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PEPFAR Implementation: Progress and Promise
by all stakeholders and using a national information system that ensures the effective flow of information at all levels (UNAIDS, 2005d).
While they are essential activities, monitoring and evaluation pose a tremendous challenge. UNAIDS has described three directions of accountability—upward to donors of all types, downward to people directly affected by HIV/AIDS, and horizontally within and across partnerships and to the civil sector to encourage mutual accountability (UNAIDS, 2004b). According to UNAIDS, “a central focus for accountability in this situation is to strengthen partner countries’ capacity to manage and monitor so that reporting can be country-led and country-owned and reporting and monitoring should support the partner countries’ own needs. Credible monitoring and evaluation must serve two essential functions: to improve programme implementation, while also allowing donor sources to ensure that their funding is effectively spent” (UNAIDS, 2004b, p. 3). Follow-up to the United Nations General Assembly Special Session on HIV/AIDS has shown that among the challenges faced by countries and their partners are weak collaboration among stakeholders; shortages of monitoring and evaluation skills; insufficient resources to support the activities; and a lack of the strategic information systems needed to collect, analyze, and report the data (UNAIDS, 2005d).
Strategic Planning and Major Elements of HIV/AIDS Programs at the Country Level
As early as 1998, UNAIDS published a guide for countries to assist them in developing national strategic plans for their response to HIV/AIDS. The guidelines offer practical assistance for planning at the national, district, and community levels by governments, nongovernmental organizations, donors, and other agencies (UNAIDS, 1998). The major steps or strategic planning at the country level as outlined by UNAIDS are listed in Box 2-3.
Strategic planning may result in different priorities in different countries, but the major elements of all HIV/AIDS programs are similar (see Box 2-4). Interventions and services involve both help for those living with HIV/AIDS or otherwise affected by the epidemic (for example, children orphaned because of AIDS and family members of people who are HIV-positive) and efforts to curtail the spread of the virus through a variety of measures.
A Family-Centered and Community-Based Approach to HIV/AIDS
Programs can be offered in a variety of settings, but UNAIDS has urged that services be available in the communities where those affected live and