Evaluation of HIV/STD prevention, care and support: an update on WHO's approaches

Over the past decade only a limited number of public health initiatives have been subjected to systematic monitoring and evaluation and, in many instances, there is growing pressure to estimate which approaches work best for a given level of inputs in order to allocate resources effectively. However, evaluation is very often seen as punitive, and a change in perception is needed to allow evaluation to be owned by all stakeholders in public programs. In the field of HIV/AIDS prevention and care, the first difficulty is that many national AIDS programs lack clearly stated objectives and involve a wide variety of players. These players each have their own guidelines for project/program design, monitoring, and evaluation. The second difficulty relates to the fact that evaluation involves "multiple methods, multiple audiences, multiple funding sources, multiple perspectives, multiple paradigms, multiple roles, and multiple solutions to multiple problems" (Quinn Patton, 1986). To some people, evaluation calls for complex experimental studies while to others it means pausing at the end of an activity to sort out what went well and what went less successfully. This paper examines briefly some of the problems and challenges facing the evaluation of HIV prevention and care and summarizes the approaches adopted by the World Health Organization (WHO) to assist AIDS programs around the world in evaluating their initiatives. The paper also provides an update on the progress of developments, training, and implementation of these approaches.