EVALUATING HIV AND AIDS:

WHY CAPACITY DEVELOPMENT
IS CENTRAL TO ASSESSING  PERFORMANCE
 
 

Professor Desmond Cohen

HIVDEV Consultant

August, 2000 
 
 

Not to be circulated in altered form without the permission of the authors 


1. UNDERSTANDING CAPACITY DEVELOPMENT

The core of UNDP's mandate is the achievement of sustainable human development, and the instrument   for doing this is capacity development. The term capacity development can be defined as follows: - 

Capacity is the ability of individuals and organizations to perform functions effectively, efficiently and sustainably.   The term 'capacity development' is preferred to 'capacity building'; while capacity strengthening is important so   are the retention of existing capacity, improvements in the way in which existing capacity it being utilized, and the   retrieval of capacity which has been eroded or lost. Thus capacity development does NOT take place only through   the training of additional staff or the creation of new organizations, but requires an enabling environment to   ensure that people are used effectively, retained within organizations and structures that need their inputs, and are   motivated to perform their tasks. 

All projects and programmes need to develop a capacity development strategy and should be evaluated   on the basis of whether they addressed the key issues that this involves. Central to evaluation of the project or programme is   whether in the formulation of a capacity development strategy it undertook a capacity assessment, and on the basis of this   assessment put in place conditions relating to capacity that ensured that the project was both feasible and sustainable. 

A capacity assessment involves an analysis of capacity issues such as the following: - 

* The overall context: an examination of relevant economic, social and political conditions. Factors   would include political commitment to capacity development; the functioning of labour and asset markets; the standards of   tertiary and professional training institutions, and the extent of the HIV epidemic. Unless a supportive overall environment is   available then resources will inevitably be wasted; identifying and addressing the policy and programme constraints to capacity   development are critical first steps in ensuring that objectives will be achieved. 

* The task network: a mapping of the array or organizations engaged in the performance of the   function and the inter-organizational relationships involved. The network will generally include non-government as well as   government organizations, users as well as providers of services, training institutions, and relationships with regional and   overseas institutions. The assessment would examine the extent to which interactions among organizations constrain or   enhance the capacity to undertake functions and achieve objectives. 

* The organization and its management: the organizational structure, management systems and   processes that affect the recruitment, utilization, recognition, motivation and retention of staff. 

* The availability of human resources: the quantity and quality of personnel available to the   organization, the quality of training available and provided, the degree to which existing human resources are utilized   effectively and likely constraints on the future availability of essential human resources. 


On the basis of a capacity assessment it is possible to examine the strengths and weaknesses of the existing arrangements for   undertaking the project or programme, the reasons for weaknesses in existing capacity and why these have persisted over   time, and factors which are undermining existing capacity such as losses of skilled labour due to HIV-related mortality. Such   an assessment would also generate insights into past failures and successes in regard to capacity strengthening and how to   build on the latter in implementing activities. 

What would be the main areas of focus of capacity development strategies in the light of the capacity assessment?

These might include at each level the following: - 

* The overall context: sustained investment in human resource development; the strengthening of   institutions that mediate and prevent social conflict and build social capital; increased participation of communities in the design   and implementation of development programmes, and mechanisms for ensuring that public policy and programmes are   delivered in ways that are efficient and respond to the needs of sustainable development. 

* The task network: targeted improvements to those parts of the network which are the most   important constraints on performance; strengthening mechanisms for coordination; and strengthening mechanisms for   systematically involving beneficiaries in the task network. 

* The organization and its management: open competitive recruitment and promotion procedures:   performance review: recognition and reward structures; strengthening problem solving procedures and skills; development of   external support structures that improve organizational performance. 

* The availability and utilization of human resources: management training: processes and reward   systems that induce commitment and effective performance by all personnel; identifying and responding to performance   constraints; training opportunities related to performance and organizational needs, and responding to changing organizational   objectives through human resource investment strategies and programmes. 


What is the role of donor organizations in capacity development?

It is self evident that donors have a clear interest in supporting the capacity development strategies of national governments   through the full integration of their programme activities with those already underway or planned at country level. This makes   it essential that donors formulate their activities for capacity development within coherent frameworks that ensure consistency   with what each other is planning to do, and also consistent with national needs and capacities.? It may be necessary for   donors to support the establishment of coordination machinery, and the strengthening of national capacity to effectively   coordinate donor activities. 

Now donors need also to avoid those activities that are destructive of national capacity, such as agency recruitment of key   staff away from national uses, and the distortion of national pay scales through excessive payments to some nationals. The   objectives of donors should be that of supporting national capacity development through human resource investment, and the   strengthening of the policy environment for a more effective delivery of projects and programmes that are relevant for   sustainable development. Achieving these objectives may in some cases require that donors through their activities seek   initially to strengthen the capacity to undertake capacity development as a prior first step towards more effective general   performance. 
 

How does one ensure that capacity development is integral to projects and programmes?

It is clear from research that putting in place a capacity development strategy and activities for its   implementation at the design stage of projects is a sine qua non for more? effective performance. It follows that unless   the capacity development issues noted above are addressed at the design stage, and relevant activities identified and   implemented as integral to projects and programmes, then there will be only very partial and weak overall performance. 

Monitoring and evaluation benchmarks will need to be developed at the design stage of projects and   programmes. These benchmarks would reflect the priorities selected for interventions based on an analysis of critical   constrains, taking into account the fact that project and programme objectives and modalities will require adjustment during   the life of the project [and not be left to end of project evaluation]. The review and evaluation processes would examine the   quality, timeliness and quantity of services provided in relation to organizational goals and client needs. It would examine these   within the broader context: of capacity assessment and follow-up, organizational management, structures and performance,   and in terms of the availability and utilization of human resources. 

It follows, of course, that capacity development for undertaking relevant project and programme evaluation may itself have to   be supported through specific activities in order to ensure that the capacity for effective monitoring and evaluation is brought   into existence. This is the familiar problem that capacity may have to be strengthened so as to have the capacity to do what is   required for better development outcomes. It also follows that once such capacity has been developed that mechanisms will be   needed to ensure that it is effectively utilized. 
 

2. CAPACITY DEVELOPMENT, THE HIV EPIDEMIC AND EVALUATION

Section 1 sets out the reasons why capacity development is the critical instrument for achieving   development objectives, and it reviews those factors relevant to its full integration in projects and programmes. The important   question seems to be not whether the principles and criteria for effective capacity development as described earlier are   changed in a world of HIV and AIDS.? If anything these guiding principles continue to be just as apposite, and the   need for capacity development is enhanced rather than diminished.? Rather the important issues relate to the way in   which the epidemic changes the context within which capacity development strategies are expected to function, and the   difficulties of sustaining capacity in the face of the epidemic. 

It is worth reviewing those factors which change the context and feasibility of capacity development and   the ways in which these affect the criteria that are important for evaluation of projects and programmes. The issues are   complex and the particular situations are very diverse, therefore the following discussion should be seen as illustrative rather   than definitive. The aim is to increase understanding of the effects that the HIV epidemic has on capacity development   strategies and the effects on implementation and thus on evaluation of projects and programmes. 
 

How is the stock of Human Capital affected by HIV and AIDS?

HIV prevalence is concentrated amongst those in the key social and working age groups ñ between the   ages of 15-45. If anything young women seem to get infected at earlier ages than young men and thus lose more years of   healthy life. There is evidence that in mature epidemics in many countries of sub-Saharan Africa that more women are   infected than men [with a ratio of 6:5]. There is also evidence that at the early stages of the epidemic that HIV infection seems   to be if anything greater for those in higher educational and occupational groups, with important implications for the   maintenance of both the stock and the flow of those human resources that require substantial social investment. While HIV   prevalence may be highest in urban areas it is nevertheless the case? that absolutely the largest numbers of those   infected are in rural areas in sub-Saharan Africa. 

Rates of HIV prevalence amongst adults in many countries in SSA are now in the range 15-35%, with   even higher rates in some locations and cities. The severity of the epidemic affects all social and occupational groups, including   both men and women, those with higher level skills and experience and those who are supposedly 'unskilled'. Amongst the   latter category are most of the rural population who in fact have very valuable and hard to replace task-specific experience   and skills. 

Since HIV is concentrated amongst the core of the working population who have important social roles, the support and   socialization of children in particular, then there are bound to be effects both on this generation and on subsequent   generations. It follows that not only is the structure within families changed by its experience of the epidemic, including gender   roles, but that there are also very important issues to do with maintaining households as productive enterprises. 
 

What can be concluded from the losses of human resources that are critical for capacity development?

Most obvious are the losses of human capital due to the epidemic ñ skilled, educated, unskilled men and   women, in both urban and rural locations. So one important issue is how to sustain production in circumstances of high   morbidity and mortality across wide swathes of the active labour force. All programmes and projects have to deal with this   fact: how can production be maintained in the face of ongoing and often severe losses of labour? In situations where losses are   disruptive precisely because they are not confined to categories of labour that may be 'easily' replaceable, but also affect many   categories of labour including supervisory and managerial. 

 It follows - 

 
* That capacity development strategies have to address the maintenance of productive capacity across   many sectors of production in both formal and informal productive organizations ñ in both urban and rural locations. 

* That because households are integrally affected both as economic units as well as ones with important   social functions there is a need to sustain their capacity in the face of erosion of their economic base through losses of labour   and reduction of productive assets. 

* That since households are the primary organization for the socialization and care of children anything   that erodes their ability to perform these roles will have effects that are inter-generational ñ on levels of poverty and on the   skills and education of the future labour force.


But the effects on capacity are unfortunately not limited to the above and there are at least three other main channels through   which capacity is undermined by the epidemic. These are as follows -: 

 
* The public sector in all countries is the main supplier of essential goods and services, such as education   and health, transport and communications infrastructure, police and military security, law and order, welfare services, etc. But   since public administration and public industries will also lose human resources due to HIV and AIDS then their capacity to   sustain production will be undermined. The question becomes in part that of how to maintain production under conditions of   losses of organizational and human resource capacity? 

* Equally important are the general effects of the epidemic on fundamental conditions relating to   security and law and order, including the maintenance of political authority and the functioning of associated organizations. It   is unclear what the effects will be either directly though their losses of human resources and indirectly through changes in   their capacity to deal with intensifying economic, social and political problems. In other words one of the outcomes of the   epidemic will be a loss of political authority and a further undermining of the capacity to address mounting problems ñ in part   due to the losses of capacity in a large number of state organizations. 

* There is widespread evidence that the HIV epidemic has significant effects on the internal matrix of   relations within social and economic organizations ñ at the level of households, private formal and informal enterprises, and   the public sector. In part this is due to the effects on productive relations due to morbidity and mortality that are extremely   disruptive, and these reflect losses of experience, management capacity and task-specific skills. In part it is the result of changes   in morale within organizations due to the mounting level of mortality. The resulting outcome for many organizations ñ social   and economic is greater dysfunctionality allied to a greater inability to address and solve problems.? 


Finally, there is the aggregation of all of these effects on development capacity since these will in total be more than the   sum of the individual components. This is the simple result of applying the concept of synergy in understanding and   measuring the impact of the epidemic in total. Parts of the social and economic system depend for their efficiency on other   parts working as 'normal' but the HIV epidemic undermines this capacity so that the feed back from one part of the system   disrupts the planning and production in other parts. In the aggregate the impacts are multiplied because of these 'systemic'   effects - including therefore further reductions in capacity throughout the social and economic system. 
 

What does this mean for Evaluation of Projects and Programmes ?

There is perhaps no need to detail what the implications of the foregoing are for capacity development and for the evaluation   of projects and programmes for this ought to be more or less self-evident. Not only are the kinds of projects and programmes   that need to be implemented changed so as to meet the new priorities of those countries that are deeply affected by the   epidemic, but projects and programmes have now to deal not only with issues of how to strengthen capacity but also how to   maintain it in the face of multiple forces that are systematically reducing existing capacity. This is occurring in conditions,   where as noted above, the capacity to address and solve problems is itself diminished by the losses of human resources and   the associated reduction in problem-solving capacity within social and economic organizations. 

It follows that it is even more essential that all of the factors and principles identified in Section 1 in   respect of designing and implementing capacity development be integral to all projects and programmes. It is not that the   principles for effective capacity development are intrinsically changed by the epidemic but rather that sustaining   capacity becomes an even more central objective for all projects and programmes, along with the aim of ensuring that   projects and programmes address how best to achieve their objectives under conditions where both direct and indirect factors   are undermining capacity.? This must also include the capacity of other organizations [such as what is happening to   relevant networks] and of public administration and other state institutions [and thus the public production of goods and   services]. 
 

What are the Strategic Evaluation Questions where the Objective is Capacity Development?

What follows is intended to provide some guidance to those undertaking evaluation of projects and   programmes in countries with high rates of HIV prevalence. It is not intended to be complete but aims instead to generate   some insight into the kinds of strategic questions that need to be addressed by evaluators if capacity development as described   above is to be realized. It is more of a check-list, as an instrument to ensuring that these important issues are addressed by   projects and programmes, and do in fact become an important part of the overall criteria used by evaluators. 
 

 Thus: - 
 *  Did those designing the project/programme undertake a capacity assessment? Did the capacity   assessment take into account the effects of the HIV epidemic? If not then why not, and what were the consequences for the   success or failure of the activity? What lessons can be learned for future projects/programmes from the failure to undertake a   capacity development assessment? 

 * Where an appropriate capacity assessment was undertaken at the design stages of a   project/programme what were the main conclusions relevant for the successful completion of the activity? To what extent did   the assessment take into account the effects of the HIV epidemic on capacity development? 

 * What capacity development objectives were set for the project/programme, and what activities were   established for the project in pursuit of these objectives? Were objectives and activities appropriate, and if not why not?? 

  * What activities relating to capacity development were undertaken by the project/programme? Did   these achieve their objectives, and if not why not? 

 * How far were capacity development constraints external to the project/programme important for the   success or failure in meeting its overall development objectives? 

 * Did the project/programme from the initial stages address the issues of sustaining its own productive   and organizational capacity in the face of HIV/AIDS? What activities were undertaken to achieve this objective, and with what   success or failure? 

 * Performance of the project/programme in part depends on capacity of beneficiaries [eg. of households   in the case of poverty alleviation projects, or of small farmers in the case of rural development projects]. Were attempts made   to assess their capacity, and what activities were proposed/undertaken to ensure that their capacity was sustained? 

 * Were those activities aimed at sustaining capacity, eg.of networks of NGOs and CBOs that were   external to the project/programme successful or not, and were appropriate lessons drawn from this experience for the   operational success of the project/programme? 

 * Did those responsible for the project/programme undertake regular reviews of performance relative to   objectives which included specific attention to capacity development both internal and external to the activity? What actions   were taken in the light of periodic assessment of capacity development aims relative to performance, and with what   outcomes? 

 * At the end of project/programme were the lessons of capacity development identified, and what   attempts made to ensure that these were transmitted to those who needed to absorb and use these lessons for future   development activities? 

 * Did the project/programme put in place the development capacity essential for sustaining this activity?   If not then why not, and what lessons can be drawn from the project/programme about the determinants of the success or   failure of such activities in ensuring sustainability under conditions of HIV and AIDS? 

 CONCLUSION

 Capacity development in the circumstances of the HIV epidemic is significantly more difficult to achieve but simultaneously   the objective becomes even more important for the successful outcome of projects and programmes. Thus ensuring that   projects and programmes at the design stage take account of the many ways that the HIV epidemic undermines capacity in all   of its dimensions, both directly and indirectly, and responding to this challenge in ways that lead to effective outcomes become   important evaluation criteria. Did the project or programme set out to achieve capacity development, and was it successful in   doing so in a sustainable way, becomes perhaps the most important criteria by which to evaluate performance.? 


Select Bibliography

 There is a large literature on the HIV epidemic and on generic issues of evaluation but relatively little that addresses issues of   capacity development and HIV in the context of evaluation. The following are some suggestions for follow up and web sites   are given as the most easily accessible way of finding sources. 

Capacity Assessment and Development In a Systems and Strategic Management Context [Technical Advisory Paper   No.3, Management Development and Governance Division, UNDP Jan 1998].

Capacity Development-Lessons of Experience and Guiding Principles [UNDP, Dec 1994].

Human Capital and the HIV Epidemic [hivdev.org.uk]

Responding to the Socio-Economic Impact of the HIV Epidemic in sub-Saharan Africa - Why a Systems Approach   is Needed [undp.org/hiv] 

The HIV Epidemic and the Education Sector in sub-Saharan Africa [undp.org/hiv]

The HIV Epidemic and Sustainable Human Development [undp.org/hiv]

The Economic Impact of the HIV Epidemic [undp.org/hiv]

Assessment of the Socio-Economic Impact of HIV/AIDS [hivdev.org.uk]
 



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