1. HIV/AIDS and Infrastructure: Monitoring and Evaluation
Presenters: Ian Anderson, Advisor; Jacques Jeugmans, Practice Leader (Health); Rikard Elfving, HIV and AIDS Specialist, ADB.

2. Outline Recent developments Emerging Issues and Questions
Opportunities to collaborate

3. ICAAP 8 in Colombo: a promising start.
Recent developments
ICAAP 8 in Colombo: a promising start.
Case studies in GMS: experience in 4 countries : quick and early insights
ICAAP 8 in Colombo, Sri Lanka, August 2007 provided good venue for bringing together key stakeholders in transport and health. Pre-conference meeting of JI partners, in collaboration with UNDP and with the participation of representatives from Governments and regional associations including ASEAN etc. Joint presentation by ADB and JBIC on their experience in Asia. Key issue emerges there: reasonably good on input and process indicators, but outcome and impact ?
Greater Mekong Subregion (GMS) case studies. Not an “evaluation”. Rather, a snapshot of experiences and lessons of four large infrastructure projects in rapidly changing region: Northern Economic Corridor Project in Lao PDR; Western Yunnan Roads Development Project (Baolang) in People’s Republic of China; Cambodia Road Improvement Project; East West Corridor Project in Cambodia / Vietnam.
Some points to note: In Baolong, Kunming Medical College contracted to develop performance monitoring and evaluation system, which includes baseline and endline survey, and case / control, to assess impact of communications strategy. Even within a short period of a year, able to identify mobile men with money (eg middle managers) most at risk. Often had more education and knowledge about HIV but also higher risk behavior => emphasizes the need to go beyond “just” education. Case and control both showed significant improvement in knowledge and behavioral outcomes.
Lao PDR – collection and disaggregation of indicators by gender and ethnicity. Eg females were 10% of direct construction workforce

4. Measuring economics
low prevalence: 8 interventions cost 0.14% cost of major construction project.
prevalence > 10% workforce: cost still below 1% total project cost.
Monitoring, analyzing and evaluating financial and economic costs can be helpful to Governments. Part of the overall “advocacy” package. Dispells myths and allows planning and budgeting. And is part of the overall value added, especially of development financers like ADB and World Bank (but bilaterals too)
Construction Workplace Interventions for Prevention, Care, Support and Treatment of HIV/AIDS. McGreevey, Alkenbrack and Stover 2003.
Eight interventions included treatment of opportunistic infections, opportunistic prophylaxis (TB) and HAART. When prevalence at or below 1%, cost of 8 intervention package is $ 6970 per annum per thousand workers. When > 10%, cost of prevention alone is $10, 600 per thousand workers. Importantly, saves downstream costs of treatment AND does not necessarily affect profits of the firm if part of the contracting environment that all bidders face.

5. Cost Effectiveness Too.
Cost of Peer Educator program higher than Health Communicator program ($15,678 versus $ 12,455).
But cost per worker reached lower for PE program ($31) than the HC ($37).
Reference : Expanding Workplace HIV/AIDS Prevention Activities for a highly mobile population: Construction Workers in Ho Chi Minh City. Horizons Program supported by USAID and Population Council. Covered 23 randomly assigned construction sites.

6. Issues to consider
Input and process indicators versus outcome and impact indicators.
Pre and post construction phase
Stationary versus rolling projects.
“Monitoring the monitoring”
Input and process indicators important. But so are outcome and impact. Yet hard (mobile) and more expensive.
Issues to address at construction phase are different to those at subsequent transport stage
Issues and indicators that collect in a “stationary” environment –eg a port setting or a power station – are different to a “rolling” road program
Monitoring is a means to an end, not an end in itself. Need to verify if the data collected is actually informing – and changing – policy decisions and operations of government and stakeholders.

7. India’s M&E Indicators specific to HIV/AIDS and Transport
Truckers reporting having sex with non-regular partners
Truckers reporting having paid sex
Truckers reporting having casual sex
Condom usage with non-regular partner
Condom usage with paid non-regular partners
Condom usage with casual partner
Perception of risk among non-users of condom
No. and Percentage of High risk men reached by intervention
No. of migrants covered through migrant vulnerability reduction programs
Source: India’s 3rd National AIDS Programme Implementation Plan

8. Next steps Meeting in Bangkok 12-13 May, followed by others.
Tangible results under paragraph 5 of the JI:
Bangkok meeting 12 – 13 May
The objective is to discuss lessons learned from the Greater Mekong region among development agencies. Expected outputs from the meeting include:
Agreed approaches on how to engage with governments – dialogue and implementation of the three one’s
Minimum elements of undertakings – project specific
M&E indicators for projects supported by development partners – if countries have not developed their owned
2nd Technical workshop in July or August will bring technical Monitoring and Evaluations specialists together to define specific key indicators on HIV/AIDS and Infrastructure. The intention is to agree on harmonized indicators to the extent possible – even though the local context may differ from country to country.
3rd Regional Conference on HIV/AIDS and Infrastructure (October / November) will provide a feedback of the first two exercises to a wider audience (governments, civil society, media etc). ADB will also present and share information on other ongoing initiatives such as:
Support for to Ministries of Transport for developing actions plans on HIV/AIDS (GMS)
ADB/IOM Regional database on HIV/AIDS and Infrastructure and mobil populations (GMS) – and videos
UNESCO GIS mapping of HIV/AIDS and Infrastructure
Other possibilities ? Paragraph 5 of the J I points to tangible deliverables: strengthened frameworks for sharing; consistency with partner Governments; partnerships with stakeholders; joint assessments; scaled up and more institutionalised.