| BackgroundThe global fund is composed of the government, the private sector, the private sector and the affected community, which represents a new way of international health financing. China successfully applied to the third round of the global fund, the fourth round, fifth round, sixth round, eighth round and rolling Continuation Channel in2003, 2005,2006,2004,2008 and 2009, and in September 2004 began to implement,ended in December 2013. In order to assess the ten years work of the Global Fund AIDS project in China, Anhui Medical University as the third party independent evaluation agency, has undertaken the final assessment task on project.ObjectiveTo determine the objectives of the Global Fund AIDS project, as well as the role and impact on China’s AIDS prevention and treatment work, summarize the experience of the Global Fund AIDS project and to provide a reference for the development of China’s AIDS prevention and control work.Method1. Data collection method(1)The existing information collected is mainly from the national project office, and the list of the required information provided by the assessment group is submitted to the national project office. Non-project information is mainly derived from the network search and related agencies; other important information and reference data which was list by assessment team was submit to the national project office,who coordinate the relevant agencies to help collect.(2) The sites selected for investigation including Anhui Province, Sichuan Province, Yunnan Province, Heilongjiang Province, Hubei Province, Zhejiang province and Shanghai City.Two project cities were selected for each province,1-2 project counties selected for each city, a total of 7 provinces,12 prefecture level cities and 20 counties. The respondents included the national, provincial, municipal and county level health administrative departments (34), CDC (47), and 84 (29),6 persons (34), high risk group (132), and peer education (27).Field survey include group interviews(53,258), the key insider in-depth interviews (135) and a small sample of a quick survey (31).2. Data analysis method Data analysis methods include the order of the connotation of the method, the literature analysis, comparative analysis, correlation analysis, quantitative and qualitative analysis, etc.. The assessment results are as follows:Assessment results1. Project implementation was in alignment with the requirements of project design(1) The project is able to establish and improve the organization and management of the program, and carry out project management activities according to the plan; (2) The project was payed for a total of $324000000, and the investment and the use of funds was reasonable in each round of the project. Although in 2011, the funds to RCC project has been adjusted due to the impact the project, but the implementation rate of the accounts is not affected, the globe implementation rate was 99.1%; (3) The project has basically completed the expected target value, and 73 indicators of the total set of 81 indicators had achieved or exceeded the expected target,8 indicators (7 indicators in fourth round, five round and six round and 1 indicators in RCC) did not complete target, but only for MSM behavior group and injection drug users,it may due to the high expected value;(4) the principles "effective integration of resources, promoting the wide participation of the whole society, establishing a sustainable development mechanism and the implementation of the target population as the center" were implemented fully in the project; (5) The project was proved to be well based on the three aspects of evidence:"diagnostic assessment" from OIG, the "diagnostic assessment" from the Global Fund Secretariat and PUDR, and rapid assessment of our project. Therefore, it is believed that the project design is scientific and feasible, and the project implementation is reasonable and effective, it is in line with the expected design requirements of the project.2. The role that project plays to China’s AIDS prevention and control work(1) The design of the project plan is in line with the "China’s prevention and control of HIV/AIDS Action Plan"Assessment shows that the project plan were related to China’s five year action plan, such as the first and fourth round of the project plan was associated with the first five year plan of action, the 5 indicators are associated with third, four or five and 6 of the 8 objectives of the project are associated with the five six year plan of action etc..(2) Project funding was an important supplementation for the Chinese AIDS prevention and control of resourcesIn 2004-2013, the project had spent total funding of $324000000 in the field of antiviral therapy, high-risk groups intervention, social organizations,in each field with 63800000,47400000,46270000 respectively. Compared with government investment between2005 and 2012, the highest proportion is 28.16%,the low is 15.19%. The total international investment is $483660000, of which $405357000 is from Global fund project. Assessment shows that the project funding play an important complementary role for AIDS prevention and control of China’s resources(3) The project has promoted the development of HIV/AIDS prevention and control in China at a specific timeThe project has taken into account the needs of AIDS prevention in China at the beginning of the project. The project invest in the key moment, priority areas, special areas and key people in China,and has played a positive role in promoting in comprehensive development of China’s AIDS prevention and control work.As of 2004, with the timely input of the third project, problems of treatment funding needs, as well as second-line drugs and the lack of children’s medicine in 7 central provinces in China were effectively solved; In 2005, aiming at key areas and key groups in China, focus on intervention work on injection drug abuse and prostitution in 7 China provinces, the fourth round of project build a methadone maintenance outpatient treatment, voluntary counseling and testing site and needle exchange intervention/service platform to create a good working atmosphere of intervention in high-risk groups; In 2006, focus on rising proportion of sexually transmitted AIDS, the fifth round of project shift the focus to the low epidemic area of sex workers and MSM. For the first time in China, the project promoted non-governmental participate in the organization and filled up the blanks in the field of the MSM intervention work in a large-scale; The special investment in social organizations in sixth round project has effectively drove the country and the project supporting investment for the first time; RCC project pioneered in the integration of HIV/AIDS resources, established provincial work plan and budget development model, built a platform for social organizations to explore the AIDS prevention policies,prevention and control strategies and service system construction, etc..(4) The implementation of the project has played an important role in China’s key areas of AIDS prevention and controlIn the field of anti-virus and care:the project has invested $55300000, supporting the establishment of a AIDS treatment system, care and support system, drug procurement and management system, and helping the construction of the national drug resistance monitoring system and laboratory network. Till the end of 2008,31284 were treated by three round of project, accounting for54.6%;794 children were treated accounting for 63.5 percent of the children;In the fourth round of project,28358 people accepting antiviral therapy,26000 people taking anti opportunistic infection treatment,52736 infected with the/patients receive care and support services, proportion of still alive patients who received antiviral therapy for 12 months were 70.0% in 2003 rose to 84.6% in 2009. In the sixth round of project,11622 PLWHA and 2659 affected children were cared and supported by community organizations. RCC project supports 167837 adults and 2818 children receiving antiretroviral treatment, the proportion of HIV infected persons, patients and their families receiving care, support and services had rose from 46.4% in 2012 to 85.4% in 2008, an increase of 39 percentage points.Intervention in high-risk groups:the project invested $63800000 to support grassroots organizations and community organizations to expand the intervention team, improve the coverage and quality of work, explore the intervention unit cost estimates and the purchase service model, and promote the work of MSM group fully and deeply. Such as the coverage of AIDS intervention services in commercial sex workers in the third round has reached 97.6%;The fourth round 45276 received junkie provide methadone maintenance treatment; 147899 women who were injected with drugs were provided with the needle; 196980 sex workers received outreach and peer education;"sex workers recently a occurred in commercial sex ratio" of condom use had rose from 64.7% in 2005 to 87.9% in 2009; In the fifth round of project,2000781 people receiving intervention services;74659 people received STD service; "MSM’s last anal sex condom use rate" and "among the last commercial sex condom use rate" respectively had rose from 2007 to 66.7% to 80.6%,77.2% to 90% in 2009; In the sixth round of project, community organizations participated in the intervention among commercial sex workers and clients(242650), MSM(66095) and IDU(39599); "the proportion of condom use in MSM " and " the proportion of condom use in the last commercial sex" has rose respectively from 54.9% to 59.7% and 68.7% to 84.7% in 2006; The RCC may intervene 62.5 million sex workers,25 million MSM and 41 million people intravenous drug addicts; condom use rate of sex workers, MSM and drug addicts were rose from 2008 80.3% and 73.8% and 35.40% to 2012 87.4%, 74.6% and 54.9% respectively.In the field of community organizations:the project had invested 47400000 U.S dollars, and 20 indicators of the CBO in all projects are over the expected target.First, it promote the financial investment at all levels:5660000 from central government and a total of 8647700 yuan from provinces in 2008 and 2009 were matched.Second, it promoted the wide participation of CBO, improved the coverage and effectiveness of the prevention and control;Third, it trained all levels of association/institute team members, and improve the ability of CBO and the organization’s development; Fourth, it explored different modes of CBO participation. Number of CBO and projects supported by the program were 2473 and 3184 respectively. In 2012,57098 patients,including CSW, MSM and IDU,were tested CD4 by CBO. In 2013,101268 CSW,433722 MSM,63789 IDU were intervened by CBO, and a total of 159448 were cared by CBO.In the field of floating population intervention:RCC project invested RMB 46.27 million yuan, special funds for floating population intervention. Between 2010 and 2012, the project had intervened 4094198 floating people.First, It draw the attention of government on float intervention nationally, establish national sentinel surveillance in the floating population;Second, it promoted cooperation of management departments, the work of AIDS prevention and control program, and establishment working mechanism; Third, it explored the float population intervention model, intervention coverage from 11.9% in 2009 to 24.6% in 2012; Fourth, in the recent commercial sex condom use rate increased from 64.1% in 2012 to 74.4% in 21 cities of 7 provinces.(5) The project has made a contribution to China’s AIDS prevention and control During the implementation of the project, China has made remarkable progress in AIDS prevention and control work, the correlation analysis shows that China’s achievements had a closely relationship with the global fund projects,which was largest investment funds, the longest time,covering widely and mostly in China. From 2004 to 2010, districts supported by the project had expanded from 7 provinces to 14 provinces,21 provinces and at last 31 provinces, not only effectively promote the development of AIDS prevention and control work in the project area, but also as part of China’s AIDS prevention and control work.3. Influence of projects to China’s AIDS prevention and control work(1) "Resource integration" is a way to improve the efficiency of AIDS prevention and control. First, integration of all rounds project themselves; Second, integration with all levels of government financial investment and international project;Third, the project committed arrangement and rational planning on various sources of provinces funding for AIDS prevention and control by the way of planning and budget, "resources integration" had ensured rational allocation and use efficiency of the AIDS prevention and treatment resource.(2) A wide range of social organizations participation has laid a foundation for the sustainable development of the AIDS prevention and control.Through the implementation of the project, the advantage of community organization participation has been widely recognized by the government departments,created a supportive environment for the participation of social organizations,promoted the development of the relevant policies of all levels, and built a platform for community organizations to participate in the community organizations. In particular, the RCC project and the sixth round of the project tried a different types of community organizations participation in the management model, which achieved good results and accumulated experience for the future of Chinese community organizations participation in AIDS prevention and control.(3) The establishment of a sustainable development model had been a demonstration for the effective development of AIDS prevention and control. Project form a variety of work patterns, such as community organizations participation mode, high risk population and floating population intervention model, planning and budget development model, which had provided a demonstration for the future of China’s AIDS prevention and effective development.(4)The management team trained in the project is an important talent pool for the AIDS prevention and control. The project employs a lot of full-time and part-time management personnel who were provided with a very good training and opportunities in the project. Such as a variety of training courses, the exchange of experience, and project planning, data management, supervision and evaluation of the actual work of the exercise, which had improved the team members ability greatly. high quality management team trained in the project will become valuable follow-up force for China’s AIDS prevention and control work in the post Global Fund era.4. The accumulation of work experience for AIDS prevention and control(1) Establishment of provincial project work plan and budgeting model, not only ensure feasibility and the indicators completion of the project plan, but also helpful for the quality control and project supervision; (2) The project developed effective mechanisms for community organization participation, including three kinds of management modes:the provincial level management, CDC hierarchical management model and association hosted management models, as well as three kinds of participation:open tender, hosted directly and purchase services, and effectively promoting participation of community organizations and goals completion; (3)The project explored AIDS prevention mode based on grassroots institutions by means of "buy service", and expand the intervention teams and intervention coverage; (4) The project established different modes of migrants interventions according to different places and different objective, such as commission of workplace intervention model, commissioned by the grass-root health organization intervention models and grass-roots social organizations commissioned intervention model, these intervention model adapted to local conditions, greatly improving the effectiveness of migrants intervention. Experience accumulated in project could provide valuable lessons for sustainable development for China’s AIDS prevention and control work in the future.5. Problems and challenges of the projectAlthough the implementation of the project has produced a great effect, but there are still some problems and challenges, including:1) The sustainability of project results,including:(1)The sustainability of the important activities undertaken during the project;(2) The project is a platform for CDC, social organization advisory group, CBO-SR/SSR and related organizations.how to find new platform to take over the work; (3)The project incorporated the grass-roots organizations into projects implementation through the purchase of services, how to work with grassroots organizations; (4) How to continue to carry out MSM population and floating population intervention work, which were carried out in the support of project, after the project.2) The problem of unit price calculation and rationality. Including:the unity of the unit price and the proportion of the distribution did not take into account the level of economic development, there is no distinction between different types of people and different modes of intervention, without taking into account the level of consumption and the level of staff salaries, etc..3) Effective cooperation and coordination between CBO and CDC at all levels. Such as lack of adequate information communication between CBO and CDC in some areas,lack of mutual cooperation, lack of trust in some CBO and CDC, etc..4) The development of community organizations involved in HIV/AIDS prevention and control. Including:CBO registration issues, CBO balanced development and CBO development issues.Conclusions and recommendationsThe main conclusions of this assessment:(1)The project is carried out according to the plan and designed to meet the needs of the project. The project design is reasonable and feasible, and the implementation of the project is effective.(2) The project planning is aligned with the implementation of China’s "three five-year plan of AIDS prevention and control action", meeting the needs of China’s AIDS prevention and treatment of AIDS, and is timely and necessary.(3) The project has made great contribution to China’s AIDS prevention and control, in the ten years of the implementation of the project, China’s remarkable achievements in AIDS prevention and the implementation is closely related to global fund project.(4) The assessment also found that the decision-making and management has a negative impact on the implementation of the National AIDS prevention and control work, even brought a certain degree of loss to it. The main recommendations of this assessment:(1) After the end of the project, it is proposed that areas, institutions, organizations and interventions which dependent fully on the areas of the project support,should incorporated into the local AIDS prevention and control work plan. The locality is responsible for raising funds, technical force, etc. to ensure the activities to be continued development.(2) In the aspect of social organizations’ management, it is recommended that the national social organizations participate in the project’s leadership coordination mechanism, and set up social organizations (groups) in the country’s CDC to co-ordinate the work of the whole nation. In the level of funding mechanism which the social organizations involved in both "social raise fund" and "national transfer payment" are proposed to develop the funding mechanism, through the tender, incubator and buy services etc. to support various types of community organizations to participate in AIDS prevention and treatment work.(3) Continue to support and strengthen grass-roots organizations to carry out AIDS prevention and control work. Combine the work with the basic public health services of the country and establish long-term mechanism for the prevention and control of AIDS.(4) Increase the application of comprehensive intervention in the MSM population, explore more effective intervention model for MSM.(5) Embed floating population intervention in equalization items of the national basic public service to solve the problem of HIV/AIDS prevention and control of the floating population fundamentally. |
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