominantly on activities undertaken by one party rather than being strategic. However, loose as they were, they were not devoid of positive results although we believe much more could have been achieved with full commitments dedicated to continued care and treatment of PHAs. It is commendable, that at the national level, partnerships were established with senior level officers. The national partnerships with the line Ministries served as useful entry points into the districts especially where MoUs with WV Inc did not exist as yet. Liaison was mainly through the HIV/AIDS focal persons at the ministries, districts or agencies. Through these (Prison HIV/AIDS focal person, Prison and Police medical services, District HIV/AIDS focal persons) the project was able to solicit for and mobilize effective participation of the officers at workplaces and to a limited extent their families. The future of the partnerships especially with CSOs and NGOs is uncertain. First it will depend on whether more clear partnership strategies and synergies are developed with implementing partners and then secondly depend on the capacity of the implementing partners. Information shows that some new care programs like SUSTAIN, The STARs, Mildmay, Baylor and MJAP are likely to expand operations having secured new grants with their development partners while on one hand others like PACE and JCRC, NULife and NUMAT are scaling down as their grants come to an end. This will certainly affect their support and collaboration with the SPEAR program especially the PHA’s care and treatment which is critically needed in the next phase. 2.1.6 Key challenges and Limitations i) Large resources were spent on sensitizing, training and preparing policy champions whose enthusiasm seemed to have waned with time, as a result of a strategic change to stop separate standalone policy champion activities. Resumption of activities is likely to be costly in terms of time and resources needed to refocus people whose priorities and duties may have changed. In some Ministries like MoLG, there have been several changes including the transfer of key officers dealing with HIV/AIDS and hence dis￾continuity. ii) Transfers and redeployment of staff within these key institutions is a big challenge to the successful implementation of the project as it currently is. Some of such decisions are sensitive administrative matters complicated in part by a general ban on recruitments within GoU civil service. In consequence, many public institutions have skeleton HR structures that even with a good will and commitment to the needs of PHAs, transfers would seem inevitable as explained by some senior officers. Both PHAs and BCA have been transferred or redeployed to areas where there is neither access to HCT and VCT services nor operational SPEAR programs. In such cases the PHAs are dis-advantaged and the BCA training is turned redundant most especially when not supported to disseminate the information. Conversely, some of the policy champions who are 9 redeployed continue to be active in their new areas when supported to do so. For example evidence was found where officers transferred from MoLG to MoPFED and MoWE and a number of redeployed police officers have continued to champion the policy at the new workplaces. iii) At the moment, policy interpretation is over simplified and seemingly narrowed to a limited perception of staff welfare, addressing only staff transfers, redeployment, sick leave, and retirement. This is because these issues are the ones that employees, especially PHAs, are most concerned about. Missing the broader picture of defining roles and responsibilities, funding, and legal implications and any such issues that affect the implementation of the policy for example PSW don’t know the legal implication of contravening the law. iv) The project was defined around staff at three line ministries, the RFA, and thus, implementation was narrowed to a scope of staff at only these 3 ministries and their associated institutions such as UPS, UPF, Immigration, Community Service, private guard services, Ugandan local authorities association, Urban Authorities Associations and educational institutions. Major education institutions like public universities which are high risk groups were not considered in the RFA. Equally significant, but not included also are the private schools which constitute a big component of the Education Sector .Strategies to ensure that they benefit from the efforts already put in by public school teachers are needed. 2.2 Access to and Utilization of Services This component majorly focuses on i) access to and utilization of HIV/AIDS prevention, care and support services including palliative care, treatment and psychosocial support and ii) improve /increase perception of risk. The ‘SPEAR’ program is synonymous with mobilization of public sector workers and autonomous department to undertaken VCT and HCT sessions. The project distributed 375,247 IEC materials, supported 74,274 voluntary testing and HCT services, and supplied 41 PHA groups with home based care and hygiene kits and IGAs. Box 2: Strategic Action points - Policy 1. Integrate policy champion, S&D champions and BCAs’ skills into a complete package of skills given to one individual instead of having separate individuals with these specialized skills and support them to roll down their activities. 2. Review activities to further roll down the policy to ensure adoption through sector road maps plans specifying indicators for monitor progress on policy dissemination and practice adoption 3. Plan and conduct regular round table discussions to share lessons and discuss policy dilemmas within and between stakeholder groups 10 2.2.1 Stigma and Discrimination There is substantial evidence showing a significant reduction of stigma and discrimination in workplaces where the SPEAR project is implemented. The targeted numbers of BCAs trained to reach out with messages on sexual prevention in HIV/AIDS was 5,469 which is 79% of the 3 yr target and 54.7 % of the LOP target ( Table 3). There is similarity to targets for messages of evidence based prevention which were 80% and 52% respectively. For stigma and anti discrimination messages, 2,999 persons were trained, a number that not only surpassed the 3 yr target by 77% but also the LOP target by 20%. The outputs are comparable since targets of people reached with anti S&D messages were also surpassed (170% 3 yr target and 101% LOP target). These achievements are regardless of having organized only 19 % of originally planned events, in the wake of which a change in strategy after consultations with USAID was adopted to integrate S&D into existing events instead of having stand-alone S&D events. The anti S&D messages contributed to reduce S&D with a net increase of confidence for testing and status disclosure in all 3 key ministries. Consequently 41 PHA groups were formed known as POSH, UPRO and TAAGS. The groups have continued to disseminate and reach out with anti –S&D messages through official and non official gatherings like parades and regular PHA meetings supported by various activities like drama groups. Several personnel benefitted from in-service training and they extended services through HCT outlets and outreach programs. Both public sector employees and communities attested to the effectiveness of the services and appreciated the services getting nearer to people and especially the hard to reach communities. In every institution, BCAs were trained and there is evidence that they undertook several activities to sensitize public workers and sometimes their spouse and /or families. 2.2.2 Risk prevention and Provision of HCT Services The training generated sufficient knowledge and skills to elicit positive behavior change among communities where they operated. Avoiding multiple partners, transactional sex, alcohol, indiscriminate drug use and promoting use of condoms crowned by voluntary testing and counseling were some of the key messages and practices elicited. Supported with information on benefits of adoption of health precautions, the messages reached a number of people in all selected districts especially the under-served who would normally miss the opportunity by nature of their work. From the services of the BCAs, those that accessed T&C services and received their test results were only 48% of the number targeted due to nationwide scarcity of testing kits. Other indirect unexpected positive benefits are linked to increased demand of other laboratory services immediately following the SPEAR outreach programs as attested to and observed by laboratory data in Arua prison laboratory. All districts visited attested to having received specialized services (HCT and VCT) and facilities like circumcision beds, condom supplies, and testing kits. Unfortunately, the enthusiasm of some BCAs has waned over time with slowing down of activities in some districts. Reasons cited include: - lack of or inadequate facilitation, delayed and irregular report pick-up by coordinators which became a dis-incentive to continue working, transfer of sector coordinators and insufficient supervision of the BCAs from new coordinators. 11 2.3 Utilization of wrap around services Following voluntary testing and counseling, those who had tested positive were supposed to receive Psychosocial support, treatment for opportunistic infections and benefit from referral centers and services from partner services linked to disease control. Partners were to provide basic health care services including treatment packages and continue with the psychosocial support where needed. Although the value addition concept of wrap around services and referral –linkage program in support of PHAs was appreciated, there was limited success in this component. 2.3.1 Referral and linkage program Skills development for undertaking wrap around services was done with 89% achievement on the number to be trained for this purpose. However, only 6,226 persons out of the targeted 15,000 received wrap around services and of the 100 projected partner MoUs to be signed, so far only 13 have been signed. With the exception of AIC, PACE and Nulife no other performance based contracts had been signed with direct service providers at both national and district level. However PACE and Nulife made substantial coverage each of 15-17 districts across the country. 3 This is the new target after strategic change. Initially LOP was 200 and 3 yrs targeted 193.   Table 3: Utilization of Care and Treatment Services Planned LOP Targets 3 yr Target (Fy2009- 11) Mid Term achievement (MTA) MTA vs LOP # successfully trained In-service training program in Sexual Prevention of HIV/AIDS during the reporting period. 10,000 6,900 5469 (79%) 54.7% % # of targeted population reached with HIV prevention interventions evidence based or meeting minimum standards required (ABC clients & AB clients) 350,000 (adjusted ) 230,000 183,891 (80%) 52% # of individuals trained in HIV-related stigma reduction 2500 1750 2999 (171%) 120% # of Stigma & Discrimination work￾based events organized and or supported 373 37 37 (100%) 100% # of people reached with anti-stigma and reduction messages 10000 7523 20,258 (268%) 202% # of individuals trained in workplace HIV-related community mobilization for prevention, care and/or treatment 2500 1052 812 (77% ) 32% # of Service outlets supported to provide Testing and Counseling (T&C) 100 150 144 (96%) 150% # of individuals who received T&C services for HIV and received their test results 116,667 128,600 74,274 (58%) 112% 12 Failure to have hit the target is also attributed to various reasons. While it is accepted that the number that receive wrap around services, depends on the number that choose to disclose status after testing positive. It is however also true that disclosing status at that stage also depends on the actual anticipated benefits and value usually based on information available, experiences learnt from others and /or simply the individuals’ perception. On one hand, some PHAs who went through the referral system, complained that the project did not offer sufficient psycho-social services and where they were referred, the care and treatment was neither satisfactory nor and was the environment conducive. Issues like long distances, long waiting or repeated visits with frequent failures to access anticipated services were common. On the other hand, the SPEAR project implementers maintained that once the beneficiary (PHA) was referred and linked to another partners organization, they did not get feedback from the referred beneficiaries and thus was the furthest they would go. Some of the partners talked to were of strong views that, it was a poor assumption in the design for the SPEAR project to have believed that i) implementing partner service outlets would always readily avail care and treatment services without anticipating resource constraints and ii) the program would work easily with limited joint planning and coordination since all those involved are USG partners. For services like psychosocial assistance which were overly lacking, the evaluation found that BCAs were not in position to handle specialized psycho social support and they were not technically competent to do so as the task required specialized skills which cannot be developed within such a short time that BCAs were trained. In consideration of all the above, it can be deduced that this particular component has not performed to the expectations of the project. 2.3.2 PHAs beneficiary groups Over 41 groups of PHAs have been formed and group formation, we observed is to a great extent reliant on the active support of the Regional Coordinator . In some districts visited like Arua, UPS, the PHAs who have openly disclosed their status have not yet been assisted to form groups and yet in a not so far away neighborhood there exists a very strong UPF PHA group. Group cohesion is wedged on tangible benefits like IGA, & access to wrap around services as well as groups leadership and regular meetings. Most PHAs have received support in form of an agriculture enterprise like good quality cereal seeds ( Arua UPS), Apiculture enterprise (Hoima), and poultry farming (Jinja and Mbarara). The groups also received sewing machines which were rejected by some groups which because of lacking electricity power felt they were not about to use them in the near future. Gifts in Kind (GIKs) in form of Home Based and Hygiene Kits were also provided to all, albeit the several complaints that arose of inequitable and poor supervision during distribution. Three main complaints that i) non PHAs received kits, where PHAs missed, ii) kits had some expired items like drugs at the time of distribution, iii) that kits were very limited and not enough for each PHA and spouse to have a kit. Information from PHA FGD in Arua, was that the kits were so highly valued that some people PHAs who had previously withheld information on their status did so in order to secure a kit once it was mentioned that the kits were meant for PHAs only. The flip side was that some PHAs felt that the colour had a stigma and discriminatory connotation for it was easy to conclude that whoever was seen with the ‘blue bag’ was HIV positive. This in our view however was not by design and was 13 beyond the project for the simple reason that gifts are wrapped. It nevertheless sends message about how some PHAs feel even when they have disclosed their status. 2.3.3 Communities and family benefits The program was designed to reach out to both PSW and their immediate families. The activities targeting them were to have included sensitization and training of spouses, and selecting BCAs from among who would in turn reach out to other spouses and people in the communities surrounding them. In over 30 FGDs held for spouses and families within the police and prison quarters, , information gathered from the evaluation exercise showed that there was limited systematic programs designed directly to reach out to them although there were records of outreach activities for the surrounding communities. 2.4 Key concerns and challenges 2.4.1 Access to and utilization of services i) Dis-incentives such as lack of privacy at venues selected for conducting VCT, difficult to physically access hard to reach areas were mentioned as some of the reasons for non￾utilization of services. The beneficiaries also maintained that inconsistence in access of services e.g. In Soroti where some beneficiaries said the HCT services were only availed once in 3 years although records from SPEAR mention that there were 5 outreaches per year in Soroti and Katakwi. In another incidence in Gulu, there were claims of un-ethical behavior where some nurses and assistants failed to maintain confidentiality of client results ii) Limited referral and linkage services for PHAs and failure to offer specialized psychosocial services (PSS) was also noted have a negative effect and remains a challenge to be addressed. Citing one PHA, [‘This, is a gross dis-incentive to disclose status’, said one PHA. “People don’t feel like there is value to test after all when one finds that she is positive, she has nowhere to run …….’] iii) Whereas some groups have been linked to existing PLHIV groups, there is still stigma leading to discomfort of uniformed services mixing with a civilian population or high ranking officers mixing with subordinates. Some districts have supported special ‘windows” for care of the public sector workers a case for Hoima and Kaberamaido and in some others like Kaberamaido, Soroti, Mubende and Mbarara, district local governments have provided office space for PLHIV. iv) There is limited accomplishment in harmonizing and integrating the HIV workplace policy or its activities with other existing policies at the Districts. In some districts, it was expressed that SPEAR regional coordinators are rarely participating in meetings held to discuss HIV/AIDS activities while coordinators say time to attend is one of the constraints v) Although districts have limited and constrained budgets, there appears to have been no deliberate effort to secure any additional funding for any of the SPEAR activities beyond what the project offers in the district. 2.4.2 Existing PHAs groups formed 14 There is still an overwhelming need for psychosocial assistance for PHAs and people that test positive and the activities in the last 3 yrs have been inadequate to address these needs. Some of the PHAs interviewed by the evaluation team, although supported to engage in IGAs, lack business skills and some have hardly any knowledge of simple group dynamics. Note worthy is the concern of presenting to them sewing machines when none of the group members has knowledge or is willing to invest in tailoring skills. Although SPEAR has of late started addressing this concern by encouraging PHAs to submit their own concepts or IGA strategies, many of the concepts are hampered with the ceiling of 1 million Uganda shilling. While variations existed between districts on the amount of IGA cash given to PHA groups depending on the concept submitted, the upper ceiling of I million for IGAs per group is prohibitive for any meaningful small enterprise in Uganda at the current inflation rates. The groups also need skills in writing proposals and conceptualization 2.5 Sustainability and ownership Box 3: Strategic Action points- Improve Access to Services i) Increase the seed capital for the PHA groups IGAs and support them with skills in business management, proposal writing, resource mobilization, group dynamics and formation through regular learning and sharing activities like exchange visits within and across districts. ii) Review referral strategies and follow up for the continued care and treatment services. Psychosocial services are in great demand and donors and implementing partners must find a way to offer more berths and increase quality of PSS to PHAs. 15 To what Extent is SPEAR strengthening ownership and sustainability of HIV related change process within the public Work place institutions? Ownership of the project at the workplace would ensure that benefits are sustained after the project has come to an end. 2.5.1 Political ownership: This has been registered through top leadership support majorly by drumming up stakeholder interest through participation in consultative dialogues and workshops at national and country wide launches of the HIV/AIDS policy at the work place. In each line Ministry, an HIV/AIDS focal person is charged with liaising with SPEAR on preparing and ensuring work plans are integrated within the line Ministry’s schedule. In some, the top leadership continues to actively participate in the project activities whereas in others participation is predominantly by delegation of lower officials. This has a tacit implication and has in some cases been construed as lack of support from leadership. 2.5.2 Institutionally Several activities have been undertaken which indirectly indicate ownership and affirm possible sustainability of the benefits. Institutionalizing a training component within the curricular of all 3 key institutions of police , prisons and PTCs and in police as an example, discussing HIV/AIDS at police parades is a good indicator for ownership. The trained BCAs within every institution will also augment the capacity to continue to provide support to ensure that some needs are addressed. As far as the other institutions are concerned, we find most of the existing linkages and partnerships loose and not effective enough to sustain what has been initiated. 2.5.3 Social, economic and financial sustainability: The PHAs networks when strengthened with income generation and committed to regular social sharing between and within groups, will be the nexus for cohesion and continuity. At the moment, not all PHAs have appreciable knowledge of the HIV/AIDS policy and /or the adoption practices. Their needs are many including psycho social care, ARV and support drugs, laboratory and even livelihood support. Since many of these are through linkages to other implementing partners and beyond the mandate of SPEAR, they need to be explored beyond SPEAR through other donor and government support opportunities. Some groups of PHAs have already benefitted from other sources of funds as a result of firming up their position as registered community based groups with a constitution, clear objectives and a functional leadership. Such groups are the minority. Well managed savings and credit schemes used by such groups to manage their small business have been tested as viable support components in Uganda and such capacity development can be extended to SPEAR PHA groups. 2.5.4 Challenges to ownership and sustainability 16  The political and institutional leadership is being judged by the apparent superficial participation and more importantly commitment to expedite and ensure that guidelines are both in place and being systematically implemented. Furthermore, inadequate monitoring, quality assurance and facilitation4 of activities by BCAs, ToTs and anti￾S&D champions are interpreted as lack of ownership.  At district level, BCAs, ToTs and other Champions have no forum that brings together all 3 ministries for sharing experiences, lessons and challenges nor learning or harmonizing strategies and work plans for handling HIV/AIDS policy and related activities.  Some champions like BCAs maintained that the IEC materials like handbooks used are not language user friendly (strong English) making it difficult to unpack and communicate the information contained therein. The IEC materials would have achieved maximum benefit if they were supplemented with visual aids especially for special groups like youth and families. Whilst agreeing that this is critical and significant, it further affirms that joint planning and coordination between partners is lacking since other partners have these facilities and they can be shared. Box 4: Strategic Action Points - ownership and sustainability i) Strengthen partnership agreements, defining clear roles and responsibilities for planning, implementation, funding and monitoring. SPEAR to systematically and gradually dis –engage from or reduce active services while enhancing partnership involvement. ii) Design and implement activities to engage stakeholders in more strategic round table discussion for strategic planning and support functionality of district networks beyond simple regular meetings 4 The facilitation fee of Ushs 10,000 per 3 months given to BCAs is little compared to other organizations like Red Cross and AMREF working within the same area who give that same amount per person per month   17 2.6 Efficiency This evaluation looks at strategic efficiency in terms of implementation and cost efficiency. In doing so, the evaluation has sought answers to the following questions:  Have the results been achieved strategically with minimum resources (time, funds, human resource and logistics)?  Could the same results have been achieved with fewer resources?  Could more of the same results have been produced with the same resources? In attempt to answer the above questions, the evaluators have considered the questions of whether the project administration structure is the most appropriate for promoting efficiency in its operations, whether activities have been implemented in a timely manner, whether the strategies employed and the activities conducted are the most cost-effective for achievement of the stated objectives, the ratio of administrative overheads to project costs and whether or not the activities have been conducted within the planned budgets versus the actual obligated budget. 2.6.1 Administrative Structure efficiency The SPEAR project team was carefully selected to represent technical expertise in response to the project objectives namely: - Executive leadership as Chief of Party, Policy expertise, communication and HIV/AIDS prevention specialist, Finance team, M&E, program manager, person in charge of care and treatment and ICB experts supported by a research team at RTI. In addition the program has regional field hubs for handling operations at the district level for the central, eastern, western and northern regions each with a regional coordinator and a recently recruited technical assistant. The team is also supported by a Project Advisory Committee. 2.6.2 Design and implementation efficiency The project was designed to work with National Structures at the line Ministries in alignment with already existing institutional structures like HIV/AIDS Control programs in the ministries and autonomous departments in the three target ministries. They include structures in UAC, ACP national program, DAAC at the districts and SACC at the sub countries. This was a sound strategy given the thin staff (high staff to workload ratio) at the SPEAR office and the need to ensure direct participation and ‘buy- in’ by stakeholders. In addition, the implementation was designed with a sub –contractual approach in mind where organizations and other private sector firms or partners may be sub-granted to offer How efficient are the strategies and approaches implemented by SPEAR in achieving intended outputs and outcomes. 18 various services under contractual or MoU arrangements which leverages resources like time, human resources and brings together a pool expertise. For example SPEAR is working with Local and government hospitals like Gulu independent hospital, Lacor hospital, Mulago and Mbarara government hospitals to offer various HIV/AIDS related services to PSWs, while prison and police medical services, and Rakai Health Sciences offer support in VCT, HCT and SMC services. This became more effective but not without challenges which are mentioned further on. It is also true that increased demand for and uptake of HCT by PSWs is attributed to the work of active BCAs whose efforts have simplified the task of mobilizing PSWs to receive embrace and utilize services. Some of key design issues are below highlighted:- The project design envisaged addressing HIV/AIDS response in all districts of the country. The assumption was that entry and implementing partnership would be easier in districts where WV Inc is operating. It was assumed that no additional MoUs would be required for such districts and that WV staff on ground would mobilize the support that would be a springboard. This did not work as WV Inc has MoUs with only 29 of the 58 SPEAR districts and even then in each district, only operates in one or two sub counties. Re visiting this approach to a more effective one delayed the project entry and initiation within the districts. The program efficiency was further constrained by the exponential multiplication of districts. Instead of spreading the already constrained resources thin, the project made a positive critical administrative decision to work in only 58 districts. While this appears to have worked better than the previous approach, it is in essence still not effective especially with the low intensity of district activities in the 58 districts and limited coordination at the district level. Thirdly, implementation efficiency is also affected by delays in accountability from district beneficiaries which is further complicated by the un –friendly cash advance systems at SPEAR office set at a maximum cash of Ush1,500,000/= per person per advance request and yet tagged to accountabilities. This working amount effectively between the Regional Coordinator and Technical Assistant becomes a total of Uganda shillings 3,000,000 in cash that can be advanced per request, which is low given the activity loads in each district. Elucidating on the gravity of the workload, it was observed that all planned outputs and outcomes cannot be achieved efficiently at the regional level given workload of the Coordinators in the absence of a non functional partnership arrangement as was earlier assumed in the proposal document. Each is assigned between 10-15 districts, assisted by the Technical Associates and a Driver who literally facilitates all processes while World Vision ADP support is concentrated on the accounting function, administration, employee benefits like processing payroll and office support. The operational structure is such that the Regional Coordinator’s physical presence is required in almost all districts and at all activities especially where money disbursements are to take place such as transport refund and facilitation. Whenever they are undertaking a bulk activity in one district, the activities in other districts are literally at standstill. These tasks are too heavy for only three staff to handle and it therefore hampers effective delivery of services. Furthermore, the work overload for the coordinators limited the effective time that was spent on lessons learning and adopting changes for better practices. Whereas the 19 coordinators received lots of useful information, there was hardly time to analyze the data and use it for effective planning. The situation was aggravated by having failed to effect MoUs and performance based service contracts with partners who may otherwise alleviate the workload. Subsequently, the Coordinators have found themselves taking over the workloads designed to have been addressed by partners such as supervision and monitoring of BCA activities through sector coordinators. The entire situation has a negative effect on the operational efficiency and may be reflected in subsequent delays and /or failures to achieve some of the anticipated project outcomes if not addressed. The remuneration package of the staff, we observed may have silent effect on the implementation efficiency since comparably other organizations working in similar regions have higher packages than those of SPEAR staff. Not surprising therefore is the high turnover and replacement delays in some of SPEARs establishment. For example, records show that the Mid Western region spent over 6 months without a permanent regional coordinator, the position of the COP has had three different occupants, the M&E position has also changed hands for more than three times. . 2.6.3 Financial efficiency In assessing resource utilization by the project, the evaluators have in the first instance, analyzed its cost structure and the following are observations from table 4 on cost efficiency:- Staffing and administration costs have ranged from 52% in 2009, reducing slightly to 49.5 % in 2010 and standing at 38% in 2011. While there is no agreed to benchmark or best practice with regard to the ratio of administrative costs to direct project costs, 25% is commonly accepted as a reasonable threshold and yet in this case, the total project overheads at 38% which is still well over the reasonable thresholds5 . 5 Although the evaluators feel strongly about this point, the implementers did not agree with this statement Table 4: Costs and Expenditure structure Actual Costs % costs Fy 2009 Fy 2010 FY2011 Fy 2009 Fy 2010 FY2011 Program and administrative Salary and benefits costs * 4,571 485,109 395,323 31.5% 34.04% 27% Program and administrative Overheads** 402,875 221,165 157,768 20.7% 15.52% 11% Direct Project Costs 1. Policy 154,628 112,641 169,517 7.93% 7.90% 12% 2. Institutional capacity building 66,269 168,962 174,502 3.40% 11.86% 12% 3. Behavioral Change Communication 308,881 143,285 104,076 15.84% 10.05% 7% 4. HCT and VCT services 22,253 51,923 128,426 1.14% 3.64% 9% 5. Care & Treatment 2,132 3,947 22,360 0.11% 0.28% 2% 6. Wrap around services 378,522 238,000 294,321 19.41% 16.70% 20% 1,950,131 1,425,031 1,446,293 100% 100% 100% 20 The overall project budget apportioned to the direct project costs in comparison to the administrative and program cost is low for example for care and treatment. While it is appreciated that this was a function of the referral and linkage program and allotted to partners with a critical assumption that partnerships will be effective and efficient, and it did not work. Strategic decisions should have been made to effectively increase the number of new care and treatment patient slots, going by the priority it holds as a key expressed need for the PHAs. Likewise, the numbers of HIV positive PSWs who receive wrap-around services are function-dependent on the number of PSW who test positive for HIV; this line was at 20% of the budget by 2011, but the number of people accessing services did not seem to match with the planned funding. There were several stock outs of HIV testing kits, reagents and drugs like septrin and ARVs which were critically needed in the health centers. Although SPEAR’s mandate does not allow procurement of reagents, ARVs, or testing kits, a one-time only approval was sought for and sanctioned to purchase testing kits. In similar, deficiencies within care and treatment services e.g. specialized laboratory services like chest X-rays, liver function test, renal function test, and CD4 and cell blood counts, it was presumed that the partners within the referral and linkage program would do the same but this did not happen. Several other effective strategic changes in implementation and funding approaches included:- i) Change in workshop modules and categories of participants to improve stakeholder buy-in, ii) facilitating the building capacity planning activities initially not provided for, iii) using existing MoH experts to train people in various activities instead of BCAs whose capacity was limited. iv) Supplementing costs for reproduction of existing IEC materials created by other implementing partners. Most of the changes although more value efficient had a higher monetary and/or time implications. Some of the other strategic approaches that worked also at a cost in terms of time and financial resources were:-  Shifting to home-based and weekend HCT outreach services to ensure couple counseling services where couples worked in different workplaces  A re-focus to BCAs and champions in the higher ranks of the Public sector workers to reach out to senior officials or PHA groups in police to reach out to barracks  Sustaining motivation and commitment of the trained volunteers to continue offering services amidst delays and institutional changes  A shift from private service providers for commodities like test kits to autonomous bodies like national medical stores to enhance their supplies to accredited units charged with procurement and distribution of test kits. The approaches addressed the needs but time delays because of these national stock outs negatively affected the uptake of VCT services. Box 5: Action points- financial efficiency i) The budget support must be revised to meet new changes that were previously not included like support for PMTCs, SMC and related activities 21 ii) Explore all possible opportunities of engaging the ministries and districts to increase participation and commit budget lines on activities for HIV/AIDS policy implementation and services in addition to funds from SPEAR. iii) Support financial resource mobilization capacity of PHAs to meet their other needs that are not met by SPEAR 2.7 Linkages and value addition How well is SPEAR activities linked with other activities pursuing similar results? What unique or value adding features does SPEAR bring to the basket and how is this utilized to leverage specific program results and overall USG development results 2.7.1 Linkages In the recent past there are many organizations INGOs, NGOs and other CSOs contributing to the national HIV /AIDs responses in the country all engaged in similar themes on prevention, care, treatment for purposes of reducing new infections and ensuring access to services. Most of the services are integrated covering structural prevention, behavioral change and biomedical interventions ranging from general education using designed IEC materials to organizing and mobilizing communities for HCT/VCT services and followed with psychosocial support for those that need it. For continued holistic care and treatment, SPEAR clients are linked and referred to other partners with complementary services who are USG funded like STAR-E, EC, SW, NUMAT, TASO,. AIC, URCS, ICOBI, PACE, MJAP and JHUCCP etc. Others are part of the broader care and treatment programs funded by CDC like Mild May International and Baylor. SPEAR’s services are extended to capacity building of service providers to offer additional services like SMC, prevention of risk like condom education and supplying physical materials like HIV testing kits, condoms, and other safe practices code named wrap services. Using Home based programs, MARPS, and outreach programs to reach the hard –to –reach communities are all shared approaches which make the link effective as all partners will be familiar them. The missing linkage with SPEAR is their absence from the service provider networks where information is often shared. At such fora information and joint planning is undertaken and discussions often focus on synergies to maximize time and financial resources as well as sharing available facilities. One organization mentioned that at one point SPEAR utilized services of BCAs that had already been trained by another organization, thereby leveraging existing resources. Some beneficiaries felt that SPEAR lacked synergies for communication and yet approaches like use of T-shirts, HIV experts, organized talk shows and use of community radios are proven communication approaches that work jointly in the communities. In addition, SPEAR has not explored approaches for sustainability like specifying user fees, or token training fee contributions that other organizations have employed. While it may be an organizational policy not to charge user fees, it is a policy that differs from what others do. Most PHA groups under SPEAR do compel their members to pay a token membership fee. While, this appears non prohibitive with an apparent 22 ‘opportunity for all’ approach, it is superficial and neither promotes ownership nor long term sustainability. 2.7.2 UNIQUE qualities or value addition from SPEAR PROJECT Unique to this project is the targeting of the public sector workplace of line ministries with institutions with people who are always at risk and yet by default always miss out on HIV/AIDS sensitization. Its strength lies in the following: i) Addressing concerns and issues of the unique groups of people at risk, the officers in prison, police and guard services who are always on the move and therefore underserved and hard- to- reach. Assisting them to benefit from HIV/AIDS, and form self support structures like PHA groups is unique to this program, ii) although these institutions operate under ‘command’, the program attempts to introduce a national policy which is above their commands structure, iii) SPEAR has to an extent overcome a degree of stigma and discrimination in the public sector where, public figures such as teachers, police, prison guards, local government officials placed in authoritative positions endure barriers to health seeking behaviors at their risk and peril. As such, disclosing their status has always been seen as a risk not only to their relationships with family, friends and neighbors, but to their careers. The project has successfully convinced all teachers in project area to undertake voluntary HIV testing and has reached MARP categories (CSWs, IDUs, MSM) through building trust iv) SPEAR contributes to measurable development results, such as public sector workers who are part of PEPFAR targets in prevention, or number of health workers trained in SMC, and refers them to partners who report on PEPFAR care and treatment targets, PMTCT targets, FP/RH targets, etc. v) Sometimes SPEAR leverages practical immediate assistance that impacts the lives of PLHIVs. For example in 2009, during a period of septrin scarcity, the only sources available in the country was a GIK from a SPEAR private partner in the pharmaceutical industry vi) The referral and linkage program though not yet functioning to satisfactorily provides a good leverage for attainment of US development results on effective use of social sector services towards improving human capacity. 23 2.8 Key risk factors The following risks will affect the project results if not addressed:  Failure to effect performance based contracts, and fee for service contracts with implementing partners and service providers in replacement of MoUs. Such agreements shall clearly define roles and responsibilities; implementation arrangements; operational time frame and funding clarity.  Un exploited mutual trust with district leaderships to enhance buy-in, commitment, and effective integration and supervision of activities within the existing district structures addressing HIV/AIDS  Un addressed workload of the regional Coordinators compromising their availability to regularly visit the districts under their operational jurisdiction, tracking progress of BCAs and other activities, ineffective quality assurance and failing to utilize the feedback in time to advice management beyond routine quarterly review meetings, success stories and required reporting. Lack of timely changes in downstream activities, will negatively affect timely achievement of the long term outcomes and eventual impact  Non scheduled delays in preparing policy guidelines risk the policy component slowly running off track. Once not institutionally grounded, could be exacerbated by changes in political and policy environment. Delays affect resources, and thus operational efficiency Cost overruns, optimism bias, and high stakeholder expectations if disregarded will results in low buy –in and reduced participation.  Failure to strengthen systems including securing strategic alliances, active participation and synergy with districts, CSOs and networks offering similar and /or related services is an implementation risk which is critical at this stage. Ineffective coordination which may result in duplication of efforts or failure to focus on activities may endanger stakeholder interest in the program. What are the key risk factors against SPEAR’s ability to achieve expected results? 24 CHAPTER 3: BEST PRACTICES, LESSONS LEARNT AND CONCLUSIONS The project has offered not only challenges but best practices and lessons from the implementation so far. Some of the key highlights are mentioned here 3.1 Best practices and lessons learnt 3.1.1. Implementation approaches  With adequate capacity building, multiple national institutions could work together to implement projects with minimized and shared resources only if, functional partnership arrangements are in place, with harmonized and well coordinated action plans including effective monitoring systems.  While Multi level support and involvement of stakeholders is fundamental and will ensure sustainability in the long run, involvement of national government especially at district level is indispensable, irrespective of the challenges. One can only learn how to effectively deal with such. Activities at the districts are best undertaken by the district officials themselves but with functional arrangements that clearly define transparent financial mechanisms, work plans, and quality assurance systems. Implementation of work plans developed by the beneficiaries themselves increases ownership and the existing working groups will provide the best entry points  The workplace is an ideal site to increase access to HIV prevention and care services since we know that most busy people who work spend perhaps more time at the workplace than in their residential areas. 3.1.2 Policy  Whereas departments with organized chains of command like the Uganda Police Force and the Uganda Prisons Service act on agreed tasks faster due to command lines of communication. they can equally be a challenge where subordinates are commanded to obey orders e.g. accepting transfers and re-deployment without entering into plea. As such, success becomes subjective and dependent on the senior officials in charge. Mobilization and rapport with top public officials is a therefore a key ingredient in success making it worthwhile to spend resources to secure their buy￾in.  As far as private guards are concerned, much as they are part of command services, the environment and conditions under which they operate are different. They operate under private entities which are business focused and only engage employees under contractual basis, which contracts hardly include health packages. Mobilizing them for testing is not easy but achievable. They are however still facing serious stigma issues and employees who test positive are likely to be dismissed or otherwise end up in un affordable legal wrangles. 25  Because many wrap-around services are provided through NGO/CBO-based efforts, more focus needs to be targeted towards strengthening linkages and referrals to assure that clients access a full continuum of needed HIV/AIDS services. 3.1.3 Institutional capacity building  Although with challenges, by being part of the target communities, the services of BCAs, were undeniably responsible for increased uptake of HCT services among the target population. They have a significant effect on peers within the communities but have limitations where their superiors are concerned. They are also limited in terms of communication, technical and psychosocial skills.  District mobilization to participate is more effective if done with the support of the respective Ministry headquarters. Better attendance and commitment from the participants was seen in districts where the ministries were directly involved in mobilization activities.  Engagement of health sector or institutional health personnel such as police or prison nurses in VCT and HCT activities provides a more effective mechanism for both mobilization and follow-up with those that have been identified as positive. Ethical observance is nevertheless a pre-requisite  Facilitation in whatever form, monetary incentives or benefits like bicycles are unfortunately inevitable. Negotiations to make them realistic without compromising desired results is the challenge 3.1.4 Wrap around services  While beneficiaries appreciated the free HCT and VCT services, they still measure success according to tangible benefits which is addressing personal felt needs and priorities which in the case of PHAs is care and treatment (ARVS, prophylactic treatment etc). As long as these are not met, the project will have measured below their expectations irrespective of the sources and who provides since the process started with SPEAR.  Although the supply of home based care kits, in the form of WV gifts in kind program, was irregular due to reasons cited earlier, this small incentive elicited a strong response and in some areas a number of PSWs who had tested positive and had not yet revealed, disclosed their status so that they could access the packages. This is evidence of the power of tangible /physical benefits and how much they are appreciated and valued by the communities.  The use of positive living groups plays a big role in giving hope to the PHAs. And the PHA experts on the other hand are also very effective in relaying messages and sharing their experiences with other PHAs. They however need motivation to do this however small the facilitation may be. 26 3.2 Summary and conclusions 3.2.1 Summary and key recommendations Evaluative Question Status Overview Key Recommendations 1. How effective has the program been in achieving the planned results to date? This will include amongst others a review of the effectiveness and contribution of the partnership between World Vision Inc. and the national level partners to achieve shared program objectives 1.1 HIV/AIDS policies in 3 Line Ministries on track 1.2 Operational guidelines in only Ministry 1.3 Capacity of building of policy champions effected 1.4 Capacity of health units and staff insufficient 1.5 Referral linkage program not functional 1.6 Wrap around services inadequate National level: support MoIA and MOLG to finalize Policy implementation guidelines District level : support  21 districts to prepare district specific plans for policy adaption  21 districts initiation policy dialogue and subsequent plans for operationalization Review & improve referral linkage program 2. To what extent is SPEAR strengthening ownership and sustainability of HIV related change processes within the public workplace institutions? 2.1 Political support was strong but waning 2.2 Institutional sustainability in place especially for policy champions 2.3 Social economic sustainability strong with PHA networks in police, prisons and education and weak with private guard services 2.4Ownership with districts insufficient i) Support the ACP to supervise and monitor performance of PSW trained policy champion institution ii) Develop and implement mechanisms to track PLHIV access to care and treatment services iii) Support dialogue with districts to promote integrated joint planning with other district teams 3. How efficient are the strategies and approaches implemented by SPEAR in achieving intended outputs and outcomes. 3.1 Technical efficiency at WV offices is strong and working through existing national structures 3.2 Staff overload at regional centers 3.3 Financial and logistical support sufficient to achieve desired outputs i) Focus on couple testing and counseling within UPF& UPS immediate and surrounding communities. ii) Scale up practices like condom distribution, SMC and PMTCs promotions 4. Is SPEAR’s design and implementation still relevant and consistent with the needs of public sector workers…, How well is SPEAR integrated and working in harmony with other USG-funded activities? 4.1 Project still relevant after creating PHLIV networks in the key institutions 4.2 Disease prevention and Behavior change insufficiently addressed in surrounding 4.3 Integration with other USG funded activities not complete for intended results and outcomes i)Effect all pending MoUs and /or contract based performance agreements with clearly defined roles and responsibilities ii) USAID to cause a Strategic intervention meeting to support joint planning, learning and sharing in wake of DTBs 5. How well are SPEAR activities linked with other activities pursuing similar results? 5.1 SPEAR inked and referred clients to several USG funded partners and other government facilities 5.2 Systems for participation and sharing not well streamlined i) Support institutional capacity development (HR and facilities) at police &prison HUs through ACP program to improve facilities for better quality prevention care and treatment services 6. What unique or value adding features does SPEAR bring to the basket and how is this utilized to leverage specific program results and overall USG development results? What are the key risk factors against SPEAR’s ability to achieve expected results? 6.1 Uniqueness and value addition  Mobilizing PSWs from hard to reach areas and institutions to undertake VCT and HCT  Complimenting the PHAs and their groups with wrap around services including referrals and linkages to other prevention, care and treatment agencies  Targeting Public Sector Workers Address following risks: i) failure to effect performance based contracts and alliance with strategic partners ii)Un exploited mutual trust with district leaderships to buy-in and commitment iii)Un addressed workload of the regional Coordinators iv)Weak and /or non functional M&E systems v)Incomplete prevention and care services for PHAs and introducing IGAs with no livelihood management skills 27 3.2.2 Conclusions The SPEAR program has so far has made very significant contributions in terms of responsiveness to HIV/AIDS at the work place and the overall national development priorities The project is generally on track and on average 80% of the targets set for yr 1-3 have been met. Learning from challenges, evidently sufficient attempt was made to apply approaches which are participatory and inclusive in order to secure buy-in from the beneficiaries. Whereas this was successful at political, institution and community (beneficiaries) level, the buy-in from implementing partners has been slow and not without effect on the efficiency and progress of the project. On project effectiveness, the project made positive strides towards achievement of the 3 main goals on policy, institutional capacity building, access to and utilization of services. HIV/AIDs policies are in place for the 3 key line ministries of MoEs, MoIA and MoLG. They have although not adequately been disseminated to the key stakeholders, information on the policies has been unpacked for the utilization by the beneficiaries and in waiting are the operational guidelines and strategies to roll down the policy to a level of full adoption. On access to and utilization of HIV/AIDS services, the project has many documented successes towards beneficiaries within UPS, UPF and public teaching institutions in the operational areas, SPEAR is synonymous with mobilizing for HIV/AIDS VCT and HCT services. Most attributes are to the anti S&D messages which consequently secured confidence among PSWs in the key institutions to undertake voluntary testing which many had not ventured into before. PHA groups were formed among those that tested positives and they have been supported by SPEAR to start engaging in IGAs to help them meet their needs. Only a few of the linkage and referral activities were undertaken. Whilst political ownership was secured through the high powered launches at the project initiation phase, the 3 key specialized institutions of UPS, UPF and tertiary education institutions also embraced the project. There are varied successes in engaging partners in complementary implementation especially of the linkages and referral activities in the care and treatment component. The efficiency of the strategies and approaches used by SPEAR were measured according to budget performance and outputs /outcomes achieved. Funding affected the implementation efficiency of the project. Resources initially spread thin due to an expanded geographical coverage which was later narrowed. Other factors that affected the efficiency included high start up administrative costs, costs outrun due to changed work plans and high workload of the regional coordinators. On linkages with other activities pursuing similar results, SPEAR works by providing services up to VCT and HCT and linking the rest of the components for care and treatment to other USG funded partners like STAR-E, EC, SW, NUMAT, TASO,. AIC, URCS, ICOBI, PACE, MJAP and JHUCC and government health facilities like health centers or hospitals. For most of these, the partnership has been informal and/or loose and still needs to be strengthened to maximize achievement of planed outputs and outcomes. They all have shared 28 goals and use similar and /or familiar approaches like capacity building, and services provision through outreaches and home based care. Most uniquely, SPEAR has addressed concerns and issues of a unique group at risk which is usually hard to reach at the work place. This target group of officers in prison, police, guard services and teaching institution has a unique feature in that they always miss out on HIV/AIDS information and services. Those that test positive qualify for continued holistic care and treatment services through client linkages and referrals to other partners with complementary services who are USG funded like STAR-E, EC, SW, NUMAT, TASO,. AIC, URCS, ICOBI, PACE, MJAP and JHUCCP etc. Others are part of the broader care and treatment programs funded by CDC like Mild May International and Baylor. SPEAR’s services are extended to capacity building of service providers to offer additional services like SMC, prevention of risk like condom education and supplying physical materials like HIV testing kits, condoms, and other safe practices code named wrap services. Using Home based programs, MARPS, and outreach programs to reach the hard –to –reach communities are all shared approaches which make the link effective as all partners will be familiar them. The project has faced several challenges which are institutional like high and over expectations of stakeholders, delayed buy –in of stakeholders, lack of effective partnership arrangements beyond performance based and declining interest of some key stakeholders which may have collectively or individually affected achievement of certain results. The project is nonetheless on track. 29 ANNEX 1: STATEMENT OF WORK BACKGROUND Uganda has a population of 28 million people, with 85 percent of the population living in rural areas. The country has had considerable success in reducing prevalence of HIV/AIDS over the past 15 years from a national average of around 18 percent (up to 30 percent in selected urban antenatal clinics) to the current level of 6.4 percent. However, despite initial successes of the late 1980s and early 1990s, the decline in prevalence has stagnated over the past five years and no longer shows a downward tendency. Available data and analyses highlight that sexual transmission accounts for 76% of all new infections, followed by mother to child transmission at 22%. Women, urban dwellers and those living in the conflict regions are the most severely affected. Approximately 1.1 million Ugandans are HIV positive, of which approximately 100,000 are children under the age of 18. Forty percent of those who are HIV positive have an HIV negative spouse. Increasingly, data from Uganda and other countries in the region show that new cases of HIV are being transmitted within the adult population. Programmatically, the emphasis of prevention activities has centered on the population of young people, both in and out of school. Programmatic approaches that address risk factors, risky behaviors, and perception of risk among the adult population need to be developed and scaled up. The inclusion of the public sector workforce in HIV/AIDS prevention programs falls within the focus on adults. People enrolled in the uniformed services (e.g., guard services, police, prisons ) are often mobile or away from home, may have increased opportunities for casual encounters with house girls, sex workers and barmaids, and may have several sexual partners thus increasing their likelihood of contracting or transmitting HIV’. In addition, local governments employ the majority of the work force at the district level. Many of these employees are the providers of key HIV/AIDS prevention, care and treatment services, but they are unable to access the same services they provide because they are working. There are very few efforts to address their special needs in prevention, care and treatment. Through the process of mainstreaming AIDS throughout the national development process, the causes and effects of AIDS will be addressed in an effective and sustained manner.6 In Uganda, the concept of mainstreaming has been applied to national efforts to implement a multisectoral response. In doing so, the emphasis, in part, is on mainstreaming HIV/AIDS across all line ministries. Under the guidance of Uganda AIDS Commission, with support from the Partnership Forum, public sector line ministries have been supported to hold joint reviews, develop work plans and streamline HIV/AIDS within their respective sectors. Despite these and other efforts however, activities have not extended beyond the development of sector specific HIV/AIDS workplace policies. On June 18, 2008, USAID Uganda signed a $10,000,000 Cooperative Agreement (CA) with World Vision, Inc. to implement a program in partnership with the ministries of Education and Sports (MoES), Local Government (MoLG) and Internal Affairs (MoIA) focusing on HIV/AIDS in the three sectors. The public sector workplace program named Supporting Public Sector Workplace to Expand Action and Responses against HIV/AIDS (SPEAR) program, works at the national level and, initially, in all districts to:  Support public sector to develop and implement HIV/AIDS policies that ensure availability, integration and utilization of sustainable HIV prevention, care and treatment services for their employees and dependants.  Increase access to quality HIV/AIDS prevention, care and support services by targeting 6 Support to Mainstreaming AIDS in Development, UNAIDS Secretariat Strategy Note and Action Framework 2004 – 2005.  UNAIDS. 30 public sector employees, with a focus on identifying HIV positive individuals and facilitating access to networked care and treatment services.  Improve access to use and utilization of wrap around services by target public sector employees living with HIV/AIDS and their families through effective partnerships with other USG and non-USG supported programs. SPEAR’s Key Intermediate Result areas:  IR 1.1 Enhanced capacity of public sector workplaces to adopt/adapt policies and practices that improve employees’ access to high quality HIV –related services  IR 1.2: Target workplaces and partner service providers equipped with HIV related technical and institutional development skills to develop and implement sustainable strategic plans and operational activities.  IR 2.1 : Increased personal perception of risk of HIV infection/transmission and utilization of prevention services through aggressive targeted behavior change programs  IR 2.2 : Increased access to and utilization of HCT services by target public sector workers and their families  IR 2.3 : Improved access to and utilization of palliative care, treatment services and psychosocial support services for HIV positive public sector workers and their families The SPEAR Project is using a network model that facilitates the acquisition of positive attitudes, personal skills, and knowledge of HIV protective behaviors. The assumption was that this model would contribute to the reduction of HIV infection among Public sector workers and their families within each of the three target ministries. Targeted institutions include: MoIA: headquarters, local police, prisons, immigration, community services, guard services; MoLG: headquarters, Uganda Local Authorities Association (ULAA) staff, Urban Authorities Association of Uganda (UAAU) and districts; MoES: headquarters (including the affiliated bodies/educational institutions), national teachers colleges (NTC), primary teachers colleges PTC), Basic Tertiary and Vocational Education Technical (BTVET) institutions, secondary schools, district education offices (DEO) and primary schools. In summary SPEAR is expected to: 1. Consolidate activities for Years 1 and 2, and implement Year 3 activities around a needs-driven, transformational development approach, with participatory and inclusive decision-making at all levels in order to achieve program objectives while engaging the public sector workforce in project implementation, monitoring and evaluation. 2. Ensure sustainability of its interventions by strategically mobilizing political and popular support through coalitions building, engagement and networking with governments, institutions, donors, USG-funded NGOs/local NGOs, CBOs and key stakeholders. 3. Generate creative and appropriate HIV/AIDS workplace interventions to build institutional capacity and a policy and advocacy environment that will engender a cultural shift at all levels of governance on the importance of protecting the lives of the public sector workforce. 4. In Year 3, to continue implementing interventions in the areas of comprehensive Behavior Change Communication (BCC); counseling and testing; linkages and referrals to care and wrap￾around services. Cross cutting themes will consist of evidence based action and responses and reaching rural and hard to reach areas; and gender and disability sensitivity and meaningful involvement of PLHIV. 5. Focus on cross cutting issues in the design, implementation and reporting of its program activities. 31 I. PURPOSE OF THE EVALUATION USAID Uganda is commissioning this midterm evaluation to assess the relevance of the SPEAR project and effectiveness of its approach in reference to contextual and programmatic changes since its inception. The evaluation will recommend ways to increase SPEAR’s contribution to HIV Prevention in the current environment. The evaluation will document major achievements (what is working well) and opportunities (what could have been done better), limitations and challenges; and establish lessons learned and good practices to inform implementation of ongoing and future program work by USAID and Government of Uganda. II. KEY EVALUATION QUESTIONS The evaluation should answer the following questions: How effective has the program been in achieving the planned results to date? This will include amongst others a review of the effectiveness and contribution of the partnership between World Vision Inc. and the national level partners to achieve shared program objectives and results. 1. To what extent is SPEAR strengthening ownership and sustainability of HIV related change processes within the public workplace institutions￾2. How efficient are the strategies and approaches implemented by SPEAR in achieving intended outputs and outcomes. 3. Is SPEAR’s design and implementation still relevant and consistent with the needs of public sector workers, current understanding of Uganda’s HIV epidemic, other interventions and other socio-political changes in Uganda? How well is SPEAR integrated and working in harmony with other USG-funded activities? 4. How well are SPEAR activities linked with other activities pursuing similar results? What unique or value adding features does SPEAR bring to the basket and how is this utilized to leverage specific program results and overall USG development results? 5. What are the key risk factors against SPEAR’s ability to achieve expected results? III. PROJECT INFORMATION AND DOCUMENTS The following information documents and sources shall be available and relevant to the evaluation: USAID:  Original Request for Proposal  USAID program and financial reporting requirements SPEAR:  Agreement and other amendments/modifications  Annual and quarterly reports  Annual work plans and Performance Management Plans  Baseline survey report  Relevant training and activity reports  Internal assessments and reviews Sector Specific Information:  HIV work place policies (Sector specific)  Work plans to implement with SPEAR project  Minutes of National Steering Committee meetings IV. EVALUATION METHODOLOGY 32 The offerer may propose a mix of qualitative and quantitative methods to conduct an evaluation that meets the stated purpose and responds to all the evaluation questions listed above. Proposed methodology should bear in mind the wide coverage and diverse group of stakeholders and show clearly how reliable and meaningful information will be collected in an efficient manner. Proposal should include a sampling methodology and analytical plan. Initial findings of the evaluation will be shared within the Mission and with the Implementing Partners. This report will form the basis for subsequent design and planning meetings between USAID and World Vision to incorporate lessons learned and proposed recommendations for improvement. The final report will be shared with the Government of Uganda, other development partners and USAID’s Development Experience Clearing House V. DELIVERABLES 1. In Briefing: Introduction of the evaluation team, discussion of the SOW and initial presentation of the proposed evaluation work plan. 2. An Inception report detailing the Contractor’s interpretations of the assignment, an evaluation design and methodology, analytical plans, sampling, tools and work schedule 3. Weekly Progress Reports: Brief informal reports summarizing progress, challenges and constraints and describing evaluation team’s response 4. Oral Presentation: Power Point presentation (including hand outs). The oral presentation should, at a minimum, cover the major findings, conclusions, recommendations, and key lessons. The evaluation team will liaise with the mission to agree on the dates, audience, venue and other logistical arrangements for this briefing. 5. Draft Evaluation Report: The report should comply with the USAID’s Evaluation Report standards set out in Annex 1. 6. Final Draft Report: Complete report incorporating comments from USAID and other stakeholders. 7. Final Report: The contractor will submit a final report incorporating final edits for wider sharing *All reports should be provided in five (5) hard copies and one (1) electronic copy. VI. DURATION OF THE ASSIGNMENT VII. The assignment is expected to start towards the end of September and be concluded by mid￾November 2011. VIII. LOCATION OF ASSIGNMENT SPEAR office(s), USAID and site visits conducted in the different institutions currently covered by the SPEAR program. IX. MANAGEMENT ROLES AND RESPONSIBILITIES The USAID Senior Strategic Information Advisor (SSIA) for the Health, HIV and Education Team will have primary administrative and technical responsibility of the evaluation process. This also includes making the necessary arrangements for USAID inputs and briefings. The Contractor will liaise closely with the Agreement Officer’s technical representative (AOTR) for SPEAR and Program office M&E Specialist on coordination and clarification of USAID requirements and standards. World Vision will contribute to the design and planning of the evaluation, provide logistics for implementation (documents, meetings, interviews), participate in the oral presentation and review the draft and final reports. GoU institutions will participate in the review of proposals, facilitate interviews and participate in the oral presentation and review of the draft and final reports. 33 ANNEX 2: LIST OF PEOPLE CONSULTED AND RESPONDED Name Designation Contact where Possible Joseph Mwangi Senior Strategic Information Advisor USAID Rhobinah Ssempebwa Sen HIV/AIDS Information Advisor USAID May Mwaka Mission Evaluation Officer USAID Catherine Muwanga OVC Specialists USAID Andrew Kyambadde HIV/AIDS Information Advisor USAID Rudo Kwaramba National Director , WV Inc Lawrence Tiyoy Programmes Director WV Inc Jesca H N Sserwanga HR and HIV/AIDS focal person MoES ( PAC ) Dr Ndiwalana Bernard Police Medical services MoIA (PAC) Edward Walugembe Ass Comm M&E MoPS (PAC) Edward Mujimba Commissioner Equal Opportunities MoL Godwin Tugume PAC Member MoLG Biddemu Charles AS Police MoIA (PAC) Kisakye Julius PAC MoES Dr. Ndiwalana Surgeon Uganda Police HQs Luzira HU Paul Bogere Asst. Comm. HRM, MoPS Dr. Edward Walugembe Inspectorate, M&E MoPs PAC Hephi Kyamuyondo Secretary MoES Dr. Joseph Andowa Medical Sup. Staff clinic Luzira Margret Ondongwen Senior Nursing Officer Murchison Bay Milly Nabulayi NO-incharge of ART clinic Luzira Alex Dragule BCA Prison Dta Luzira Mweru Olive Nursing Asst. Asst.AIDS Counsellor Murchison Bay Prison Catherine Achilo ASA, Wife to an officer 0772318117 Sophie Muhindo SNO, Trainer Jack Sibointole Health Educator Program Prison Luzira Maria Programmes Development Director WV SPEAR TEAM Wise Besigye Finance Manager WV SPEAR TEAM Derreck Musooka M&E Specialists WV SPEAR TEAM Warren Tumwekwatse Program Manager WV SPEAR TEAM Joseph Lubwama ICB Specialist-RTI WV SPEAR TEAM Caroline Odongo Prevention/Communication Specialist WV SPEAR TEAM Lillian Ayebale MaSPH CDC-HIV Fellow with SPEAR WV SPEAR TEAM George Luboobi – Policy Specialist -RTI WV SPEAR TEAM Erasmus Tanga SPEAR Chief party WV SPEAR TEAM George William Ebulu ROM /QA Director WV SPEAR TEAM Brain Assimwe Ag SPEAR Central Region Coordinator WV SPEAR TEAM Sharon Nakanwagi RC Regional Coordintor Southern WV SPEAR TEAM Jane Tushabe Mpiima Regional Coordintor Eastern WV SPEAR TEAM Shiela Kyobutungi – Regional Coordintor Western WV SPEAR TEAM Majorie Lagen Regional Coordintor Northern WV SPEAR TEAM Alfred Mubangizi Care & Treatment Specialist WV SPEAR TEAM Mr. Katungye Director Administration UPS MoIA Kettie Bagamba, , UPS MoIA Jack Siboitole UPS MoIA Mbabazi, sophie UPS MoIA Muhindo UPS MoIA Charse Bidemu ASP-UPS MoIA Mr. Ziraba Charles – PP0 MoIA Ms. Winnifred Sande FPP-Community Service Dept. MoIA Mr. Marshal Alenyo Senior Immigration Officer / DC & IC MoIA Mr Mutabwire Director of Administration MoIA Mr Ssonko currently transferred to MoPED MoIA Leofrida Oyella, Formerly HIV/AIDs Focal person MoTWC Mr. Opio Okiror Assist. Commissioner Personnel - MoES Jesca Naluzze, Departmental HIV Focal Point Person MoES Juliet Wajega Project Coordinator UNATU Affiliated to MoES 34 APAC – District Dragule Alex Data Entry Clerk APAC District Domara Charles DPC Apac (Police) APAC District Beruga Henry OIC Prison farm APAC District Lunyoro Justine Prison Officer APAC District Omara George Prison Officer APAC District Ochen Jonana Prison Officer APAC District Kidega David Prison Officer APAC District Ochom Patrick Prison Officer APAC District Abinduga Sebastian Prison Officer APAC District Amil Salim Prison Officer APAC District Poro Geofry Prison Officer APAC District Omase James Prison Officer APAC District Opeyo Simon Peter Prison Officer APAC District Tegu Emanuel Prison Officer APAC District Okumu Richard Prison Officer APAC District Luwa John Charles HIV/AIDS focal person Apac District Ogweng Denis Prison Officer APAC District Acon Mary Spouses of officers APAC District Acen Mercy Prison Officer APAC District Akello Susan Spouse of officer APAC District Bakitta Kawomba " APAC District Ongom Sarah " APAC District Okwir Goretti " APAC District Asagai Norah " APAC District Acom Josephine " APAC District Imede Salin " APAC District Alum Liberty " APAC District Lameck Mwesigwa " APAC District Aciro Betty " APAC District Mwiru Olive Nurse APAC District Gulu District James Owal HIV/AIDS coordinator Gulu District Aziku Zota Tom RPC Gulu District Apolot Agnes Regional Police Coordinator HIV/AIDS Gulu District Joyce Akello OC/CID Gulu Gulu District Zaake DPC Gulu District Madrama Charles Dr./Police surgeon-ASP Gulu District Apunyu Cyprian Clinical officer- IP Gulu District Watulo Steven Gulu District Lacaa Judith Enrolled Nurse- WAIP Gulu District Oyo Richard Oscar Police Officer PC Gulu District Opiro Jolly Joe Theatre Asst AIP Gulu District Obung William Police Officer ASP Gulu District Orena Emmanuel Police Officer AIP Gulu District Amai Bonny Police Officer SGT Gulu District Nyeko Patrick Dennis Police Officer D/CPL Gulu District Inenu Pamellah Police Officer D/w/CPL Gulu District Akwero Alice Police Officer D/w/SGT Gulu District Muwonge Robert Police Officer PC Gulu District Oyet D’Aquinas Police Officer IP Gulu District Obwang Augustine Police Officer CPC Gulu District Apolo David Police Officer PC Gulu District Uwmanich Police Officer PC Gulu District Abua Caroline Police Officer WCPL Gulu District Kilama Joel Police Officer PC Gulu District Akello Lilian Rose Police Officer PC Gulu District Onek Christopher Police Officer 2nd SGT Gulu District Odokonyero Moris Police Officer AIP Gulu District 35 Tukamwesiga Nicholas Police Officer AIP Gulu District Okello Tonny Police Officer CPL Gulu District Okello Jacob Police Officer - A/c (BCA) Gulu District Emuron Richard Police Officer CPC Gulu District OkirorGeorge Police Officer PC Gulu District Obote George Bulish Police Officer SGT Gulu District Oyella Innocent Police Officer –(BCA) Gulu District Anenorwot Stella Hope Spouse of Police officer Gulu District Christine Anywar " Gulu District Olum Hilder " Gulu District Akelo Christine " Gulu District Aliga Mariam " Gulu District Magret Oneka " Gulu District Josephine Nyeko " Gulu District Akello Patricia " Gulu District Janet Onekgiu " Gulu District Jono Irene Nurse /BCA, councilor Gulu District Okwolalo Esther Custodian and Counsellor . Gulu District Agola Lilian Prison Staff and trained BCA Gulu District Ayet Joyce Prison Staff and BCA Gulu District Ocang Nursing Officer , BCA Gulu District Auma Jane Prison staff Gulu District Aciru Rose Staff Gulu District Obuku James Staff and beneficiary Gulu District Magalo William Prison Officer and BCA Gulu District Odubire Franscis BCA Gulu District Musubika Monica Clinical Officer and BCA Gulu District Akello Margaret Staff Gulu District Dawa Catherine Health worker Gulu District Otim James Chief of Party NUMAT Northern Region Arua District Masiga Patrick Regional Prisons Commander Waleera Assistant Regional Police commander ARUA District Iwanve Robert OC Prison Arua ARUA District Rita Dranziru Social Worker Arua Prison ARUA District Aremi Peter CPL ARUA District Dr. Anguzu Patrick DHO ARUA District Sr Esatu Angela Edami Police Clinic Nursing Officer in charge ARUA District Sr Kareo Rose ASP Arua nurse ARUA District Andezu Keezi Midwife Arua ARUA District Abima Justo CPL ARUA District Aiiorwoth Onen Beatrice Asst. Matron ARUA District Chandia Beatrice In charge Wards ARUA District Nyakuni Nazarene IP- Chairperson TAJIKU ARUA District Andezu Kezzi Blick Police officer ARUA District Ngamta Flavia Police constable ARUA District Anguzu R Francis PC ARUA District Bako Lilian Police officer/BCA ARUA District Kareo Rose AIP/BCA ARUA District Amaruma John Bosco CPL/BCA ARUA District Alonzi Phillian Samuel Sgt/BCA ARUA District Ocita Yona AIP/BCA ARUA District Ocokoru Grace AIP/BCA ARUA District Drati Fredrick D/AIP/BCA chairperson ARUA District Oyoma A Florence W/PC/BCA ARUA District Anguyo Candiru Solome BCA ARUA District Abuko Gladys Deputy Principle ARUA District Tabeya Harriet Spouse ARUA District Letaru Christine " ARUA District 36 JINJA DISTRICT ASP Omara Clinical Officer, Jinja Police Grace Obeti Clinical Officer Kirinya Prison 0712862224 Emmanuel Kafeero AIC, Jinja Jinja District Kim Bwayo D/CAO Jinja 0776597365 Namutosi Sarah BCA Police Jinja District Epila Eunice BCA Police Jinja District Aje Mary BCA Police Jinja District Namboze Precious Sanyu BCA Police Jinja District Edema Jane BCA Police Jinja District Akenda Simon BCA Police 0773840053 Amuge Agnes BCA Police Jinja District Namulinda Irene BCA Police Jinja District Asimo Caroline BCA Police 0785839375 Anyait Janet BCA Police 0784258583 Achen Miriam BCA Police 0778232126 Nambogo Veronica BCA Police Jinja District Chebotibin Violet BCA Police Jinja District Nakirya Eva BCA Police Jinja District Swaha Martin BCA Police Jinja District Agwaya Samuel BCA Police Jinja District Adamba Jacinta BCA Police Jinja District Kozaala Livingstone BCA Police Jinja District Mugala Petwa BCA Police Jinja District Acen Grace BCA/VHT/Peer Educator Police Jinja District Agwang Marion BCA Police Jinja District Kakande Agnes BCA Police Jinja District Omiel Susan BCA Police Jinja District Naluyima Hadijah Mutyaba BCA Prison Jinja District Niwamanya Ivan S&D Champion Prison Jinja District Kushemererwa Owen BCA Prison Jinja District Ssentongo Joseph BCA/S&D Champion Prison Natukunda Judith BCA Prison Emuget Charles Ojackol BCA/ S&D champion Prison Okullu Martin BCA Prison Odyew Pius BCA Prison Amajo Pauline BCA Prison Omviru Florence BCA/S&D Champion Prison Iwutung Robinah BCA/ S&D Champion Prison Olupot Samuel S&D Champion Prison Kamaala Ngobi Herbert member TAAG Namusisi N.Joan member TAAG Kitakule N. Hassan Chairman TAAG Nambi Caroline Secretary TAAG Abalirya David W member TAAG Musubika Vicencia member TAAG Likicho Mary " ARUA District Linda Christine " ARUA District Achan Sharon sheillah " ARUA District Nabatanzi Judith " ARUA District Kanyunyuzi Diana " ARUA District Kamuli Beatrice " ARUA District Mutesi Diana " ARUA District Tayebwa Agnes " ARUA District Candiru Caroline " ARUA District OyellaJannet " ARUA District Aciro Eunice " ARUA District 37 BUGIRI DISTRICT Cpl Wanjala Sam Obwete Staff, BCA Police AIP Mungecha HM CLO/ BCA Police Oketcho Dedderio I/C outpost / BCA Police Najjuko Juliet Staff, BCA Police AIP Namuyonga Judith CID /BCA Police Amali Florence STAFF/MCB Police W/AIP Nabirye Christine Ass/ OC Medical Police SP Magooba Annet Sector Coordinator Police 0772413059 D/AIP Igodobe Paul Member PHA Police D/W/CPL Namutosi Rachel Anti-corruption/ BCA Police Rose Mutesi OC Prison Prison / 0772872671 Mwerero Abdul Staff/ BCA Prison Komugaso Jolly BCA Prison Naigaga Christine BCA Prison Baliraine Abdu BCA Prison Masiga Samuel BCA Prison Namukwana Florence BCA Prison Mutesi Joy Staff/ BCA Prison Chief Ilweku Elisha Staff/ BCA Prison Okware James D/OC Prison/BCA Prison Nyuliyedi Juliet Betty Child Prison Kwagala Rachel Child Prison Mutesi Alice housewife Prison Namukwana housewife Prison Omusudutu Prison Ninsiima Anna housewife Prison Nalongo Lucy housewife Prison Ssanyu Rachel child Prison Namulondo housewife Prison Tasumba Barbra housewife Prison Philip Prison Esther Prison Omoding Prison Kampi Catherine housewife Prison Emenyu C Staff/ BCA Police Nabalayo E Housewife/ BCA Police Magara Dominic Staff/BCA Police ASP Kalikolaki Amisi Staff/ BCA Police d/cpl Wanyama S.Charles Staff/ BCA Police 0772330934 Naigaga Mariah Spouse/ BCA Police W/SGT Nakaweke Monica Staff/ BCA Police/ 0772430023 Muteguya Benjamin Staff/ BCA Police/ 0774885437 Nampala K.Simon Staff/BCA Police Dr Nakendo Abubakeri Ag MS, Bugiri Hospital Butanda Shafiq Focalpoint person 0701510051 Dr Kiirya Stephen Bulolo DHO, Bugiri 0772432918 Mubballeh Ally Abdallah Sec Mobilisation TAAG Nandutu Esther M Chairperson " ARIOKT Mary Awoori member " Basirika Sarah treasurer " Hasahya Mary member " Nabwire Were Beatrice coordinator " Luvaluka Irene member " MBALE DISTRICT Wandwasi Robert Focalpoint person 0772639774 Wamburu David A/CAO Sam Wananda Branch Manager AIC 0772622040 Rhoda Buyinza Clinical Officer Prison 0782006378 38 Amusolo Faith Norah Student, Community Mob Prison Achiro Josephine BCA/ CM Prison Akoko Florence CM Prison Kajoina Rose CM Prison Mono Kevin CM Prison Nakombe Aidah CM Prison Mugide Jesca CM Prison Ukija Clara CM/ BCA Prison Akol Gilbert S&D Champion Prison Dr Francis Abwaimo SDS Programme 0772415913 Simon Zabwe Star East, Mbale 0782 356612 Lucy Amango TASO Ocheng Ronald TASO Jane Tushabe Mpiima RC Eastern, SPEAR 0392 946073 Francis Oundo Technical Associate, SPEAR Mudukoya Augustine Regional Manager, Eastern Saracen 0777 341264 Beatrice Khanakwa Mutenyo secretary TAAG Nabwire Teopista treasurer TAAG Busiku Patrick member TAAG Wataka James PHA Coordinator TAAG SOROTI DISTRICT Amodoi Martin DHE/ Focalpoint person 0772591788 Aupal Dominic DHI Sam Alutya Ass Counselling Coordinator TASO Ojera Morris Staff/ BCA Prison Ocen Peter Staff Prison Abala Camilo Don Charles Staff Prison Akurut Joyce Mary Agoda Staff Prison Akonyu Ketty Staff/ BCA Prison Christine Ejolu BCA /Nurse Prison Cherukut Leonard Staff /BCA Prison Ogwal William Staff /BCA Prison Harriet Ojera (mrs) Housewife Prison Apolot catherine Rose Staff/ BCA Prison Aluko Zaitun Sec Mobilisation TAAG Apio Anne Mercy member TAAG Apedun Agnes Member TAAG / 0775226152 Opiane Sam Assistant Chairman TAAG Amongin Jenifer member TAAG Olinga Micheal member TAAG Ilenyot Jennifer Ag DIS TAAG Akalo H.Barbara Chairperson TAAG Aruto Angela Sec TAAG Apolot Alice Olinga member TAAG Apuret DD Member TAAG D/IP Egwang Micheal Chairman PHA/ BCA Police D/SGT Apiso Susan BCA Police D/SGT Othira Stella BCA Police W/IP Adong Florence BCA Police W/AIP Ayoro Joyce BCA Police Ililaip Idoto BCA Police Peter Ewadu P/O BCA Police barracks Akello eatrice D/O BCA " Amuso Regina P/O BCA " Joseph Asiat Wife/ P/O " Nantume Naume P/O PMTCT " KATAKWI DISTRICT Amecu Francis DHE/ Focalpoint person Katakwi District Andrew Adakun D/ OC Prison 39 Walimbwa Clinical Officer, ASTU 0772 524673 Thomson Ogole Commandant, FFU ARIOKOT Juiet member TAAG / 0787252285 Adome James MEMBER TAAG 07734922 Apiny Florence Member TAAG 0775166534 / 075151453 Achieng Carolyn Member TAAG 0773086152 Iripoit Stella Member TAAG 0772987664 Atuko Jane Frances Member TAAG 0759661814 Arukol Mary Member TAAG 0781733710 Omugur Gelasio Member TAAG 0774020742 Olinga John Member TAAG 0782254916 Apuda Emmanuel Member TAAG 0712048275 Odokocan E.R Member TAAG 0775975558 Iningo Alfred Member TAAG 0753456548 Ateria Micheal Member TAAG 0782492937 MASAKA DISTRICT Juliet Mayanja Ag D/CAO Masaka District Baptista Mulindwa HM representing DEO Masaka District Miwanda Jamil Sec Social services Masaka District Nakanwagi Olivia Focalpoint person 0772641594 George Oriokot Centre Coordinating Tutor Kalungu 0772938652 Nabwire Daisy Clinical Officer I/C South Prison 0779222129 Kamya Joshua Medical staff (N/O/P) Prison Wansadha A.B. Simon OC Prison Nakanwagi Betty Receptionist Prison Nkamwesiga Frank BCA Prison Kibuule Gerald BCA Prison Musa Muwonge Clinical Officer I/C South Police 0772337301 Jackson Wafula ROM Southern, WVU Masaka Sheila Kyobulungi Ag RC SPEAR Southern 0772309003 Migadde Vincent Member TAAG Education Masaka David Akamuha Member TAAG Education Masaka Nandawula Kigongo Member TAAG Education Masaka Kaate Matovu Theopista Member TAAG Education Masaka Mutebi Charles Member TAAG Education Masaka Nakitto Jesca Member TAAG Education Masaka Ssekandi Ronald Member TAAG Education Masaka Nabulya Maurice Member TAAG Education Masaka Naula Juliet Member TAAG Education Masaka Nakalema Rosemary Member TAAG Education Masaka Nakuya Lucy Member TAAG Education Masaka Odoch John Odongtoo Lab Ass / Police Clinic Masaka District Bazibu Joseph Police Officer (P/O) Masaka District Muwonge Musa P/O MCO Masaka District Kamya Paul Office clerk Masaka District Ocha George Training Officer Masaka District Bwayiga Milly Grace Registered Nurse Masaka District Musiime Julius CLO asaka CPS Masaka District Obua Tonn Blair Masaka District Opio Alfred Masaka District Ssekiwunga John Bosco New Ug Guard Masaka District Amisi Mutegeki Supervisor New Ug Guard Masaka District Madaya Micheal Supervisor New Ug Guard Masaka District Ocen Jimmy Supervisor New Ug Guard Masaka District Nalugya Jessica P/O Masaka District NSEREKO John Paul P/O Masaka District Ssemanda Godfrey P/O Masaka District Oleru Hellen P/O Masaka District 40 Okiranyang Emmanuel Masaka District Opira Allex New Ug Guard Masaka District Twinamatsiko Bosco Police Officer MBARARA DISTRICT Umar Maseruka DHI/ Focalpoint person Mbarara District Mbabazi Edward DEO Mbarara District Tusimireyo Johnson DP Mbarara District Tindisimwa Silva Sen Distict Planner Mbarara District Jack Masamba HR Mbarara District Okuku Francis Chairman BCA Prison Victoria Nahiyema I/C Clinic Prison ASP Namakuye Harriet OC Women Prison Prison Teddy Namakula Sen Clinical Officer Prison Conkal Betty Staff/BCA Prison Okumu Hellen Housewife Prison Ochwo Betty Housewife Prison Nerima Ritah Staff/ BCA Prison Kyomugisha Medius Staff/ BCA Prison Bainomugisha Mary Prison ASP Polly Namaye Police Nerima Jesca Staff / S&D champion Police Byabagambi Norah (mrs) Midwife Police Petwa Mwesigwa (mrs) wife Police George Mwesigwa Staff Police Asiimwe Jane Staff Police Musinguzi Police Nyanda Erick P/O Police Cate Mwesigye Wife Ndyanabangi Steven Staff Police Nalongo Staff Police Prasidia Owembabazi Clinical Officer MJAP KABALE DISTRICT Besigye K Patrick C/M LC V Kabale District Nalongo R Kampereza Sec Health Kabale District Kalama Ali Sec Works Kabale District Mary Bebaziba V/ CM Kabale District Maurice HIV Focal point person Kabale District Kanagizi Flavia Dep Speaker Kabale District Nzirimana DEO Kabale District Pastoli Twinomuhangi District Speaker Kabale District Byamugisha Geoffrey Sec Education Kabale District Twesigye Flora Teacher / TAAG Kabale District Arigye Ambrose Teacher / TAAG Kabale District Turyamusiima Sam Teacher / TAAG Kabale District Tusimomwe Teddy Teacher / TAAG Kabale District Kijunguri Silvertoris Teacher / TAAG Kabale District Asiimwe Alfred Teacher / TAAG Kabale District Barugahare Moses William Teacher / TAAG Kabale District Tussime Allan Teacher / TAAG Kabale District Tumuhairwe Pelly Teacher / TAAG Kabale District Mugarura Hudson Teacher / TAAG Kabale District Tugume Juliet Midwife/ BCA Prison Sanyu Agatha BCA Prison Isingoma Peter Staff/ BCA Prison Kugonza Adolf Staff/ BCA Prison Turyahikayo Ambrose Staff/ BCA Prison Adong Susan Staff/ BCA Prison 41 Ajalo Joyce Staff/ BCA Prison Anna Tumwebaze Staff/ BCA Prison Mutaka James Dennis Staff/ BCA Prison Owomugisha Vivian CHILD Prison Turyakira Frank HIV / AIDS Police Katumwijukye Alex Coordinator Police Twinomuhwezi G Police KaanaWilly P/O BCA Police Agaba Hardrick BCA Police Abihire Frank BCA Police Tukirina W BCA Police Mbabazi Hexisty BCA Police KABAROLE DISTRICT Kwanya Wilson RPC Western, Police Kabarole District Dr Richard Mugahi DHO Kabarole District Bagambaki Peter D/ CAO Kabarole District Tumuhimbise Gervase OC representing RPC Kabarole District Moses Ikagobya Sec Health LC V Kabarole District Mpuga Hosea DHE/ focalpoint person Kabarole District Kunihira Janepher Secretary TAAG Kabarole District Nakyeyune Grace member TAAG Kabarole District Kobusingye Harriet Member TAAG Kabarole District Muhumuza Francis Member TAAG Kabarole District Komuhancu Sylvia Member TAAG Kabarole District Namazzi Gertrude Mobiliser TAAG Kabarole District Baguma John vice c/person TAAG Kabarole District Muhumuza Edward Mobiliser TAAG Kabarole District Kemigisha Rose Member TAAG Kabarole District Manyindo Benburn Member TAAG Kabarole District Mbabazi Edith secretary finance TAAG Kabarole District Kihamba Joseph DPC, Police Kabarole District Kabayaga Beatrice Clinical Officer/ Coordinator HU Prison Katusabe Jacintah CM Prison Karungi Sarah CM Prison Nkamushaba Mercy CM Prison Ateo Chrisine CM Prison Angwech Winnie CM Prison Mbabazi Mable Prison Kayumba Mary CM Prison Musinguzi Evassy CM Prison Beitasya Dorothy BCA/ Teacher Prison Ondoa Florence CM Prison Grace Idaa CM Prison Driwaru Scovia CM Prison Mwanga Issa BCA Prison Laker Jackline BCA Prison Sharon Nakanwagi RC Western, SPEAR WVU Arinaitwe Annalet BCA Police Namyalo Hadija BCA Police Mulawa Abdu OC Station Kabarole Police Kamugisha Joseph Secretary / BCA Police Ciriku Kanisto BCA Police Kiboga District Ms. Rhoda Nyakato Prog. Manager WV-Kiboga Scovia Nankabirwa Prog. Asst WV- Kiboga Lwamasaka Prosper DEOprosperlw@gmail.com 0772456706, Mr. Nsubuga Patrick PSWO, Sector Coordinator Kiboga Ssebigaju John Jelly Ag. PPO Kiboga/0783258338 Bigirwa Kaliisa Samuel DCAO 0772659563 42 Natunga Harriet Police officer 0789349878 Monday Florence Police officer Namisi Isaac Police officer 0782516268 Aliga Zachary Police officer Prisons/0772960893 Kwikiriza William Police officer Prisons/0759941198 Wandera Kennedy Teacher Kagobe p/s /0779762607 Nakalema Mariam Teacher Lwamata SSS/0700445838 Ssendege Moses Teacher p/s/0782911535 Baagala Sarah Teacher 0782896483 Nakkazi Sarah Teacher 0782311841 Tuhaise Harriet Byakora Teacher Kagobe p/s/0777963047 Kakooza Martin Teacher St. Andrews/0782122124 Wamala Ivan Teacher St. Andrews/0773689473 Namono Sarah Teacher Bamusuuta p/s/ Oyuku George Tutor Bamusuuta p/s Mbaale John Patrick Teacher Kiboga DAS/0782689026 Hoima District Mr. Ntulume CAO – Hoima Hoima District Nabwire Flavia ACAO Hoima District Byaruhanga Samuel TAAG Hoima District Ms. Nansiiti Rebecca TAAG Hoima District Mufumu Christopher TAAG Hoima District Ms. Abigaba Jackline TAAG Hoima District Ms. Kaahwa Flora TAAG Hoima District Ms. Nyamahunge Margret TAAG Hoima District Kunihira Julius TAAG Hoima District Tumusiime Janepher TAAG Hoima District Bigirwa Betty TAAG Hoima District Nakanwagi Sharon Coordinator sharonnakanwagi@yahoo.com Zondera Amon District. Sports Officer Hoima District Augustine Kasangahi DPC Hoima Hoima District Matua Alfred Otokira Police officer Hoima District Kyomuhendo Alice Police officer Hoima District Kalungi Blandibah Police officer Hoima District Ponji Dorothy Police officer Hoima District Katusiime Oliver Police officer Hoima District Matubua Avinzo Charles Police officer Hoima District Byenkya Fred Police officer Hoima District Kanyunyuzi Annet Police officer Hoima District Ayuru Grace Police officer Hoima District Nyakabandwa Beatrice Police officer Hoima District Mukaanga Police officer Hoima District Anena Betty Officer/wife Hoima District Kaseke John Officer/wife Hoima District Nagawa Samalie Wife to officer Prison/ 0714760709 Tuhaise Everse Student Apiyo Jennipher Housewife 0774596283 Akao Susan Ongom House wife Prison Nuwabiine Provia Officer/wife 0782349010 Agondwa Lucas Police Sector Coordinator 0782941551 43 ANNEX 3 : DETAILED BUDGET PERFORMANCES Table 5 Budget Performance Summary Fy 2009 Budget Variance Planned Expenditure Actual % Administrative Salaries 593,932 614,571 (20,639) -3.46 Administrative Overheads 459,308 402,875 56,433 12.29 Direct Project Costs Policy 61,765 154,628 (92,863) -150.35 Institutional capacity building 27,794 66,269 (38,475) -138.43 Behavioral Change Communication 318,235 308,881 9,354 2.93 HCT and VCT services 126,471 22,253 104,218 82.4 Care & Treatment 40,000 2,132 37,868 94.7 Wrap around services 450,000 378,522 71,478 15.88 2,077,505 1,950,131 1277,374 61.5 Table 7 : Budget Performance Summary 2011 Fy 2010 Variances Planned Actual Planned Actual Administrative Salaries 465,307 395,323 69,984 15.04 Administrative Overheads 284,653 157,768 126,885 12.29 Direct Project Costs Policy 176,638 169,517 7,121 4.03 Institutional capacity building 124,022 174,502 (50,480) -40.70 Behavioral Change Communication 192,797 104,076 88,721 46.02 HCT and VCT services 146,480 128,426 18,054 12.33 Care & Treatment 58,400 22,360 36,040 61.71 Wrap around services 378,800 294,321 84,479 22.30 1,827,097 1,446,293 380,804 20.84 Table 6 : Budget Performance Summary Fy 2010 Variance Planned Actual Actual % Administrative Salaries 668,389 485,109 183,280 27.42 Administrative Overheads 371,621 221,165 150,456 12.29 Direct Project Costs Policy 176,638 112,641 63,997 36.23 Institutional capacity building 124,022 168,962 (44,940) -36.24 Behavioral Change Communication 285,682 143,285 142,397 49.84 HCT and VCT services 81,005 51,923 29,082 35.90 Care & Treatment 53,995 3,947 50,048 92.69 Wrap around services 350,000 238,000 112,000 32.00 2,111,352 1,425,031 686,320 32.51 44 ANNEX 4: SOME OF THE KEY DOCUMENTS CONSULTED 1. USAID Evaluation Standard guidelines 2. SPEAR Annual Report Fy 2008 to USAID 3. FINAL REPORT to USAID 2009 4. SPEAR Annual Report Fy 2010 to USAID 5. SPEAR Annual Report Fy 2011 to USAID 6. Formative Evaluation Report in Uganda Police Force 7. SPEAR Fy2010 report to USAID 8. SPEAR Q3 Report 2010 9. SPEAR Fy2010 report to USAID 10. SPEAR Quarterly Report Oct-Dec 2008 11. SPEAR Report Jan –March 2010 12. SPEAR Quarterly Report Jan –March 2009 13. SPEAR Quarterly Report Oct-Dec 2008 14. SPEAR Q3 Report 15. SPEAR Quarter 2 Jan –March Report 2011 16. 617 A 00-08-00015 Public sector Services 17. RFA 617 08-005 Public Sector HIV Services 18. Approved Workplans 11.2409 19. RFA 20. Public Sector Award 21. SPEAR FY 2011 Revised Work plans 2011 approved 22. SPEAR Q1 Report 2011 23. Report Oct-Dec 2008 24. SPEAR 3rd Quarter (April –June) 2011 25. Baseline Report 26. Formative Evaluation 27. Performance Monitoring Plan 28. USAID program and Financial reporting requirements 29. HIV/AIDS Work Place Policy , Government of Uganda, Ministry of Education and Sports 30. HIV/AIDS Work Place Policy , Government of Uganda, Ministry of Internal Affairs 31. HIV /AIDS Work Place Policy , Government of Uganda, Ministry of Local Government