Evaluating HIV/AIDS Programs
Continued...

Understanding Funding Allocations

Because sub-Saharan Africa has the highest prevalence rate of HIV/AIDS, major international funding has been focused on this region. The World Bank's Multi-Country HIV/AIDS Program for Africa (MAP), initiated in 2000, is exclusively devoted to this region. The program's goal is to alleviate the effects of the HIV/AIDS epidemic and eventually decrease its rate of incidence. In September 2000, the World Bank approved $500 million and six months later an additional $500 million for the program. By December 2004, the program had allocated funding to 34 sub-Saharan countries. Map 4, based on the data received by the World Bank, shows the allocation of MAP funding along with the HIV/AIDS density.

Map 4: World Bank's Multi-Country HIV/AIDS Program for Africa (MAP) commitment

As the map shows, countries in central and eastern Africa benefited from MAP more than countries in other regions. Southern African countries, such as South Africa, Namibia, and Botswana, received little financial aid by the end of 2004, although prevalence rates in these countries were among the highest in Africa. The largest recipient of aid, the Democratic Republic of the Congo, received $102 million followed by Nigeria with $90.3 million. However, whether measured by total infected population or infection rate, the Congo is not the most affected country. As for per capita MAP funding, Cape Verde tops the list with an average of $2,500 for each infected person followed by Gambia with an average of $1,785 per infected person.

In addition to the MAP commitment, PEPFAR is concentrating $15 billion on 15 focus countries that include 12 countries in Africa. Specific funding amounts for each focus country is not clear. The World Health Organization pledged $5.5 billion to achieve the goal of getting 3 million people on advanced antiretroviral treatment by the end of 2005. More than 75 percent of this amount is allocated to fund staffing needs and activities in various countries and regions.

Tracking Results and Changes

Because GIS can demonstrate how and where things move over time, analysts can gain insight into the progress of programs. The benefits of mapping changes are twofold. Mapping identifies program impacts by comparing conditions before and after an intervention. Mapping also helps anticipate needs based on the impact of these changes.

Approximately 2.1 million children who are 14 years and younger are living with HIV/AIDS. This figure includes nearly 1.3 million children living in the 15 focus countries. As part of the United States' response to the overall emergency, PEPFAR has brought pediatric HIV/AIDS crisis to the attention of leaders in the United States.

PEPFAR is working more effectively in some countries than others. Namibia and Guyana had 10 percent of the children benefiting from the program. This was the highest percentage. Of Nigeria's 290,000 infected children, only 53 children received any support. During the same time period, children in Ethiopia and Botswana didn't receive support, so the reported rates for both were zero. Because no data was available on Vietnam's total infected children, it is not shown on the map.

In addition to providing downstream support to infected children, PEPFAR also provides services to prevent mother-to-child transmission of HIV in the 15 focus countries. Short-course preventive antiretroviral treatments were given to 198,400 pregnant women over a period of two years. More than half of those treated were in South Africa.

Conclusion

GIS is becoming an effective tool for monitoring and evaluating social development programs. As the maps accompanying this article illustrate, GIS analysis can demonstrate the input, output, and outcome of the major global HIV/AIDS programs targeted at sub-Saharan Africa. The analysis helps to fill the current evaluation gap. For more information on the global HIV/AIDS program, visit www.cdc.gov/nchstp/od/gap/ or contact Dr. Xiaomei Tan at tanxiaomei@hotmail.com.

Reference

Savedoff, William, Ruth Levine, and Nancy Birdsall, 2006. When Will We Ever Learn? Recommendation to Improve Social Development through Enhanced Impact Evaluation at the Center for Global Development Web site (www.cgdev.org).

About the Author

Xiaomei Tan, an independent consultant based in Washington, D.C., has a Ph.D. in public policy from the American University. She has been applying GIS to a wide variety of program monitoring and evaluations. The fields she is interested in include health care, education, and the environment.