Development and the HIV Epidemic: A forward-looking evaluation of the approach of the UNDP HIV and Development Programme
PREFACE Another Voice "It's like growing something; it doesn't take a day. You must be prepared to wait. You need to nurture and care for the tree to yield fruits which you may never yourself [get to] see...." "[Development practice is] a process where you stimulate and assure the involvement of people from beginning to end in a project or programme they have themselves identified ... the role of the facilitator is to ensure people's ownership so that people can follow and sustain the process. It is very time consuming. It involves a significant amount of research and revision. If people do not come, you have to ask yourself why and then go out where the people are. It is something you cannot do from a desk." Sister (Dr.) Auxillia Bupe Ponga, National Commission for Development Planning, Zambia
Introduction How can we respond to the complex global challenges of the HIV epidemic? How can an international development agency, such as United Nations Development Programme, support those people who are struggling to understand the epidemic in ways which make sense within their own social, cultural, political, economic and development contexts? How can those people themselves develop responses grounded in their lived realities, which take into account other development priorities, and which are effective, adaptable and, ultimately, sustainable? These are some of the questions which have been explored over the last few years by the UNDP HIV and Development Programme. This exploration commenced with knowledge that the answers are not known, but that the challenges are urgent and immense. It took place in a context in which there was rapid and continuing spread of the HIV virus, no cure, and a potential for the HIV epidemic to impact on all aspects of human development. It was essential to develop understanding and practice simultaneously. This evaluation report is a part of that ongoing process. It summarises some of the most important lessons learnt through the work of the HIV and Development Programme; it describes new approaches to evaluation which are themselves consistent with the challenges of sustainable human development; and it suggests new ways to proceed in programme design, implementation and evaluation. Readers of this report will be introduced to some of the complex issues explored through the Programme, will hear some of the voices of the people whose lives are affected, will have some of their own ideas and programming approaches affirmed or challenged.
The HIV and Development Programme and use of Special Programme Resources The UNDP HIV and Development Programme is engaged in responding to the HIV epidemic using new approaches to development within a framework described by UNDP as "sustainable human development." It aims to build the capacity of people, communities and nations: building capacity to understand the ways in which the epidemic evolves through its interaction with human development, and the ways in which people can act in response to its causes and consequences. During the fifth UNDP programming cycle (l992-96), the HIV and Development Programme (HDP) was allocated US $5m from the UNDP Special Programme Resources (SPR), subsequently reduced to US $3.5m. The HIV and Development Programme (HDP) used the SPR resources to further explore and enhance understanding of the ways in which the principles and approaches of sustainable human development can be applied towards developing understanding of, and effective responses to, the HIV epidemic. Its plans were based on a set of related understandings about the nature of human development, the nature of the HIV epidemic and the role of UNDP. The approach recognised that the most effective responses to the epidemic would grow out of people's interaction within their own contexts: their own communities and their own countries. The approach was therefore based on capacity building, with an emphasis on the development of effective partnerships, in order to ground responses in people's shared experiences of the realities of the epidemic. The approach involved constant reflection based on the lives, dreams and hopes of those people struggling to respond. Focussing on the need to generate more effective responses to the HIV epidemic, the central question which guided the approach of the Programme was, "How can we, together, move forward?"
The evaluation The evaluation was forward-looking, starting with consideration of what has been learnt through the HIV and Development Programme to date, but aiming to generate further and deeper understanding of the nature and approach of this type of sustainable human development programme as applied to the HIV epidemic, its causes and consequences. The evaluation explored the extent to which the programme enhanced social learning and capacity development, by focusing on a broad range of critical indicators of the extent to which these are taking place. These indicators centre around the emergence of new understanding and approaches which have arisen as a result of the Programme. In line with the forward-looking purpose of the evaluation, and acknowledging the need for sustainable human development to grow out of people's lived experiences, the central issue of the evaluation process, reflecting the central question of the Programme itself, was "How can we, together, move forward?" In this case, the question was asked in relation to how we can use evaluation processes to generate a deeper understanding of the newer approaches to development practice. For this reason, a retrospective evaluation process, focussing on measurement of inputs, outputs and performance indicators, was considered to be less appropriate than an evaluation methodology which would generate deeper understanding of how new development practices can work. The evaluation itself explored ways in which the people whose lives were (and are) affected by the Programme could be the ones to make judgements and suggestions about how to proceed from now on. The process used enabled those people to themselves consider the relevance of the principles on which the Programme is based, to explain how those principles which make most sense to them can work in practice, and to interpret the ways in which the lessons learnt through the Programme might be most effectively incorporated into ongoing development practice, and ongoing development of deep understanding and effective responses to the HIV epidemic. The starting point was the Programme, but the evaluation enabled people to explore the Programme's issues with reference to their own lived experiences. This is consistent with the principle that, "The perspectives of and experiences of those persons who are served by applied programmes must be grasped, interpreted, and understood if solid, effective, applied programmes are to be put in place" (Denzin, 1989, p.105). The process was, in these ways, based on the qualitative research method of interpretive interactionism (Denzin, 1989). This method emphasises the need to interpret real-life phenomena in order to reduce complex reality to simple, understandable and debatable notions. It suggests doing this in an interactive way, because deeper understanding about the meanings and significance of experiences and relationships arises when people reflect and engage in dialogue with each other. The evaluation team of four people, who have all been partners of the Programme, visited four countries (Zambia, Senegal, Mexico and the Philippines). Within each country, the evaluation team used a series of related processes including interactive discussions and workshops with people whose lives are affected, and meetings to share what was learnt with UN and donor agencies. Further interactive discussions were later held in New York amongst evaluation team members and Programme staff. Thus, the evaluation, like the Programme itself, was a process of partnership. A large number of people explored together the issues of most importance: reflecting, sharing, discussing and debating what matters most. This was considered to be more appropriate than an approach in which a small number of experts interact with a Programme for only a short period in order to assess it. The evaluation report summarises the findings of this interactive process.
This report The report is presented in eight sections which describe the Programme, the evaluation and the findings and recommendations. Two case studies are also included in the body of the report, to illustrate key components of the approach of the Programme through concrete examples. Attached appendices describe more about both the Programme and the evaluation, including a paper which explains the conceptual framework of the evaluation process, and a list of publications available through the Programme. The report is a contribution to the ongoing exploration of approaches which will catalyse deeper understanding and more effective responses to the HIV epidemic in the context of development. Readers' responses will be an important next step. Unlike many evaluation reports, there is no summary, and a cursory glance at the conclusions and recommendations will provide only a limited insight into what has been learnt about how we might, together, move forward from now on. It is recommended that readers commence with reading the sections of most interest. The following short descriptions of each section of the report should assist with this process.
Section one: Introduction: The UNDP HIV and Development Programme and Special Programme Resources The setting of the evaluation.
Section two: The evaluation process The purpose of the evaluation, the interpretive interaction framework used, and the practical stages of the evaluation process are described.
Section three: The SPR-funded activities This section provides a concrete understanding of the activities of the Programme, thus complementing the more conceptual focus of most sections. It includes an overview of the Programme which was evaluated, incorporating both the philosophical basis of the Programme and a brief description of major activities.
Section four: Understanding the approach in the context of evolving new development paradigms and practices This section includes a theoretical exploration of the approach of the Programme in the context of recent discussions about new approaches in development practice, highlighting how these discussions might inform the development of more effective responses to the HIV epidemic: - recent discussions about the need to revise development practice are introduced; - the relevance of these discussions to the HIV epidemic is described; - the way these considerations have been applied within the Programme is summarised; - the implications of new approaches for the design of programmes, including the need to emphasise process rather than structure, is introduced; - the role of strategic questioning as a crucial component of such processes is discussed; the nature and importance of process consultation is acknowledged; - the notion of transformation as a Programme goal is introduced; and - the evolving nature of approaches of sustainable human development is explored.
Section five: Deepening understanding of practical implications of a sustainable human development approach Section five is a description, based on evaluative discussions, of the ways in which people experience the new approaches in practice. This section enables the voices of the people whose lives are affected to be heard, in a framework which reflects their own interpretation of what matters most. It includes: - people's understanding of capacity development, why it matters, and why it needs to be different in various contexts; - characteristics of partnerships which develop capacity, as compared with those which do not; - some immediate effects of partnerships which build capacity: inclusion, the importance of safe spaces, reflection and sharing of experiences; - what people experience as a result of these processes: validation, developing empathy and deep understanding, solidarity, empowerment and the unleashing of energy; and - a description of how these processes lead to sustainable social change.
Case study 1: Enhancing national capacity through HIV action research This case study provides a practical example of how the Programme used approaches based on partnership to develop capacity. It is inserted as an adjunct to Section five to illustrate how the approaches people say they find helpful can be incorporated into practical programme design. This concrete example, reported in retrospect, shows how such a programme worked to develop people's capacity to initiate and conduct the types of research which would find answers to the types of questions they considered were most important to help them understand the way the epidemic impacts on their own lives and the ways in which they could develop effective responses.
Section six: Grounding responses in people's realities: listening to how people talk about the epidemic Section six provides an introduction to the importance of recognising the way people talk about the epidemic. The approaches of sustainable human development ideally commence with people's own perceptions of reality and build capacities in ways which are consistent with how people understand that change comes about in their own contexts. The use of language is an important starting point: if programmers use different langauge to the people whose lives are affected by their programmes, then much of importance is likely to be missed. While much current discussion is critical of an over-reliance on use of the social engineering metaphor to guide development practice, the way in which development of alternative approaches might occur is rarely addressed. This evaluation attempted to at least start exploring what other types of metaphor might already be in use. This section is exploratory in nature, aiming to identify metaphorical patterns in the way people talk about their own experiences of the epidemic and their own understanding of how effective responses come about. It tentatively suggests a few different metaphor systems already in use in different countries, and challenges programmers to revise the way programmes are designed and implemented to take account of these different perceptions of reality and social change.
Case study 2: The partnership between the Salvation Army and the HIV and Development Programme This case study is inserted as an adjunct to Section six because it records the way in which the use of language and the development of useful concepts was explored through one series of partnerships, commencing but moving beyond the partnership between the Salvation Army and the Programme under consideration. The case study demonstrates how values have been shared, concepts formed and consequently new types of programming developed as a result of open-ended and reflexive cooperation between two international organisations. Reflecting how a move away from the metaphor of social engineering can work in practice, the partnership centred around articulating and sharing values, developing concepts of hope, acknowledging and understanding the role of suffering in the epidemic, and developing a culture of mutual learning which incorporated recognition of these complex human experiences.
Section seven: Some issues relating to the nature of change within development practice This section outlines some of the most salient features of the differences in approaches for achieving sustainable human development as experienced in the field of HIV and Development. Even with understanding and good intentions, developing the approaches of sustainable human development will not be a straightforward or easy process.
Section eight: Conclusions and recommendations Some of the key conclusions of this evaluation are outlined in this section. Once again, the central question of "How can we, together, move forward?" is addressed, this time with reference to the need to move beyond what has been learnt so far in both the Programme and the evaluation. Specific recommendations are made for further consideration by UNDP. However, it is the hope of both the Programme staff and the evaluation team that reading of this report will result in further development of understanding and responses to the HIV epidemic in ways which cannot be pre-determined by those already involved. The epidemic is highly contextualised, in that its evolution, its effects, and the ways in which it can be addressed are different in each country, in each community. While there can be no such thing as universally recommended practices, there do appear to be a range of effective approaches. Since partnership is central to these approaches, it is impossible for one group of people to recommend specific paths without an awareness of partners' own contexts. The writers of this report are keen to hear of responses which are stimulated or otherwise encouraged through the reading of this report; this will be more relevant than making recommendations about contexts of which we are not a part.
Appendices The appendices contain further information about the evaluation process, the activities of the Programme in the countries in which the evaluation took place, and further resources available through the Programme. These appendices are provided in order to make the processes of the Programme and the evaluation more transparent for those with further interest.
The reader's role in further development The contents of this report give space for the voices of those whose lives are affected by programmes addressing the challenges of HIV and development. The evaluation process has enabled continual exchange of experiences and ideas in ways which have ensured that many people have been able to share and develop their insights to the question, "How can we, together, move forward?" Such a question can now be asked by those about to embark upon reading this report.
Bruce Parnell, Evaluation Team Leader June 1996
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