Evaluations 2016


Evaluation of Extended Basic Health Care Projects, OCA, Dollo, Ethiopia

by: Catherine Lalonde and Jared Mala [March 2016]

Médecins Sans Frontières (MSF) has been providing health care to populations affected by conflict related violence in the Dolle Zone of Ethiopia's Somali Region State since 2007.  This evaluation was comissioned by the Swiss Agency for Development and Cooperqation (SDC) who has been funding the project entitled "Extended Basic Health Care Project in Dollo Zone" from September 2008 to December 2014.  Because SDC contributed to the entire Wardher project rather than supporting a vertical project, the evaluation will assess the resutls of the entire Wardher project from 2008 - 2015, using 2007 as a baseline, with the understanding that SDC funding will have contributed to these results.  The evaluation draws lessons from this engagement, including on how to best engage in conflict prone and similar fragile contexts in the future. It is also an opportunity for MSF to reflect on this project for future interventions. The evaluation identified lessons learned and provides recommendaitons which would be useful for both MSF and the SDC, and assessed the relevance, efficiency, effectiveness, sustainability and impact of MSF's activites in the Zone since 2007. 


VIRAL LOAD MONITORING in Gutu District, Zimbabwe

by: Richard Bedell Stockholm Evaluation Unit. [January 2016]

MSF launched an ambitious project to establish routine viral load monitoring for patients on antiretroviral therapy beginning in 2013 in Gutu District, Masvingo Province, Zimbabwe. This evaluation of the viral load (VL) monitoring system was commissioned in order to more fully understand the experience and outcomes of the introduction and scale-up of VL in one district of Zimbabwe, but also undertaken with a view to the national scale-up of VL monitoring, and the general issue of VL monitoring in sub-Saharan Africa in light of the UNAIDS 90-90-90 targets. 

Summary report


by: Richard Bedell. [February 2016] 

MSF has been providing 3 modalities of community HIV testing in KZN since late 2012, to complement the standard, health facility (HF)-based testing provided by the Department of Health. Fixed sites (FS), Mobile 1-Stop Shops (M1SS) and Door-to-Door Community Health Agents (CHAPs) provide testing throughout the project area of Eshowe, Mbongolowane and the adjacent rural areas. Given that community HIV testing is often more expensive than HF-based testing, it is important to fully understand the relative advantages of community testing modalities.
The UNAIDS 90-90-90 targets necessitate a dramatic increase in HIV testing and linkage to HIV care; implementers and health authorities need evidence on which to base their program plans in order to effectively approach those ambitious goals.


EVALUATION OF DECENTRALISATION TO AND STRENGTHENING OF PERIPHERAL HEALTH STRUCTURES​: Part of the MSF OCB Project “Integrated HIV project in the public health structures of Conakry” Guinea. 

By Miranda Brouwer of PHTB Consult. [March 2016] 

English: The Integrated HIV project in the public health structures of Conakry, Guinea is a continuation of the support to HIV care and prevention that MSF has given to Guinea since 2003. MSF’s intention was to work towards withdrawal of their support at the end of 2017; however, in 2014 and 2015 it became clear that this would be difficult with the approach in place at the time. In 2015 MSF organised an internal round table conference and revised the approach. The main principles of the revised approach are addressing the identified problems (stigma, access to voluntary testing, HIV treatment capacity and retention in care) with new or different operational approaches; demonstrating the additional value of these tried approaches, if successful, through documenting these (operational research); and participating in the country’s efforts to improve quality of HIV care and increase coverage of ART. The approach has presently four elements: 1. To promote access to early HIV diagnosis, to strengthen the capacity of associations of people living with HIV (PLHIV), and to reduce stigma of PLHIV; 2. To guarantee access to HIV care for PLHIV in CTA Matam and at the peripheral health structures supported by MSF; 3. Quality of HIV services; and 4. Support PMTCT services in Matam and the peripheral health structures supported by MSF. The evaluation described in this report is part of the funding agreement with the donor. In addition, given the changes that the project has gone through, it is an opportune moment to evaluate the strategies put in place in order to provide further recommendations for implementation of the project in Guinea. Element number two of the present approach is the most relevant pertaining to this evaluation and is the focus of this report even though other elements may be touched upon.

Franciais: Le projet VIH intégré dans les structures de santé publiques de Conakry, en Guinée, est une continuation de l'appui aux soins et à la prévention du VIH que MSF a donné à la Guinée depuis 2003. L'intention de MSF était de préparer un retrait pour la fin 2017 ; cependant, en 2014 et 2015, il est devenu clair que ce serait difficile avec l'approche en place à l'époque. En 2015, MSF a organisé une table ronde interne et a révisé l'approche. Les grands principes de l'approche revue abordent les problèmes identifiés (stigmatisation, accès au dépistage volontaire, capacité de traitement VIH et continuité des soins) dans le cadre d'approches opérationnelles nouvelles ou revues, cherchent à démontrer la valeur ajoutée des approches testées, en cas de succès, en documentant celles-ci (recherche opérationnelle), et en contribuant aux efforts du pays pour améliorer la qualité des soins du VIH et augmenter la couverture du traitement antirétroviral. L'approche comporte actuellement quatre éléments: 1. Promouvoir l'accès au diagnostic précoce du VIH, renforcer la capacité des associations de personnes vivant avec le VIH (PVVIH), et réduire la stigmatisation des PVVIH. 2. Garantir l'accès aux soins pour les PVVIH au CTA de Matam et dans les structures de santé périphériques soutenues par MSF. 3. Qualité des services liés au VIH. 4. Soutenir les services de PTME à Matam et dans les structures de santé périphériques appuyées par MSF. L'évaluation fait partie de l'accord de financement avec le bailleur. En outre, étant donnés les changements que le projet a vécu récemment, le moment est opportun pour évaluer les stratégies mises en place afin de fournir de nouvelles recommandations pour la mise en œuvre du projet en Guinée. Le deuxième élément de la présente approche est le plus pertinent dans le cadre de cette évaluation, et constitue l'élément central de ce rapport, même si d'autres éléments peuvent être abordés. 


EVALUATION OF COUNSELLING: Part of the MSF OCB Project “Distribution of Antiretroviral Therapy through Self-forming Groups of People Living with HIV-AIDS” Tete, Mozambique. 

by Miranda Brouwer of PHTB Consult.  [March 2016]

The project ‘Distribution of Antiretroviral Therapy through Self-forming Groups of People Living with HIV-AIDS” Tete, Mozambique” is a continuation of MSF’s interventions in the provision of HIV care and prevention services that started as early as 2003 in Tete. Over the years interventions moved from the provincial capital Tete towards other districts and now concentrates in Changara district. The focus of the Changara project initially was to introduce community testing, and accreditation of 12 health facilities in the district for ART provision. However, after the introduction of routine VL testing for patients on ART for 6 months or more, the focus shifted more towards the counselling. The finding that a substantial proportion of the patients had a high VL of more than 3,000 copies/ml (the criteria at the time) raised questions on the efficacy of the counselling services and contributed to initiating this evaluation.




By: Association Intern