CGD Proposal

Gender Policies and Practices of Global HIV/AIDS Donors:

A Comparative Analysis of the President’s Emergency Plan
for AIDS Relief, the Global Fund for AIDS, TB and Malaria
and the World Bank MAP in Mozambique, Uganda and
Zambia

Proposal to the Swedish International Development Agency (SIDA),
submitted via the Swedish/Norwegian Regional HIV/AIDS Team for
Africa, Zambia

Center for Global Development
Washington, D.C.
Submitted October 18, 2007
Revised Feb 1, 2008

1
BACKGROUND AND STUDY DESIGN

Introduction
Whether or not gender inequities are being adequately and appropriately
addressed in programs supported by the major sources of development
assistance for the fight against AIDS is a question of major and urgent
importance. In recent years it has become increasingly recognized that gender
inequities lie at the heart of the HIV pandemic. For example, in 2004 the Global
Coalition on Women and AIDS was established to respond to the increasing
feminization of the AIDS epidemic and the concern that existing AIDS strategies
did not adequately address women’s needs. In 2007, UNAIDS made responding
to the gender‐related aspects of the epidemic a corporate priority. These actions,
and others, were taken on the basis of evidence that the epidemic is driven in
important ways by unequal gender norms, which lead to gender‐based violence
(a proven co‐factor in HIV infection), the inability of women to support
themselves economically or to own and inherit property, and other
discriminatory practices. International mobilization to address AIDS cannot
succeed without effective and sustained attention to these types of gender‐
related concerns.

Through an established policy research program called the HIV/AIDS Monitor,
the Center for Global Development (CGD), the International Center for Research
on Women (ICRW) and African research teams in Mozambique, Uganda and
Zambia propose to undertake and disseminate policy‐relevant analytic work on
how major sources of funding take gender issues into consideration in their
programming. This work has the potential to improve the ability of donor
countries and their national partners to respond effectively to the HIV/AIDS
pandemic. Through strategic outreach and broad dissemination of results, both
at the country level and at international venues, the work will stimulate
informed conversation and promote action by donors, implementers and
advocates.

The research proposed here fits into a broader agenda of studies of the
performance of three major donor funding mechanisms for AIDS – the US
President’s Emergency Plan for AIDS Relief, the World Bank Multi‐Country
AIDS Program, and the Global Fund to Fight AIDS, TB and Malaria. Overall, the
country‐level research being undertaken by the HIV/AIDS Monitor is working
on seven themes: 1) tracking the funding; 2) inequity analysis with a focus on
gender; 3) relationship between funding and performance; 4) relationships
between HIV/AIDS and reproductive health programs; 5) effects of donor funds
2
on the national health system; 6) recurrent cost burden and sustainability; and 7)
the impact of donor programs on the labor market on health workers and
managerial talent.

In this proposal, CGD, ICRW and three African research teams 1 propose to
document the extent to which, and in what specific ways, these three important
funding mechanisms are addressing gender‐related drivers of the HIV epidemic.
This proposal requests support from SIDA for the technical and managerial
oversight of this work, as well as the in‐country data collection, analysis, writing
and dissemination.

The objectives of this study are consistent with SIDAʹs core commitment to
addressing poverty, and the agency’s demonstrated concern with gender
imbalance as one of the key social inequities both driving and being driven by
poverty. Moreover, the focus of the study is aligned with SIDA’s “health is
wealth” perspective, highlighting the persistent inequalities in disease burden
among and within countries, and between men and women, girls and boys.
Importantly, the policy research seeks not just to create a refined description of
the problem but – like SIDA itself – to develop constructive, practical approaches
to solving the problem.

Background and Context
Women and girls are now at the center of the global HIV/AIDS epidemic. The
global statistics speak for themselves:

• 17.2 million adults have died of AIDS, 52% of whom were women; 2
• 50% of those living with HIV globally are women and girls; 3 and
• More than 60 percent of those who are living with HIV in sub‐Saharan
Africa are female 4

Young women between the ages of 15 to 24 are the most vulnerable: in sub‐
Saharan Africa 75 percent of people living with HIV from this age‐group are
1 Makerere University School of Public Health, Kampala, Uganda; Health Economics Program,
Department of Economics, School Of Humanities And Social Sciences, University Of Zambia;
Austral‐Cowi Consultants, Maputo, Mozambique.
2 UNAIDS/WHO 2006. AIDS Epidemic Update: a special report. United Nations Special Program
on AIDS and the World Health Organization, Geneva.
3 UNAIDS/WHO 2007. AIDS Epidemic Update: December 2007. United Nations Special Program
on AIDS and the World Health Organization, Geneva.
4 UNAIDS/WHO 2007.
3
female, and it is estimated that in some African countries, anywhere between 3 to
6 times more young women are infected with HIV than young men of the same
age 5 . These trends are mirrored in the three focus countries of this study, as
shown in the table below.

People Aged 15-49 Living with HIV
Country Total Women Men
Mozambique 6 16%
58% (percentage of
(percentage 42% (percentage of people
people living with
of people living with HIV who are
HIV who are
living with men)
women)
HIV)
Uganda 7 6% 8% (prevalence rate
5% (prevalence rate among
(prevalence among adult
adult men)
rate) women)
Zambia 8 17%
57% (percentage of
(percentage 43% (percentage of people
people living with
of people living with HIV who are
HIV who are
living with men)
women)
HIV)
Women bear a disproportionate share of the burden in the AIDS epidemic,
however, not only because they are infected in equal or greater numbers than
men, but because of the difficulties they face in adopting the prevention options
offered to them; in accessing information and services necessary to protect
themselves from infection or treat themselves once infected; and because of the
extraordinary burden of care they experience. The underlying causes accounting
for much of the toll on women can be traced to gender inequality. Factors such
as gender norms that assign greater privilege and power to men, the (related)
economic dependency of many women on men and their extended families, as
well as the social acceptance in many communities of practices such as gender‐
based violence and child marriage, play a key role in increasing women’s
vulnerability, and in reducing their ability to protect themselves and cope with
the consequences of the epidemic.

Understanding the special role that gender plays in the HIV epidemic requires a
shared definition of terms. We define gender as the widely held expectations
and norms within a society about appropriate male and female behavior, roles
5 UNAIDS/WHO 2006.
6 UNAIDS/WHO 2006.
7 Government of Uganda, Ministry of Health (MOH) 2006. Uganda HIV/AIDS Sero‐Behavioural
Survey 2004/2005.
8 UNAIDS/WHO 2006.
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and responsibilities. It is a social and cultural construct that differentiates women
from men and defines the ways in which women and men interact with each
other. Gender is culture‐specific; what women and men can or cannot do differs
significantly across cultures. What is fairly consistent, however, is a marked
difference in womenʹs and menʹs roles, obligations and privileges, particularly in
terms of access to productive resources and decision‐making authority. Although
the extent of that difference is more pronounced in some locations than others,
generally speaking, in most societies gender norms dictate that men are
responsible for the productive activities outside the home while women are
responsible for reproductive and productive activities within the home. As a
result, women have less access to and control over productive resources than
men, as evidenced through persistent gender gaps in education, employment,
income, ownership of land and housing, and access to credit.

Sexuality is distinct from gender yet intimately linked to it. It is the social
construction of a biological drive. An individualʹs sexuality is defined by whom
one has sex with, in what ways, why, under what circumstances, and with what
outcomes. It is more than sexual behavior; it is a multidimensional and dynamic
concept. Explicit and implicit rules imposed by society, as defined by oneʹs
gender, age, economic status, ethnicity and other factors, influence an
individualʹs sexuality.

Predictably, the inequality that characterizes the social and economic spheres of
society, in which women have less access to productive resources than men, is
often mirrored in sexual interactions, creating an unequal balance of power in
sexual relations. As a result, many women have less control than men over when,
where, why, with whom, and how sex takes place. This inequality in sexual
decision‐making is perpetuated by gender norms of femininity and masculinity
that curtail women’s sexual autonomy and expand men’s sexual privilege, place
greater emphasis on male pleasure over female pleasure, and cast women in the
role of passive recipient rather than active agent. The complex interplay of social
and economic gender differences and inequalities, combined with an unequal
balance of power in sexual relations that favors men, significantly increases
women’s and men’s vulnerability to HIV.

Policy Relevance of the Findings
Very little currently is known about how donors’ high‐level policy language
about the need to attend to gender issues is being interpreted by recipient
countries and recipient organizations, and operationalized into programming.
Even less is known about how intended beneficiaries experience and receive the
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programs. By generating evidence on these aspects of their programming, the
HIV/AIDS Monitor will be able to assess how the donors are addressing the
gender drivers of the epidemic. Where gaps or weaknesses exist, the study will
provide specific recommendations for how to improve these efforts to maximize
the impact of their support. Broad dissemination will ensure that donors are
held accountable for living up to the commitments that they have made to
considering gender‐related factors in their program decisions.

The project has profound policy relevance at the national level in each of the
three focus countries. We anticipate that the results will be revealing to policy
makers and program managers, and will permit a more open discussion about
how to create an enabling environment for effective programming that takes
gender considerations into account.

Overview of the Research Process
The purpose of this study is to determine the extent to which the gender‐related
drivers of the HIV epidemic are being addressed in three focus countries, and
how the three funding mechanisms are supporting (or indeed inhibiting) this
process.

The attached Log Frame (Appendix I) summarizes the objectives, main activities,
indicators, means of verification and important assumptions made in this
research proposal. The main topics 9 to be explored are summarized in the
attached Outcomes Table (Appendix II) with relevant research questions,
outcomes of interest, possible data sources and data collection instruments.

These research topics include:
I. Assessment of attention to gender and women’s needs within
national & donor programs at the country level;
II. Demonstrated commitment to addressing gender and needs of
women at the level of recipient and sub‐recipient organizations;
III. The integration of attention to gender and women’s needs among
recipient and sub‐recipient organizations;
IV. Beneficiary‐level impact of gender related programming

9 These topics were identified as a result of stakeholder assessments conducted by CGD in 2005 in
six African countries in preparation of the design of the HIV/AIDS Monitor
6
Key research questions include the following:
• What commitments to gender have been made in the relevant policy
documentation?
• How are these commitments being operationalized by recipient and sub‐
recipient organizations?
• How is monitoring data collected and used to shape programs?
• Are these funding mechanisms investing in capacity building on gender
within the recipient organizations (ROs) and sub‐recipient organizations
(SROs)?

Methodology
Through document review and key informant interviews, the project will build a
picture of how each of these important funding mechanisms are addressing
gender‐related vulnerabilities in AIDS policy and practice on the ground in three
African countries. Qualitative research methods will be used to conduct in‐
depth interviews with key informants who will be purposively selected. These
will include staff of the donor mechanisms in country, staff of recipient and sub‐
recipient organizations, and, where possible, a selection of beneficiaries.

This research will build on the findings of the global‐level policy analysis on
gender, which is being conducted by CGD and ICRW, with separate support.
The global‐level comparative analysis will identify key policy positions,
statements and commitments to addressing gender‐based vulnerabilities. The
country teams will then determine whether and how policy statements are being
put into operation at national and implementation levels.

At the national level, the process will involve research among the country‐based
donor staff (or their representatives) as follows:
• a gender analysis of donor policy and program documentation assessing the
extent to which the gender‐related needs and vulnerabilities of women
and girls are being addressed in policy; and
• key informant interviews with purposively selected stakeholders involved in
policy formulation and program management to explore the extent to
which they see gender as a priority, whether they perceive that current
programming is adequately addressing this issue, and how they see policy
and programming on gender moving forward in the coming 5 years.

The next level involves research among the implementing partners, ROs and
SROs, to determine whether and how policy statements are being put into
operation. Where possible, the country teams will conduct this assessment with
7
the same recipient organizations they have been working with for the other
HIV/AIDS Monitor themes, with whom they have already developed trust and
rapport. Data collection here will involve:
• analysis of program documentation and data, and
• key informant interviews with program managers and other relevant
personnel of ROs and case study SROs; as well as
• key informant interviews, where possible, with users of SRO services.

Key Research Products
A) COUNTRY REPORTS, by month 6
Three country reports will detail an in‐depth understanding of how the three
funding mechanisms and their recipient organizations are addressing gender‐
related drivers of the HIV/AIDS epidemic.

B) FINAL SYNTHESIS REPORT, by month 10
Synthesis of findings from the three individual country reports in a final report
to submit to SIDA.

Dissemination of Research Findings
The main goal of each of our studies is to inform and improve the policies and
practices of the three major global HIV/AIDS programs, so we have developed a
dissemination strategy that is similar across all research themes. The
dissemination strategy is outlined below:

A) AUDIENCE
The primary audience will be officials within the funding mechanisms, including
primarily those with authority to make decisions.

Secondary audiences include (but are not limited to):
• Policymakers within the US, Canada, Europe and other donor countries,
including informing discussions about funding levels and future
direction;
• Policy makers in three African countries through our in‐country research
partners;
• Regional actors in Southern Africa, including Regional Economic
Communities and Regional Civil Society Organizations, through a
partnership with the SIDA HIV/AIDS Team for Africa (see Appendix VI
for detailed explanation)
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• Advocates within the US (and to a lesser extent Europe) who engage in
conversations about these issues but often without complete and correct
information;
• Advocates in three African countries though our research partners; and
• Journalists seeking comprehensive and accurate information about the
three initiatives in the U.S. and globally.

B) CGD APPROACH

First, we consider the potential impact of our work from the inception, and
develop the agenda for analytic work with broad input from those who we hope
will ultimately use the work – from advocacy groups to the policy community to
the research community. We do not depend solely on our individual research
interests or impressions, but systematically and on an on‐going basis solicit ideas
and questions from a broad set of players. This is a fundamental aspect of our
agenda‐setting in our global health program (see
http://www.cgdev.org/content/calendar/detail/4447/), the MCA Monitor (see
http://www.cgdev.org/section/initiatives/_active/mcamonitor), the HIV/AIDS
Monitor (see http://www.cgdev.org/section/initiatives/_active/hivmonitor) and
our overall CGD research program (our “Policymakers’ Wish List” is available
upon request).

Second, we seek to provide value to various audiences by putting new
information “on the table,” and making it accessible in a balanced and
transparent way. This permits others – advocacy groups, agencies and other
stakeholders – to use the information to advance their own understanding,
activities and policy messages. By being seen as bringing added value to complex
policy questions, we earn a role in both public and behind‐the‐scenes discussions
about aid delivery mechanisms and development policy more generally.

Third, we seek to provoke new thinking and responses by generating analyses
that challenge conventional wisdom and/or provide a new angle or answer to an
old question. A typical approach we have taken in the past is to identify specific
problems associated with particular aid delivery mechanisms, based on
empirical work, and then propose specific, constructive and practical solutions
and options for addressing the problem. In this way, we help to set the agenda
for broader discussions about how to move forward, rather than just generating
critiques and generic recommendations.

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C) OUTREACH STRATEGIES

Dissemination and outreach strategies for the HIV/AIDS Monitor include:

At the US and Global Level:
Public Events: For the HIV/AIDS Monitor we expect to focus our direct efforts
largely on the international audience – that is, the donor and technical agencies
that are setting the overall funding envelopes, allocation and implementation
policies, and other “rules of the game.” We will reach these audiences as we have
for other projects, through a combination of public events.

Private events: such as invitation‐only briefings on work in progress, or debates
about policy questions before Congress or the Administration. While all of our
written products are made available publicly, with active web‐based
dissemination, the private conversations are important ways for us to
understand what policy questions are of interest to those who are making key
decisions; and to convey research findings in a language and form that can be
easily understood. Despite the small‐group nature of the discussions, however,
we are not in any way “part” of the programs we are analyzing, nor do we
provide formal technical assistance or consulting services. Rather, we seek to
make our research findings available as decision makers can use them. For
example, CGD hosted a private meeting in April between Michel Kazatchkine,
the newly appointed Executive Director of the Global Fund, and members of the
Working Group led by our Senior Fellow, Steve Radelet. Details about the
Working Group, including the report, “Challenges and Opportunities for the
New Executive Director of the Global Fund: Seven Essential Tasks,” are available
at: http://www.cgdev.org/content/publications/detail/10948/.

Engaging with advocacy groups: who have an interest in global health and
HIV/AIDS, to make them aware of new research findings in the event that they
are useful background materials for their work. For example, we have started to
engage with Washington, DC‐based advocacy groups through the four Global
AIDS Roundtable discussion groups for Prevention, Treatment, Aid Architecture
and Gender. We have an opportunity to gain from and influence messages that
are being communicated by advocates to policy‐makers over the course of this
year, as the discussions for the re‐authorization of PEPFAR rapidly gain
momentum.

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At the Country‐Level:
The International Center for Research on Women and in‐country research
collaborators will complement CGD’s strengths in communication and outreach
to in‐country decision makers in the government, NGO and donor communities.
We would expect to share the results of every analysis (within and across
countries) with in‐country stakeholders. Our research partners are currently
convening several different stakeholders in their respective countries to share the
goals and objectives of the HIV/AIDS Monitor. They plan to target these
audiences for the dissemination of results and we have requested them to plan
for these activities in their work plans and budgets.
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PROGRAM AND FINANCIAL MANAGEMENT

Management Approach
CGD will provide overall leadership of this study through the Washington, DC‐
based HIV/AIDS Monitor Team, which includes the Director and two Program
Coordinators. The team will manage the implementation of this study in
accordance with agreements, work‐plans and budgets; and will be responsible
for submitting program and financial reports to SIDA. The team will work
closely with CGD’s Nairobi‐based Field Director, who will serve as the key
contact person for this study at the field operational level. This HIV/AIDS
Monitor team will work closely with the gender experts from ICRW who will
take the technical leadership on the project. (See Appendix III for CGD’s
institutional profile and capacity statement.)

ICRW will execute its technical leadership by working with the research partners
to strengthen their capacity to achieve high quality gender research. This will
include provision of technical support during the research planning workshop,
developing research tools, analytical frameworks and in writing up synthesis
papers. In collaboration with CGD, ICRW also will provide support as needed
for the dissemination of results. (See Appendix IV for ICRW’s capacity
statement)

The Field Director (FD) will be responsible for the coordination of all the field
activities; monitoring the utilization of funds on a quarterly basis; receiving
regular financial and activity progress reports from the country partners; and
submitting these reports to CGD headquarters for further analysis, consolidation
and reporting to SIDA. The FD also will be the key link between CGD in
Washington, the country research partners and SIDA regional office for Africa in
Zambia. Working within the existing operational structure of the HIV//AIDS
Monitor research program, the FD will ensure that effective communication
through electronic mail, regular site visits and teleconferences is sustained and
responsive to the needs of CGD and the country partners. In collaboration with
ICRW and the Washington‐based CGD staff, the FD will be responsible for on‐
going technical support to the country research partners.

The country‐level research will be conducted by each of our three research
collaborators. In Zambia the study will be conducted by the Health Economics
Research and Training Program (HERTP) in the Department of Economics, in
collaboration with the Gender Department of the University of Zambia. HERTP
has a long track record in health economics, and has coordinated and managed
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the health economics projects from 1995 to 2005. The study team consists of
individuals with sound experience and training in applied social and economic
research and management. (See Appendix VII for a description of HERTP.)

In Uganda, the Makerere University School of Public Health (MUSPH) will
conduct the research. The school has the professional experience and capability
of conducting operations as well as social science research. The school has
assembled a complementary team with required technical expertise in health
policy and health systems research, anthropology and behavioral sciences, social
work, gender, community outreach, health education and communication.
Through previous work with CGD, this team has demonstrated a strong
understanding of the government and donor processes. (See Appendix V for a
description of MUSPH.)

In Mozambique, Austral‐Cowi, a private consulting firm with well experienced
social and economic researchers with a solid background in HIV/AIDS will
conduct the study. The disciplines represented in the team include development
economics, gender analysis, sociology and anthropology. The firm has conducted
several pieces of research including for example, “The Monitoring of Access to
Donor Funds for HIV/AIDS by Civil Society in Southern Africa,” funded by the
Open Society for Southern Africa in 2006. (See Appendix VI for a description of
Austral‐Cowi.)

In each country, the team leaders have identified a focal person (gender
specialist) who will report to the country team leader (Principal Investigator of
the entire HIV/AIDS Monitor program in the country). The focal persons, in
consultation with the country team leader and the FD, will ensure sound
coordination of the research activities, address any bottlenecks affecting project
implementation, and ensure that timely financial and program reports are
submitted.

Timelines and Work Plan
The country level studies will be completed in six months and the final synthesis
paper will be completed in the following 3 months. The Gantt chart below
captures both the lower and upper limits of the country‐specific work‐plans
submitted to CGD by our in‐country partners.

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Project Month
Activity 1 2 3 4 5 6 7 8 9
a. Identify, acquire
and analyze
documentation of
3 donors at
country‐level
b. Identify, obtain
documents and
analyze
information about
national
(government)
approach to
gender and HIV
c. Identify, acquire
and analyze
documentation of
ROs and SROs
d. Analyze program
(RO/SRO) data;
e. Interview
country‐level
donor staff
f. Interview RO and
SRO staff
g. Interview service
users
h. Code and analyze
all interview data
i. Analyze and
write‐ up findings
j. CGD and ICRW
write up
synthesis paper of
three country
studies
k. Disseminate
findings of
synthesis paper at
global level
followed by
findings from
country reports at
national level

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Financial Management
CGD has a full complement of financial systems to support successful
implementation of both major and minor policy research projects, including
those with in‐country components. CGD’s Director of Finance will provide all
necessary support services to research partners, including preparation and
execution of contracts specifying disbursement arrangements, accounting
requirements and expected outputs. CGD has a range of experience with
different types of public and private financiers, and can provide financial
information in any format required by the funder.

Research Budget:
CGD requests US$485,756 to support the proposed gender study in three African
countries. A summary of the budget is shown below.

Budget Line Item CGD ICRW Zambia Uganda Mozambique Total
Personnel 63,650 44,015 28,650 24,450 69,325 230,090
Fieldwork 87,065 19,470 11,200 20,290 4,998 143,023
Communications & Dissemination 30,000 15,875 2,400 4,000 3,047 55,322
Administrative Costs 20,798 27,776 2,113 5,134 1,500 57,321

TOTAL 201,513 107,136 44,363 53,874 78,870 485,756

A detailed budget for each of the partners, corresponding to the level of effort, is
attached as Appendix IX. Some 58% of the budget requested from SIDA will be
spent on implementation of field activities in Africa. This includes the three
country budgets and field work paid by CGD and ICRW.

Feasibility
The proposed research program takes advantage of existing research capacity
and relationships, developed under the HIV/AIDS Monitor program. This
research will be implemented within the framework of the HIV/AIDS Monitor
program, in collaboration with the three country partners and under the overall
guidance of CGD. Mobilization of key stakeholders in the HIV/AIDS field,
including host governments, policy makers, donors, UNAIDS, civil society
organizations has already been successfully initiated under the earlier phase of
the HIV/AIDS Monitor. For the proposed work on gender, consultative
workshops and meetings are planned with key stakeholders to ensure that they
are involved and supportive of the research activities. The research partners have
been involved in the preparation of this proposal and have demonstrated their
capacity to deliver by executing and submitting research reports for other parts
of the HIV/AIDS Monitor program. They have provided country‐specific gender
15
inputs into this proposal. The practical conditions necessary for the successful
implementation of the proposed research program exist in all the three countries.

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APPENDIX I: LOG FRAME

Objectives Main activities Measurable Indicators Means of Verification Important Assumptions
Goal: To contribute to the See Below Study recommendations have Monitoring of funding Making each funding
effectiveness of the three been adopted by all three mechanisms’ policies mechanism more
largest AIDS funding funding mechanisms, and
(which are public) and responsive to gender‐
initiatives (the Global Fund, consequently each funding
mechanism is more effectively discussions with key donor drivers of the epidemic will
PEPFAR and the World
Bank’s MAP program) in addressing the gender-related officials following the translate into a more
addressing the gender-related drivers of the epidemic. completion/dissemination effective response to
drivers of the HIV/AIDS of study. fighting HIV/AIDS.
epidemic in the following
three countries: Mozambique,
Uganda and Zambia.
Purpose: To assess the See Below Three country reports and a Country and synthesis Researchers are able to
effectiveness of the three synthesis report that detail reports completed. implement and complete all
funding mechanisms in an in‐depth understanding phases of data collection,
addressing gender-related
of how the three funding analysis and writing.
drivers of the AIDS epidemic
in Mozambique, Zambia, and mechanisms and their
Uganda, and to develop a set recipient organizations are
of recommendations to further addressing gender‐related
enhance their effectiveness. drivers of the HIV/AIDS
epidemic have been
written.
The three funding Report written and Researchers are able to
mechanisms and their distributed. implement and complete all
recipient and sub‐recipient phases of data collection,
organizations (ROs and Report of dissemination analysis and writing.
SROs) in each of the three meetings held in each
project countries have country.
received a report outlining
how current programming
is currently addressing, or
17
not addressing, gender‐
related drivers of the
HIV/AIDS epidemic and a
set of recommendations for
how to do so more
effectively.
(1) Research and Analysis Necessary documentation
will be available and
To determine the degree to The activities associated All of the salient CGD carefully vets the accessible. Informants will
which each AIDS programs with each objective are information from these information in each report agree to interviews and will
funded by the three donors listed below: activities will be and holds detailed be forthcoming about
have adopted policies and documented in the reports discussions with each team gender policies.
practices that are submitted by each country about their key findings. Organizations
addressing the gender‐ team to CGD. Records of CGD’s Field Director implementing gender
related drivers of the interviews, copies of policy maintains regular activities can be identified
epidemic. documents, etc. will be kept communication with each and visited. All data
by researchers in each team during the data collectors trained in
a) Donor Level Objectives country and are available if collection period and conducting qualitative
required. conducts quarterly site interviews and have a
(i) To ascertain the extent (a‐i) Review of publicly visits to monitor progress. detailed understanding of
to which the donors are available documents, CGD and its research the project, its objectives
explicitly providing requests for non‐public partners circulate drafts of and the specific issues
program and policy documents, interviews all reports to key related to this theme on
direction on gender and to with donor officials and informants, external experts ‘gender’.
document these recipients of donor and donor officials. At this
directives/guidance. funding. stage, reports are checked
for factual accuracy as well
(ii) To assess the priority (a‐ ii) Comparative as technical soundness.
accorded to gender within analysis conducted by
each donors overall researchers in each
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country program. country in collaboration
with ICRW and CGD staff.

b) Policy Level Objectives

(i) To determine the extent (b‐i) Review of publicly
to which relevant policy available documents,
makers outside the donor interviews with relevant
agencies (such as the policymakers, analysis of
Ministry of Health, non‐ funding trends and
governmental principal available capacity among
recipients of Global Fund funding recipients.
grants, etc.) incorporate
gender‐related drivers of
the epidemic into policy
and programming, and
allocate funding/build
capacity accordingly.

c) Implementation Level
Objectives

(i) To determine existing (c‐i) interviews with
capacity among implementing organization
implementing staff, observation of their
organizations to undertake systems and programming,
gender programming analysis by researchers
(ii) To document the (c‐ii) review of guidance
support/guidance provided documents provided by the
by the donors, interviews with
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donors/policymakers to implementing organization
implementing staff
organizations
(iii) To learn how gender (c‐iii) interviews with
work is being monitored implementing organization
and how data on gender is staff, observation of
being incorporated into monitoring systems,
new/ongoing analysis of program data
programming.
(iv) To assess the overall (c‐iv) Analysis of policies
relevance and and practices by
appropriateness of the way researchers in collaboration
gender programming is with staff at ICRW.
being implemented in each
country

d) Beneficiary Level
Objectives

(i) To document the (d‐i) interviews with
experiences of individual program beneficiaries
service users, including
how the program has
improved their
circumstances and what
they feel could be
improved about these
programs.

20

(2) Dissemination and
Advocacy

To implement a multi‐ CGD has an established All of the indicators in the Evidence‐based
pronged strategy that will dissemination model column immediately to the recommendations will be
encourage the donors ‐ and whichwe will use, in an left are straightforward used by the donors if the
other relevant stakeholders adapted form, to “counts” that will be importance of these
who can implement policy disseminate this study. recorded by the HIV/AIDS recommendations can be
themselves or influence The activities listed below Monitor staff. reinforced through the
donor policy will collectively make up dissemination strategies
implementation ‐ to adopt this strategy. CGD has listed to the left
the policy experience using all of
recommendations these tactics and we are
proposed in the final report confident they can be
of this study. The strategy applied successfully here.
will attempt to influence The specific activities are:
actors at multiple “levels”, I. Holding public events I. Number of events held
including: – in Washington and in and number of
Southern Africa – that attendees
a) Global level – feature the findings of
• Central level donor our report.
staff, including the II. Disseminating our II. Number of people
Global Fund report electronically reached through
secretariat, the through direct emails, internet outreach
Office of the US newsletters and an
Global AIDS engaging webpage
Coordinator, and III. Developing policy III. Number of products
the ACTAfrica briefs, blog posts and developed and
Office of the World other ancillary distributed
21
Bank. products that will
• Private profile our
foundations such recommendations
as the Gates IV. Generating media IV. Number of media
Foundation and articles profiling the articles featuring our
Open Society report’s research
Institute recommendations
• Research V. Holding direct V. Number of meetings
organizations such meetings (in person or held
as the Overseas via phone or
Development videoconference) with
Institute (ODI), or key decisionmakers
the Development VI. Attending conferences, VI. Number of
Assistance workshops and conferences/workshops
Committee (DAC) seminars relevant to /seminars attended
of the Organization our research (eg.
for Economic International AIDS
Cooperation and Conference in Mexico
Development City)
(OECD). VII. Using “surrogates” –ie. VII. Number of surrogates
• International Civil friends of the engaged and the
Society HIV/AIDS Monitor means by which they
Organizations that are were used
including Oxfam, prominent/influential
Action Aid, and people – to bring our
CARE recommendations to
• Multilateral bodies, key decision‐makers
especially UN VIII. Working with VIII. Number of advocacy
technical agencies advocacy groups who groups engaged and
such as UNAIDS, can use our policy the means by which
22
WHO, UNICEF recommendations as they used our research
and UNDP part of their own
policy‐influencing
b) Regional level – activities
• Parliamentary IX. Using our website to IX. The website in itself
groups of regional publicly track the will be an indicator of
development status of uptake of our the status of uptake of
agencies such as recommendations by our recommendations
the East African each donor
Community, South
African
Development
Community
(SADC), and the
African Union
(AU)
• Regional meetings
of National AIDS
Councils
• Regional civil
society
organizations such
as AMREF and
Gender Links
• Regional research
institutions such as
the Institute for
Democracy in
South Africa
(IDASA) and the
23
Human Sciences
Research Council
(HSRC)

c) National level –
• High level officials
including
Presidents and
Cabinet Ministers
• Senior government
officials at the
Ministries of
Health, National
AIDS Councils,
Ministries of
Women (where
applicable), and
elsewhere
• Civil society
organizations in
each country,
including
organizations of
people living with
HIV/AIDS
• Organizations
receiving donor
funding in each
country
24
APPENDIX II: Outcomes Table – Theme 2: Beneficiary Analysis on Women and Gender
Topic Question Outcome Data sources Instrument Development

Required?

I. Attention to gender A. How are gender and 1) Specific programmatic goals National Govt. Program policy Yes ‐ Guidelines for gender
and women’s needs women’s specific needs and objectives (and clear documents analysis of policy (1)
within the National and vulnerabilities being indicators) exist on meeting
Govt. and Donor addressed in the National needs of women and girls Donor Country level Program
Country level AIDS Govt. and Donor’s country 2) Programs addressing policy documents
Program level AIDS Control gender‐based vulnerabilities
Program? exist, e.g. Yes – Key Informant
i. Unequal access to and/or use Key Informant Interviews with Interview guide national
of prevention, treatment and staff level staff (2)
care
ii. Programs which protect
women’s legal rights and/or
work with women and
communities to ensure
property and inheritance
rights are protected;
iii. Strengthening women’s
access to income and
productive resources;
iv. Programming that addresses
gender‐based violence?
v. PMTCT+ (programs that
provide mothers and their
partners who participate in
PMTCT with long‐term ART)
vi. Programming directed at
25
Required?

changing men’s norms and
attitudes towards women
and gender relations
vii. Programs working with
adolescent girls (and boys) to
address issues of gender and
sexuality and increase safer
sexual choices.

B. Within the National and 3) Surveillance and National and Donor Program No
Donor Program are data monitoring data are records and reports
disaggregated by sex and disaggregated by age and sex
age?
C. Has a situational 4) Donor country level Program documentation No
assessment been programs have conducted a
conducted to ascertain the situational assessment of the Situational Assessment report No
specific epidemiological epidemiological and sociological
and sociological nature of the epidemic; key
dimensions of the vulnerable groups have been
epidemic nationally? identified

D. How are gender‐specific 5) Assessment of the donor’s Country level policy donor Same guidelines as above
vulnerabilities and options understanding of the impact of documents
for empowering women the epidemic on women and girls
addressed in strategies and as evident or not in policy
policy documents at language and framing of program
national level within donor goals and objectives
26
Required?

programs if they exist?
6) Specific programmatic Country level donor policy and Same guidelines as above
goals and objectives (and clear RO/SRO documentation
indicators) exist on meeting
needs of women and girls

F. Are there restrictive 7) The health needs of Country ‐level donor policy Same guidelines as above
policies that present beneficiaries are prioritized over documents;
barriers to provision of ideological factors.
services to women or the Interviews with Same KII guide with
vulnerable? e.g. program/implementer staff at national level staff as above
prostitution pledge, national level
abstinence‐only‐until
marriage prevention under
PEPFAR
II. Commitment to G. Does staff of 8) Effective gender training Interviews with national level Yes ‐ Key Informant
addressing gender and implementing partner has taken place at all levels of staff & ROs/SROs Interview guide RO/SRO
needs of women at level organizations have program (National, (3)
of implementation. appropriate training to implementation) Training documentation,
implement gender‐related 9) # of people trained on monitoring and evaluation docs No
programming? gender and related issues (e.g.
GBV; stigma, etc)
III. Importance of H. Do the funding 10) Specific indicators exist RO and SRO documentation Yes‐ data assessment tool
addressing gender and mechanisms require ROs (and are used regularly and (4)
women’s needs has and SROs to track their correctly) to track program Interviews with staff at national
been integrated into success in meeting the success against gender‐ and level and RO/SROs Same KII guides as above
programming at the different needs of women vulnerability‐related objectives
implementation level. and men? (sex disaggregation is required
27
Required?

and compliance is good;
indicators for # of people trained
on gender and related issues;
indicators for specific gender‐
transformative and/or
empowerment programs, etc)

IV. Beneficiary impact I. How effectively are these 11) Women and men living Interviews with donor staff at all Same KII guides as above
of gender‐related strategies translated into with HIV and AIDS are levels
programming program implementation? meaningfully included in
(Implementation and program design and
community levels) implementation at national,
district and local levels

12) The needs of women and RO and SRO documentation Same Data assessment tool
men, girls and boys are being met and outcome data as above
by the program

Interviews with RO and SRO
staff Yes‐ beneficiary interview
guide
Interviews with service users of
case study SROs if possible

13) Beneficiaries have found Interviews with service users of Same beneficiary guide as
programs useful – can provide case study SROs if possible above
clear examples of impact of the
28
Required?

program in terms of gender
relations, women’s and girls’
access to services, etc.
J. To what extent do donor 14) Programs exist and are National level donor policy and Yes ‐Checklist for
supported programs being implemented that are program documentation document review (5)
implemented by RO and gender sensitive, gender
SROs address the transformative, and/or empowering Interviews with donor and RO Same KII guides as above
gendered aspects of (descriptors available for these staff at national level RO/SRO
HIV/AIDS terms) based on findings of staff at district and local levels
comprehensively, through situational assessment Same beneficiary guide as
both social and economic Interviews with service users of above
sector interventions as well case study SROs if possible
as health sector
interventions?

29
APPENDIX III: CGD’S INSTITUTIONAL PROFILE AND CAPACITY
STATEMENT

Institutional Background
The Center for Global Development (CGD) is dedicated to reducing global
poverty and inequality through policy‐oriented analysis and active engagement
on development issues with the policy community and the public. A principal
focus of the Center’s work is how the policies of the US and other industrial
countries can more positively affect development prospects in poor countries.
CGD was established in November 2001 by pioneering development economist
Nancy Birdsall (CGD President), Fred Bergsten (President of the Institute for
International Economics) and Edward W. Scott, Jr. (Chairman of CGD’s Board,
and co‐founder of BEA Systems, Inc.) to generate practical, creative solutions to
the problems of poor countries that are related to policies of rich countries,
including burdensome debt, ineffective aid transfers and unfair trade practices.
By bringing scholarship into the service of global policy debates – and by
focusing squarely on how the U.S. and other rich countries can improve policies
and practices – the Center has a unique niche in the policy world.

Capacity Statement
At CGD, we use the concepts and methods of economics, political science and
other disciplines to assess the impact on poor people of globalization and of the
policies of industrialized countries and multilateral institutions such as the
World Bank and the International Monetary Fund. From its position as a non‐
partisan, non‐profit organization, the Center seeks to identify alternative policies
that promote equitable growth and participatory development in low‐income
and transitional economies. We then work with civil society and private sector
groups to translate policy ideas into policy reforms. The Center establishes
partnerships with other institutions to improve public understanding of the
economic, political and strategic benefits of improved living standards and
governance in developing countries. Partnerships with research institutions in
Africa for the HIV/AIDS Monitor is a new approach for CGD as we are working
with African colleagues to contribute evidence directly from poor countries that
are affected by rich country policies, in this case for HIV/AIDS.

CGD influences contemporary policy debates in the US, Canada, Europe and
Japan by bringing the analyses and ideas of leading development scholars to the
attention of policymakers and key constituencies in the general public. CGD has
an effective communications program that includes preparation of tailored
written materials for distinct audiences, briefings for Congressional and
30
Executive branch staff, joint events with advocacy groups, and media outreach.
Although the Center is a relative newcomer to the Washington scene, its
influence has been clearly demonstrated in the design of the U.S.’s Millennium
Challenge Account aid program, as well as in debt relief policy. (See the CGD@5
report, included as Annex 7 and available online at
http://www.cgdev.org/section/annualreport/.)

In early 2007, an independent external evaluation of CGD concluded that the
Center produces high‐quality, policy‐relevant research, and influences real‐
world policy change. The evaluators found that “CGD’s research and advocacy
work for policy influence is widely seen to be well founded, timely, empirically
or analytically based, and highly effective among its audience. Prominent in the
United States, its visibility is growing in Europe and elsewhere. Its products are
extensively used and cited, regularly read by development‐related audiences,
and, in total, have built its stature.” For more information, see
http://www.arabellaadvisors.com/research.html

31
APPENDIX IV: ICRW’s CAPACITY STATEMENT

Over the past 30 years, the International Center for Research on Women
(ICRW) has earned an international reputation as one of the leading research
institutions in gender and development, valued for its ability to link research
and policy advocacy and to produce evidence–based solutions to advance
gender equality.

Founded in 1976 and based in Washington DC, with a regional office for Asia in
New Delhi, India and additional offices in Hyderabad, India and Kampala,
Uganda, the mission of ICRW is to empower women, advance gender equality
and fight poverty in the developing world. To accomplish this, ICRW works
with partners to conduct empirical research, build capacity, and advocate for
evidence‐based, practical ways to change policies and programs.

Under the leadership of President Geeta Rao Gupta, ICRWʹs international staff of
80 includes economists, public health specialists, anthropologists, demographers,
and policy specialists.

Capacity Statement
ICRW conducts action‐oriented research in collaboration with leading
developing country individuals and teams of researchers, service providers, and
representatives of governmental agencies, multilateral organizations, and the
media. ICRW provides technical support and capacity‐building training to its
partners and to governments, nongovernmental and multilateral organizations,
foundations and corporations to improve the delivery of services (e.g. health
care, nutrition, reproductive health services, and adolescent programs) and to
foster integration of gender considerations into organizational programs,
policies, and budgets. Finally, through its publications, policy communications
and advocacy activities, ICRW channels research evidence to policymakers,
development organizations, the media, and others to inform policies and
programs and help them to become more effective in advancing women’s
economic and social status, health, and rights.

ICRW’s program comprises a number of development objectives, including
increasing economic security, improving the lives of adolescent girls, enhancing
nutrition, and reducing violence against women. A major portion of our portfolio
concerns health and development and, specifically, the prevention of HIV and
AIDS and the mitigation of their impact. ICRW brings to this project a strong
32
track record in two critical areas of expertise: issues relating to gender and
HIV/AIDS and critical activities in strategic planning, analysis and program
evaluation.

33
APPENDIX V: INSTITUTIONAL CAPACITY STATEMENT OF MAKERERE
UNIVERSITY SCHOOL OF PUBLIC HEALTH

The Makerere University School of Public Health (MUSPH) has the professional
experience and capability of conducting formative and operations research as
well as social science research. MUSPH has assembled a complementary team
with a complete package of the required technical expertise to implement this
research project. The areas of technical expertise include health policy and health
systems research, anthropology and behavioural sciences, social work and
community outreach as well as health education and communication. Through
previous work, this team has a strong understanding of the government
processes and policies relating to approval and adoption of new public health
technologies. Activities are predominantly in the areas of public health training,
intervention research and community service. Training activities include
teaching public health and its sub‐specialties to undergraduate and post‐
graduate students (in‐house as well as distance‐training), while research and
community service depend on national needs and the interests of the teaching
staff. MUSPH is periodically contracted by the ministries of health and local
government, districts, NGOs and bilateral/multi‐lateral agencies to provide
consultancy services. This provides a source of revenue for the MUSPH through
levying of institutional overhead fees.
Human Resource Capacity
Currently, the School has 15 full‐time and 10 adjunct faculty who are broadly
trained in the public health sub‐specialty areas of epidemiology, biostatistics and
health informatics; communicable and non‐communicable disease control;
environmental and occupational health; health policy, planning and
management; community health, nutrition and reproductive health; and
behavioral sciences, to mention but a few. MUSPH also collaborates with the
Ministry of Health, NGOs and other departments, institutes and faculties in
Makerere University from which it can potentially draw additional capacity
when required. A full list of collaborating partners can be provided on request.
Information and Learning Resource Capacity
There is an information and learning resource centre located on the ground floor
of the MUSPH building. Many publications, including journal articles,
dissertations and reports of MUSPH staff members and students can be found
here. There are resource files on a wide range of public health subjects available
for reference. Articles and books can be borrowed with permission from the
34
librarian. The resource centre is open during weekdays from 8.00am to 5.00pm.
There is also access to electronic database systems (e.g. POPLINE, MEDLINE,
etc.) in the resource centre and Data Management Centre. Other libraries with
useful resource materials also exist within the adjacent medical school and the
University main campus. The Albert Cook medical school library has access to
the Internet MEDLINE services in addition to AIDSLINE and POPLINE and can
aid in the access and exchange of information via an inter‐University loan system
with Case Western Reserve University in Cleveland, Ohio that can mail or fax
copies of requested journals and articles. The main library of the University is
located at the main University Campus and it provides access to physical
literature and electronic database systems, many of which can also be accessed
on‐line through the webpage. A number of faculties and departments have
collections of literature which are accessible through special arrangements.
Libraries in other research institutions like the Child Health and Development
Centre (CHDC) and the Makerere Institute of Social Research (MISR) provide
great sources of information that can be utilized.
The Data Management Center
The Data Management Centre is located on the 2nd floor with desktops for use by
both the students and staff. MUSPH has a team of 2 full‐time and 2 part‐time
statisticians as well as 5 data entry clerks who have the capacity and competency
to handle data sets from large population surveys. The School has also
established a Local Area Network with fast Internet link over wire and wireless.
Linkage to MOH and training districts is currently underway. The ICT centre
has spearheaded the development of capacity and access to internet‐based
resources for training and research. The SPH website (www.musph.ac.ug) is
currently being updated and serves as an electronic‐based resource for
dissemination of research outputs as well as supporting distance education
programs.
Previous Relevant Research Experience
The MUSPH has a wealth of experience conducting health systems and policy‐
relevant action research. Freddie Ssengooba, George Pariyo, Stefan Peterson and
others at MUSPH have conducted studies on:
• Health Systems Effects of Rapid Scale up of Antiretroviral Treatment and
Maternal and Child Health Services (ARVMAC)
• From Approval to Use. Understanding the Approval of New Public
Health Technologies
• Evaluation of the Impact of Government Contracting of Health Services
with Private not‐for‐Profit Providers
35
• Applying an Equity Lens to analysis of Health Sector Reforms
• Uganda IMCI Impact Study (part of Multi‐country evaluation of IMCI)
Understanding the Impact of Decentralization on Reproductive Health

36
APPENDIX VI: INSTITUTIONAL CAPACITY STATEMENT OF AUSTRAL‐
COWI CONSULTANTS

For the present assignment, Austral‐Cowi will offer a team of four well
experienced social and economic researchers with solid background in the
HIV/AIDS context. Their work will be supported by one administrative assistant.
A brief description of each team member follows below.

Project Coordinator and Quality Control – Dirce Costa
Dirce Costa is a senior development economist with more then 25 years of
experience in project development and research initiatives. She has expertise in
development‐related problems and institutional problems of the public sector,
including the health, water, education and justice sectors. Her experience also
includes the planning, management and finance of such sector projects.

During the year 2006, she was the team leader of the regional research team for
the study “Monitoring the access of civil society to the Funds for the HIV/AIDS”.
The research was funded by the Open Society Initiative for the Southern Africa
(OISISA) and was conducted in Lesotho, Malawi, Mozambique, Namibia,
Swaziland and Zambia by the Centre for AIDS Development Research and
Evaluation (CADRE). This study investigated the effects of large‐scale funding
for HIV/AIDS on the work of civil society.

Mrs. Costa has worked on policies and different issues related to the
development economy. She developed a number of project evaluations at the
local level using an array of research methodologies. Mrs. Costa has also lectured
on health economics and management.

Within the present research Dirce Costa will coordinate the research team and
control the quality of the outputs. She will also liaise and coordinate with CGD,
ICRW and the three country teams.

HIV/AIDS and Gender Analyst – Minna Tuominen
Minna Tuominen’s background is in the area of cultural history and
development studies. She is very knowledgeable about social development
issues, particularly about issues related to gender and HIV/AIDS. She has
conducted many evaluations of HIV/AIDS‐related projects and conducted
several strategy formulation processes for public as well as private institutions,
including donor agencies and NGOs. Minna is experienced in looking at
37
HIV/AIDS through a gender lens. While working at UNAIDS, she gained a good
insight of the HIV/AIDS funding institutions, their policies and practices.

Within the context of the present research, Minna Tuominen will lead the gender
analysis. Her main tasks include instrument design, analysis of the results and
reporting.

Sociologist– Georgina Montserrat
While the consultant has an academic background in political science and
development studies, she is skilled in the sociological analysis of issues related to
social and economic development. The consultant is experienced in quantitative,
qualitative and participatory research methods, including the management and
processing of data. Furthermore, she is experienced in managing and
coordinating field work assignments. Currently, she has a central role in the
management of a consultancy that seeks to design an HIV/AIDS workplace
program for the Ministry of Education.

Georgina Montserrat will prepare the field work component of the project and
participate in the design of the research instruments. Together with Eleásara
Antunes (see below) she will conduct all key informant interviews, systematize
and organize the information, and participate in the analysis and reporting.

Anthropologist – Eleásara Antunes
Eleásara Antunes is a development specialist with a background in
anthropology. She has seven years of work experience within the public sector
dealing with policy development and implementation issues for gender, poverty
and HIV/AIDS issues within the transportation sector.

Mrs. Antunes has also worked in the preparation of socio‐economic assessments.
While implementing these activities the consultant acquired experience in the
use of qualitative and quantitative research methods.

Together with Georgina Montserrat, Eleásara Antunes will conduct all key
informant interviews, systematize and organize the information, and participate
in the analysis and reporting.

38
APPENDIX VII: CAPACITY STATEMENT OF THE HEALTH ECONOMICS
PROGRAM; DEPARTMENT OF ECONOMICS, SCHOOL OF HUMANITIES
AND SOCIAL SCIENCES, UNIVERSITY OF ZAMBIA

The Health Economics Program (HEP) is a unit within the economics department
at the University of Zambia (UNZA). For the past 10 years, HEP (with funding
from SIDA) has focused on policy‐oriented research for the Ministry of Health
and the Central Board of Health. The program is coordinated by Caesar Cheelo, a
well regarded lecturer in the economics department. Chairman of the program’s
advisory board is Professor Manenga Ndulo, also of the economics department.
HEP is made up primarily of faculty in the economics department, bringing in
individual experts from outside the university as required to staff projects.
Students are routinely involved in HEP research projects, and HEP faculty all
teach at the university.

HEP’s most regular partner in research collaboration has been the Swedish
Institute for Health Economics (IHE), collaborating on studies on cost
effectiveness, health systems, and user fees in the health sector. (The last study
contributed substantially to current MOH deliberations about abolition of user
fees.) HEP also has produced biannual studies for the MOH on National Health
Accounts, with the 2006 study featuring an HIV/AIDS sub‐analysis. HEP
currently is collaborating with the Health Economics and HIV/AIDS Research
Division in South Africa on a three‐country study about the degree to which
HIV/AIDS programs are integrated with or parallel to public health systems.
CGD will work with HEP to ensure that there is complementarity, not
duplication, between these two related studies.

The study team for the gender component of the collaborative research with
CGD includes 4 staff members from the Department of Gender Studies and three
from the Health Economics program.

39
APPENDIX VIII: THE HIV/AIDS MONITOR RESEARCH PROGRAM

i) Rationale for the HIV/AIDS Monitor
In response to both public health imperative and unprecedented political
pressures, the HIV/AIDS pandemic has resulted in massive increases in donor
assistance in recent years, relative to other global health (and development)
problems. According to UNAIDS, global funding to combat HIV/AIDS has
nearly tripled since 2001, from $2.1 billion to an estimated $6.1 billion in 20041
and reached an estimated $8 billion in 2005.2 The three most prominent new
initiatives for this funding are the Global Fund to Fight AIDS, Tuberculosis and
Malaria (the Global Fund), the United States’ President’s Emergency Plan for
AIDS Relief (PEPFAR) and the World Bank programs, including primarily the
Multi‐country HIV/AIDS Program (MAP). The new global efforts to fight
HIV/AIDS have brought substantially larger‐scale funding to countries and
governments for aggressive responses to the pandemic.

Although the increased funding is welcome, there is little doubt that current
global funding is vastly insufficient to meet the needs for prevention and
treatment of HIV/AIDS in low‐income countries, estimated at $15 billion in 2006
and rising each subsequent year.3 In addition, debate rages about the most
effective ways for donors to deliver and manage these increased aid flows: the
three major initiatives noted above use distinct approaches to design and
implement programs to fight HIV/AIDS. While the HIV/AIDS Monitor program
will not measure public health outcomes or the impact on individuals’ health
status of donor‐supported HIV/AIDS programming, we will assess the policies,
practices and decision‐making of the donor institutions, as well as the
consequences of those decisions at the country level. In doing so, we will be able
to draw inferences about the level and quality of the response of different aid
mechanisms to the real‐world challenges in countries heavily affected by
HIV/AIDS.

Finding out what is working, fixing what is not, and making these three funding
mechanisms work more effectively should be a high priority – as high as
mobilizing more resources. Generating support for increased funding in the
future and using that funding more effectively will require a combination of
sound analysis of the strengths and weaknesses of current programs along with
skilled advocacy. Existing programs must show large‐scale achievements
commensurate with both the need and the funding provided; the lessons of those
programs must be clearly communicated to policymakers, legislators, and the
general public. Lessons learned from these initiatives are likely to have
40
substantial impact for years to come on donor practices and aid modalities for
HIV/AIDS programs and foreign aid programs more generally.
The Center for Global Development (CGD) is well placed to undertake and
disseminate comparative analyses of the three major sources of global funding
for HIV/AIDS. We are examining the programs’ characteristics and performance,
both at the global level and in three sub‐Saharan African countries. This work
complements other recent and on‐going work on global HIV/AIDS, and will
inform a broader set of questions about the effectiveness of distinct aid delivery
strategies.

ii) Goals and Objectives of the HIV/AIDS Monitor
The overall goal of the HIV/AIDS Monitor is to improve the performance of all
three initiatives by examining key issues in their design and approach, and
providing timely analyses to improve the efficiency and effectiveness of each
initiative. The specific objectives are:

1) To conduct high quality research and analysis on topics that affect aid
design, delivery and management for donor‐funded HIV/AIDS programs.

2) To conduct effective outreach and dissemination of results to inspire and
influence change in donor programs for HIV/AIDS

3) To stimulate informed conversation among donors, implementers and
advocates around these and other related issues.

The perspective taken is broad: we are concerned not only with the narrow aims
of the programs, but how the programs approach major challenges of
implementation and what are the broader impacts on the health system and
national development strategies.

iii) Program Design
The program is designed to gain a clear understanding of the policies,
procedures, methods of implementation and implications of the three funding
mechanisms by capturing both global and country‐level perspectives. This will
be accomplished by two interconnected branches of analysis: analysis of
principal themes at the global and headquarters level and in‐depth studies
conducted in three African countries that receive funding from all three sources:
Mozambique, Uganda and Zambia. Studies conducted by these two branches,
both coordinated by CGD, will feed into one another and benefit from lessons,
data and information.
41
A) Global Analysis:
The global analysis piece of the project will explore how the three funding
initiatives address major challenges in HIV/AIDS program design,
implementation and evaluation, and where and when these approaches are
successful or less so. By framing the questions as challenges that all three donors
confront, we hope to avoid simplistic or overly‐politicized interpretations.
Currently, the global‐level research is focusing on five major areas of research:
i. Disbursement: What are the implications of disbursement policies and
practices on the transfer of resources from donor to recipient countries?
ii. Procurement and Supply Chain Management: What are the donor’s
selection and procurement policies and practices and the implications of
these for recipient countries? How do these measure against standard best
practices for procurement?
iii. Performance‐based Funding Decisions: What is each donor’s approach to
the relationship between funding and performance?
iv. Beneficiary Analysis of Vulnerable Groups: How do donor programs
address gender and the specific vulnerabilities of women, or orphans and
vulnerable children?
v. Monitoring and Evaluation: How do donors monitor and evaluate their
programs?
B) Country Level Analysis:
In preparing the country‐level research questions, CGD conducted a series of
assessments in six African countries (Ethiopia, Malawi, Mozambique, Rwanda,
Uganda and Zambia) to determine the key challenges facing governments and
in‐country stakeholders as a result of the aid flowing from these three donors.
With lessons learned from this process, we developed an initial framework of
seven questions which we will address through in‐depth analyses by the local
research partners (with assistance from a field director and CGD as necessary) in
three specific countries – Mozambique, Uganda and Zambia. The local research
institutions were identified by CGD during the initial assessment period and
were selected for their competency in public health, economics and/or policy
research.
42
Specific areas of research include:
i. Tracking the Funding: How much money is being committed/disbursed
and who are the recipients? Do recipients have the capacity to use the
funding they are given?
ii. Gender Analysis: How are gender concerns reflected in donor programs?
iii. Relationship between Funding and Performance: How is each funding
mechanism operationalizing the concept of performance‐based funding?
How are results measured?
iv. Relationship of HIV/AIDS and Reproductive Health Programs: How does
the large volume of funds for HIV/AIDS programs affect other essential
health interventions such as reproductive health?
v. Effects of Donor Funds on the National Health System: Are donors using
existing mechanisms within the national health system to implement their
aid, or creating new and parallel systems? What combinations of
approaches to systems work most effectively in what contexts?
vi. Recurrent Cost Burden and Sustainability: How has donor funding for
HIV/AIDS impacted government spending, and what measures are in
place among the donors to ensure long‐term financing?
vii. Impact on Labor Market for Health Care Workers and Managerial Talent:
How have the donor programs affected the labor market?

43
APPENDIX IX: DETAILED BUDGET

CGD/USA ICRW/USA

Personnel Personnel
Director HIV/Monitor
Program 21,840 Lead Investigator 7,999
Program Coordinator 7,280 Research Associate 8,723
Program Assistant 6,800 Program Assistant 1,696
Communications Team 15,000 Communications Team 12,470
Total Personnel 50,920 Total Personnel 30,888
Benefits 12,730 Benefits 13,127

Total Compensation 63,650 Total Compensation 44,015

Field Work Field Work
Travel 25,000 Airfare 9,000
Field Director 20,000 Per Diem 10,470
Workshop Kampala/Uganda 42,065 ‐ ‐
Total Field Work 87,065 Total Field Work 19,470

Dissemination/Communications Dissemination/Communications
Outreach & Events 20,000 Outreach & Events 10,875
Publications 10,000 Documentation 5,000
Total Dissemination/Comm. 30,000 Total Dissemination/Comm. 15,875

Administrative Costs 20,798 Administrative Costs 27,776

Total CGD Budget 201,513 Total ICRW Budget 107,136

44
Makerere University Uganda Austral‐COWI/Mozambique

Personnel Personnel
Team Leader 7,200 Team Leader 6,375
Researchers (3) 10,500 Researcher (gender specialist) 14,250
Research Assistants (3) 6,750 Researchers (2) 42,700
‐ ‐ Administrative Assistant 6,000
Total Personnel 24,450 Total Personnel 69,325
Benefits Benefits

Total Compensation 24,450 Total Compensation 69,325

Field Work Field Work
Vehicle/Fuel/Driver 12,510 International consultant 1,500
Training & Workshops 3,200 Travel 2,951
Travel/Telephone/Postage 4,580 Telephone/Postage/Supplies 547
Total Field Work 20,290 Total Field Work 4,998

Dissemination/Communications Dissemination/Communications
Seminars & Workshops 4,000 National Workshop 3,047
Fees for Ethics Review 300 ‐ ‐
Total Dissemination/Comm. 4,300 Total Dissemination/Comm. 3,047

Administrative Costs 4,834 Administrative Costs 1,500

Total Uganda Budget 53,874 Total Mozambique Budget 78,870

45
University of Zambia

Personnel
Team Leader 2,750
Research Coordinator 8,225
Researchers (3) 9,775
Research Assistants 7,900
Total Personnel 28,650
Benefits ‐

Total Compensation 28,650

Field Work
Local Travel 1,100
Per Diem 8,800
Stationery/Communication 1,300
Total Field Work 11,200

Dissemination/Communications
National Workshop 2,400
‐ ‐
Total
Dissemination/Comm. 2,400

Administrative Costs 2,113

Total Zambia Budget 44,363

Budget Summary

Budget Line Item CGD ICRW Zambia Uganda Mozambique Total
Personnel 63,650 44,015 28,650 24,450 69,325 230,090
Fieldwork 87,065 19,470 11,200 20,290 4,998 143,023
Communications & Dissemination 30,000 15,875 2,400 4,000 3,047 55,322
Administrative Costs 20,798 27,776 2,113 5,134 1,500 57,321

TOTAL 201,513 107,136 44,363 53,874 78,870 485,756

46
Explanatory Notes about the Budget

(i) Differences in Personnel Costs

Factors contributing to the differences in personnel costs across organizations
and countries include:

1. Each country has a different market rate for researchers, based on the supply
of and demand for these workers in that particular country. In Mozambique, for
example, the few economists and health experts that conduct research are in high
demand, and therefore command high salaries.

2. Austral‐COWI, unlike Makerere University and the University of Zambia, is a
private consulting firm. Austral‐COWI does not receive government grants or
other public monies to defer overhead expenses. These expenses must be paid
for through their research projects.

3. For the Washington‐based institutions, the higher personnel costs for CGD, the
lead organization, reflect the fact that it will devote more staff time to the study
than will ICRW.

(ii) Differences between Costs of Researchers and Research Assistants

The researchers possess technical expertise and have advanced degrees (typically
PhDs) in their area of specialty. On the other hand, research assistants have
fewer years of formal education. In some cases, for example, they are students
enrolled in Masters degree programs. The difference in their expertise is the
reason for the difference in the labor rates between these two personnel sub‐
categories.
47
Appendix X : ORGANOGRAM AND INTENDED DISSEMINATION TARGETS FOR PROPOSED GENDER STUDY

Nancy Birdsall
President
Lawrence
Ruth Levine Dennis de Tray
MacDonald Vice President for Vice President for
Director of Programs and Special Initiatives
Communications Operations Dissemination to donor
officials and HQ staff,
international conferences,
Jessica Ogden Nandini and international advocates
ICRW Oomman
Director, HIV/AIDS
Monitor
In partnership
with SIDA
William Okedi Dissemination to regional
Field Director actors, including regional
economic communities and
civil society
Michael Steve
Bernstein Rosenzweig
Program Program
Coordinator Coordinator
Dissemination to national
Austral-Cowi Makerere University of stakeholders, including
Consulting University School Zambia donor officials, government
Mozambique of Public Health Zambia officials, and civil society
Uganda
48
Appendix XI: RESPONSES TO QUESTIONS FROM MICHAEL TAWANDA
(ROUND 1, NOV 30, 2008)

(1) The Alliance for Health Policy and Systems Research (HPSR)/Global
HIV/AIDS Initiatives Network(GHIN) ‐ partly funded by Sida HQ ‐ are also
involved in research on the ʺBig 3ʺ (WB, GFTAM and PEPFAR). How CGDʹs
work differs from the latter is not (and should) be mentioned in the document. In
particular, it must be quite clear that gender is not a focus in the HPSR/GHIN
programme.

CGD’s HIV/AIDS Monitor is focused on a series of comparative analyses of the
three major HIV/AIDS donors at the global level and at the country level. GHIN
studies to date are mainly focused on the effects of a single donor’s funding at
sub‐national levels, while the HIV/AIDS Monitor’s unique analytical approach
allows comparisons across the three donors’ policies in three countries and the
policy interface between the donor and national level stakeholders (and some
sub‐national) —government, civil society, private sector etc. While both
initiatives have some overlapping areas of inquiry (such as effects of donor
funding on health systems, human resources etc) in a given country, the
HIV/AIDS Monitor includes a specific gender analysis of donor funds for
HIV/AIDS at the global level and at the country level. Like GHIN, the HIV/AIDS
Monitor is producing research evidence to influence policy, but with a more
concerted effort to engage donor officials on an ongoing basis, maximizing the
desired shift in policies for HIV/AIDS.

(2) In addition to the detailed budgets, a Summary Budget table would be
useful, utilizing the same sub‐headings ‐ Personnel+Benefits, Field Work,
Diss/Comms, Admin. At the same time, could you also explain the differentials
in Personnel costs, especially between the Country Teams ‐ CGD/USA 28%;
ICRW/USA 20%; Makerere 11%; Austral‐COWI 31%; UZ 13% ‐ and within the
categories of Researcher/Research Assistant.

Please see additions to Appendix IX.

(3) Could you also send copies of:

(i) CGDs Financial Management and Administration manual(s)

49
CGD does not have such a manual, but our Director of Finance and Human
Resources, Ellen MacKenzie, would be happy to answer any questions you have
about our procedures. She can be reached at emackenzie@cgdev.org

(ii) CGDs last two (2) Financial Audit Reports, if they are available. These are
requirements within our system

Attached in separate document.

(4) It would be useful to insert an organogram of the decision‐making and
management structure ‐ from CGD HQ (inclusive of more than just the HIV
Monitor Programee) through to all relevant partners, including intended targets
for the communications/dissemination strategy

Please see Appendix X.

(5) The logframe/goal hierarchy:

(i) Regional actors as a target group ‐ Our raison d’etre as a Team is to add‐value at
the regional level. In that regard, could we not include regional actors as a target
group for your Diss/Comms strategy. The good work CGD has already done,
and the findings from the proposed study will greatly empower entities such as:
the Regional Economic Communities (AU, SADC, EAC ‐ specifically their
Parliamentary Fora, and occasional gatherings of Member State NACs); and
Regional Civil Society Organizations, to name a few.

The primary target audience for our research is the donors themselves, including
high‐level staff at donors’ headquarters and field‐based staff at the country level.
Nonetheless, CGD is in principle committed to the idea to target regional actors
as part of our dissemination activities. CGD and/or its collaborating research
institutions in Africa have links to many regional actors, including regional civil
society organizations. To most effectively disseminate our research to regional
bodies, however, we would like to request that CGD establish a partnership with
SIDA’s HIV/AIDS regional team for Africa; the SIDA HIV/AIDS Team for Africa
has an established network of regional contacts, and could help us access
appropriate platforms, such as regular meetings of the SADC and EAC, for
disseminating our research to key regional actors. Working in partnership with
SIDA, we believe that we can exercise significant influence over actors that
influence the region’s HIV/AIDS response.
50

(ii) Goal ‐ as is the goal (assessment) sounds more like ʺPurposeʺ: it does not
engender images of intended/anticipated developmental change. To start from
the end, a useful indicator at that level might be ʺEndorsement of the
recommendations of the study by (a) the ʺBig 3ʺ, (b) RECs, (c) other relevant
Regional Actors). Then, the Goal would be ʺTo contribute to the effectiveness of
the ʺBig 3ʺ in addressing gender.....ʺ.

See updated log frame.

(iii) Purpose(s) ‐ on the basis of the foregoing, this/these might be ʺTo assess the
effectiveness.....and Develop a set of recommendations for more effective.....ʺ.

See updated log frame.

(iv) Objectives ‐ for ease of reading could the objectives (p.38) be incorporated in
the logframe?

The items listed on page 38 are not objectives, but rather the seven research
themes that will be investigated as part of the HIV/AIDS Monitor’s country‐level
research.

51
Appendix XII: RESPONSES TO QUESTIONS FROM MICHAEL TAWANDA
(ROUND 2—FEB 1, 2008)

1. Legal/institutional ‐ what is:
a) CGDs organization #, and place of registration

EIN number is 52‐2351337. We were incorporated 2001 in DC.

b) the CGD Presidentʹs role/function vis‐a‐vis the Vice‐Presidents and the
Board of Directors/Executive Committee?

The President reports to the Chairman of the Board and is accountable to the
Board of Directors. The Board meets twice a year to review the Center’s activities
and finances and to provide advice and counsel to the President. A subset of the
Board, the Executive Committee, meets quarterly to provide ongoing oversight.
The Board is responsible for the overall control of the Center’s property, funds,
and affairs.

In consultation with the Board, the President maintains primary responsibility
for setting the research agenda of the Center and for hiring new staff. The
President reviews all of CGD’s major publications. She also uses her extensive
personal and professional connections to help disseminate the Center’s research
findings to high‐level officials in governmental and non‐governmental bodies. In
addition, the President conducts her own research on topics including aid
effectiveness, pro‐poor growth, and Latin American development.

CGD’s two Vice Presidents supervise the growing staff, particularly those parts
devoted to fundraising, fiscal management and general administration. They
also maintain their own research portfolios. The President, Vice‐President, and
other senior staff meet every two weeks to discuss management issues.

2. Financial Audits
‐ could you sent the Management Letters for the 2005 and 2006 Audit Reports
already sent?

The management letters requested are addressed to the Board of Directors of the
Center for Global Development, and are generally considered private and
confidential documents. All public information is provided in the audited
financial statements. If there is a specific type of information that is required by
SIDA to evaluate the grant proposal, please advise and we will obtain a
52
statement from the Chair of our Board of Directors, based on the information in
the management letter

‐ we will not be expecting a separate audit on our contribution, but only as part
of the overall CGD audit. When can we expect the 2008 Audit Report (with
accompanying Management Letter)

The 2007 Audit Report will be completed in March. We should be able to send a
copy to you shortly thereafter.

3. Logframe ‐ I really need for CGD/HIV&AIDS Monitor to nail down some of
the following more concretely in the logframe:

Please see revised log frame

Statement of Goal and Purpose ‐ OK
Indicators for Goal and Purpose ‐ I feel the two (2) given relate most
appropriately to the Purpose. For the Goal, albeit long‐term/past the life of the
programme, something of the form ʺStudy recommendations adopted......ʺ
would be fitting. Please feel free to react..

Please see revised log frame

Objectives
‐ I really do need to see a statement of each Objective in the matrix (not just
the expected outcome). In that regard, I see two (2) objectives (in general
terms) as being relevant: (a) Research/analysis, with sub‐objectives for the
different levels of data collection , and (2) Dissemination/lobbying, with sub‐
objectives for the different levels of dissemination
‐ Much of what is currently in the matrix under Outcomes look more like
activities related to (a)

Please see revised log frame for statements of each objective

‐ Dissemination/lobbying ‐ please be specific on the who (target groups at all
relevant levels ‐ global, regional, national) and the how

Please see revised log frame for specific target audience

53
4. Budget
Mozambique ‐ I need further clarification on why you feel that Austral‐COWI
is the most cost‐efficient solution to the program requirements, in
Mozambique
Personnel costs ‐ re my query in an earlier communication regarding
Researcher/Research Assistant cost differentials, there appears to have been a
misunderstanding. I am aware of the educational/skills differentials
separating the two categories. My query related rather to the within category
(as opposed to across category comparison) ie Researchers in one country
being remunerated at a vastly different level compared to Researchers in
another country ditto with Research Assistants,

We explained this in the proposal in Appendix IX as explanatory notes to the
budget. I have copied the text from that Appendix here for easy reference.

Explanatory Notes about the Budget (from Appendix IX)

(i) Differences in Personnel Costs

Factors contributing to the differences in personnel costs across organizations and
countries include:

1. Each country has a different market rate for researchers, based on the supply of and
demand for these workers in that particular country. In Mozambique, for example, the
few economists and health experts that conduct research are in high demand, and
therefore command high salaries. CGD considered university based researchers in
Maputo, but it was clear that they would not have the time availability to participate in
these studies and research would be compromised in terms of quality and speed. Other
consulting groups were also approached by CGD, but were found to have rates much
higher than those of Austral‐COWI.

2. Austral‐COWI, unlike Makerere University and the University of Zambia, is a private
consulting firm. Austral‐COWI does not receive government grants or other public
monies to defer overhead expenses. These expenses must be paid for through their
research projects.

In addition:

CGD conducted country assessments before the HIV/AIDS Monitor was launched.
Through these country assessments, CGD also selected our partner institutions, chosen
54
based on a number of considerations, including general research and analytical capacity,
previous work with international partners, connections with in‐country stakeholders,
interest, time and availability to dedicate to the project, and referrals from others.

Here are some of the specific reasons why we chose Mozambique and Austral‐Cowi
Consultoria E Projectos Ld.:

Mozambique: Emerging from decades of political unrest, Mozambique has quickly
become a “darling of the donors,” with the many international players accounting for
approximately 50% of the national budget. The large number of multi‐ and bi‐lateral
donors and international NGOs that operate in the country use a wide variety of aid
modalities, ranging from completely vertical to well integrated and from bilateral to
common pools of finding. The Government of Mozambique is now actively working to
align donors with national strategy on HIV/AIDS and with the Government funding
mechanisms, including the SWAp, making the country an interesting case study on
country ownership.

Austra‐ Cowi Consulting (Mozambique): Austra‐Cowi is the most established private
consulting firm in Mozambique, founded in 1986. The firm has extensive experience in a
wide variety of development areas. Austral has significant experience conducting
research on HIV/AIDS, including an on‐going long‐term project on HIV/AIDS activities
in the private sector. They also have strong skills and experience conducting socio‐
economic surveys, including qualitative and quantitative analysis. The group regularly
works for and with the Ministry of Health, the National Aids Council, the Ministry of
Planning and Development, US Agency for International Development, the World Bank
and other agencies. The principal investigator, Dirce Costa, is a senior development
economist with over 25 years of experience in development issues. Among many other
projects, she was the manager of a multi‐year study of ʺHIV/AIDS Projects at 40 Small
and Medium Enterprise in Mozambiqueʺ, financed by DFID. She has served in various
roles in the Ministry of Health in Mozambique and teaches health economics.

55

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