Developing National Capacity to Address HIV / AIDS in Yemen , Award ID YEM-307-G05-H

Developing National Capacity to Address HIV / AIDS in Yemen , Award ID YEM-307-G05-H

[Developing national capacity to address HIV / AIDS in Yemen], Award ID [YEM-307-G05-H]



Final Project Review Report


United Nations Development Program

The Republic of Yemen

Developing National Capacity to Address HIV/AIDS in Yemen

Award ID: YEM-307-G05-H
Project Duration: January 2008-June 2010
Extension(s): December 2010 (Grant Closure: November 2011)
Implementing Partner: WHO, UNAIDS, UNFPA, NAP, NPC and NBTRC
Total Budget:
[Donor] Contribution[1]:GFATM USD 10,568,459.00
UNDP TRAC Fund: USD 150,000
GoY: Nil
CO Focal Points: Khaled Magead
Report Prepared By: Dr. Sudhir Kumar
Date of Report: February 2012

Table of Content






Progress review

(i)Overall progress towards the CPAP outcome and output(s)

(ii)Capacity Development

(iii)Gender Mainstreaming

(iv)Human Rights Mainstreaming

(v)Impact on direct and indirect beneficiaries

(vi)Communication and publicity

Implementation strategy review


(ii)Participatory/consultative processes

(iii)Quality of partnerships

(iv)National Ownership

Management effectiveness review

(i)Monitoring and Evaluation

(ii)Timely delivery of outputs

(iii)Resource Allocation

(iv)Cost-effective use of inputs




Financial Summary

Financial Overview

Financial Utilization


Annual Work Plan

Project Document

Charts, tables and visual aids, with accompanying analytical descriptions (1-2 paragraphs per table/chart).

Table 1: Issues Log

Table 2: Lessons Learned

Table 3: Financial overview for the whole duration of the project

Table 4: Financial utilization by donor and activity for [ex. 2009]


AIDSAcquired Immunodeficiency Syndrome

ARTAntiretroviral Treatment

BCC Behavior Change Communication

CCM Country Coordinating Mechanisms

CSOs Civil Society Organizations

CSWCommercial Sex Workers

FPMFund Portfolio Manager

GFATM Global Fund to fight AIDS, Tuberculosis and Malaria

HIV Human Immunodeficiency Virus

HRGsHigh Risk Groups

IECInformation, Education and Communication

IDU Intravenous Drug Users

KAPBsKnowledge, Attitudes, Perceptions and Beliefs

LFA Local Fiduciary Agent


MBBU Mobile Blood Bank Unit

M&E Monitoring and Evaluation

MoPH&P Ministry of Public Health & Population

NAP National AIDS Program

NBTRC National Blood Transfusion and Research Center

NGO Non-Governmental Organization

NPC National Population Council

OIOpportunistic Infections

PCRPolymerase Chain Reaction (in specific HIV tests)

PLWHA People Living with HIV/AIDS

PMTCTPreventing Mother-To-Child Transmission

PR Principal Recipient

RBTRCRegional Blood Transfusion and Research Center

RDSRespondent Driven Sampling


STIs/STDs Sexually Transmitted Infections/Sexually Transmitted Diseases

TB Tuberculosis

UN United Nations

UNAIDS Joint United Nations Program for HIV/AIDS

UNDP United Nations Development Program

UNFPA United Nations Population Fund

UNGASS United Nations General Assembly Special Session on AIDS

VCT Voluntary Counseling and Testing

WHO World Health Organization


The project was successful in delivering the planned program activities and resources (USD 10.56 Million) and managed to achieve 10 out of 12 program indicators. A reprogramming exercise was carried out to address the 2 program indicators which could not be achieved due to inherent challenges in the NBTRC (change in leadership, lack of planning {MBBU} and severe human resources limitations). The project was able to achieve landmark policy introduction for the rights of PLWH (the first in Middle East), greater decentralization of the program with involvement of the decentralized structures such as the Focal Point at the Governorate level, NGOs (36) and PLWH Associations. Wider involvement of religious, political and community leaders and spread of awareness regarding HIV/AIDS among the marginalized and at risk populations such as Commercial Sex Workers (CSW), Men having Sex with Men (MSM), hotel workers, Al-Akhdam (marginalized community), refugees, fisher men, youth groups, prisoners, armed personnel, etc. was achieved. A network of 5 ART sites, 5 PMTCT sites, 17 VCT sites and 8 Regional Blood Transfusion and Research Centers was set up across the country under the program. It would be pertinent to note here that the program was delivered in a security phase 3 environments with serious limitations in recruitment of professionals / consultants and other travel related restrictions. Further, as documented in UNDAF, the country faces serious challenges with reference to corruption and other ethical issues which inevitably affected the program.

Under the grant, UNDP, WHO, UNAIDS and UNFPA recruited national and international consultants and mentors for VCT, ART, PMTCT, Blood Safety to build the data based for reviewing the existing structures, systems, processes and capacities to understand the key challenges and mentor service sites to overcome them. Several surveys and studies were undertaken to better understand the pandemic and the program challenges and to take evidence based decisions. The blood safety component in the program was very weak and thus a short term senior consultant was recruited to provide technical leadership in assessing the structures, systems, processes and capacities of the National Blood Transfusion and Research Centre, and accordingly develop strategies to address the same. Under the grant, several national guidelines on clinical management of HIV infection have been revised setting new standards of excellence. With support from PR, UNAIDS has also been able to provide significant technical support to SRs to conducting mapping & assessment of MARPS focusing on MSM & IDUs in Aden. A BCC strategy for HIV/AIDS has been developed. A M & E guide which will help to establish and strengthen M & E system in Yemen was formalized and introduced.

A series of national and international training programs / workshops and learning / exposure visits were facilitated under the grant focusing on M&E, BCC, procurement and supply management, ARV forecasting, ART & PMTCT services and management related issues. The PR especially focused on strengthening the SRs capacities for better monitoring system including record keeping, qualitative data reporting and increasing the role of M & E officers with SRs. Monitoring field visits were made to VCT, ART, PMTCT and NGOs sites to discuss the challenges, progress and provide onsite guidance and support.

During the second phase of the program, all the project indicators have been achieved except the ones related to blood safety, for which the PR coordinated with the NBTRC, LFA (KPMG), CCM, the Global Fund and various program partners to re priorities the NBTRC program funds, fine tuning the NBTRC program strategies to enhance the reach of the program and help achieve the program indicators.


Yemen has improved its rating on the human development index since 1990, but the country remains classified as a low human development country. While the population growth rate decreased from 3.7% in 1994 to 3% in 2004, high population growth remains an underlying cause of many of the problems Yemen faces. Population dynamics have negatively impacted improvements in water management, economic growth, education and primary health care. The country has even regressed on child malnutrition where the rate worsened from 1992 to 1997, with the situation remaining unchanged through 2003. The progress on maternal and child mortality has also slowed to a crawl since 1997. At a current 3% annual rate of growth, the population will double in 23 years, implying the need for rapid expansion of social services and job opportunities. The ability of Yemen to respond to this challenge is hampered by slow economic growth, which is extensively depending on oil. During recent years oil production has been on a declining trend and unsustainably high rates of water use threatening the very survival of many areas due to depletion of water resources is also adding to challenges that Yemen faces.

Although Yemen is a low prevalence country in terms of the number of reported cases of HIV/AIDS, evidence in both Yemen and the entire Arab region suggests a rapid increase in HIV infections. In addition, there is little institutional capacity to respond to and monitor the spread of the virus. Yemen could also experience a large increase in the incidence of HIV infection in the coming years unless measures are taken now. There is an alarmingly low awareness of HIV/AIDS in the country, and governmental and non-governmental leaders lack the basic understanding of the means of contracting the virus and measures that can prevent transmission. Stigma and discrimination continue to undermine the existing efforts to fight HIV/AIDS, and while few in numbers, many People Living With HIV/AIDS (PLWHA) require immediate treatment. Few donors support Yemen at this time, and the success of the Global Fund Program may very well determine future donor support in the health and other sectors.

The Country Coordinating Mechanism (CCM) of the Republic of Yemen was approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in its third round of funding for an HIV/AIDS grant for an amount of USD 5.5 million over the first two years and USD 14.8 million over the full five year period. In consultation with the Global Fund, the CCM requested that the Program be split into two distinct Programs, with separate Principal Recipients (PR). As a result, in the summer of 2005, the Global Fund signed a grant agreement with the National AIDS Program (NAP) in the amount of USD 2.8 Million, and a second grant agreement with the National Population Council (NPC) in the amount of USD 2.7 Million. Broadly speaking, the focus of the NAP grant was on voluntary counseling and testing (VCT), treatment, care and support of People Living With HIV/AIDS (PLWHA), service provision to vulnerable populations and blood safety. The focus of the NPC grant was on advocacy targeting policy makers, information, education and communication (IEC) activities to raise awareness of HIV/AIDS among vulnerable groups and the general population and the strengthening of civil society to coordinate HIV/AIDS activities.

While Yemen had much of the technical expertise to implement program activities, weak management systems and cumbersome financial regulations hindered both PRs’ ability to successfully achieve its targets. The CCM therefore nominated UNDP as the PR for the second phase of the programs, supporting both the NAP and the NPC in a harmonized program for the second phase. The CCM further requested comprehensive technical assistance from the UN system, in particular from UNFPA, UNAIDS, UNICEF, WHO and UNDP. In spite of the poor implementation during the first phase of the program, there were strong indications that the re-organized management structure and technical assistance plan could yield significant results in the second phase. First, while an upgrading of technical capacities was greatly needed, the staff of both the NPC and the NAP was highly motivated and enthusiastic. The UN partners agreed to develop comprehensive technical assistance plans which could be financed under the grant. Second, UNDP had extensive experience serving as a PR throughout the world, and could quickly disburse funds to finance key activities in order to address the financial management weaknesses experienced during the first phase. Finally, UNDP would provide management support to build the capacity of both institutions to better manage donor funds in the future.

  1. Project Description

3.1 The project title is “Developing National Capacities to Address HIV/AIDS” in Yemen

3.2 Project’s Goal:

To ensure that the HIV prevalence rate amongst the general Yemeni population and high risk and vulnerable groups will be stabilized, and that the internationally recognized rights of PLWHAs, including entitlement to humane medical care, are upheld.

3.3 Project’s Objective

  • To enhance HIV/AIDS prevention, care and support capacity among Government and Civil Society stakeholders
  • To create awareness of HIV/AIDS and other STI's among general population and identified vulnerable and high risk groups is enhanced and risk behaviour is reduced
  • To strengthen HIV surveillance system - both biological and behavioral studies
  • To increase coverage of HIV/AIDS - safe blood for transfusion, establish and enforce national blood safety standards.
  1. 4 Project Partners:

National Partners

  • National AIDS Program
  • National Population Council
  • National Blood Transfusion and Research Centre

UN Partners

  • World Health Organization


  • 36 NGOs across the country
  • 3 PLWHA Associations

3.5 Target Group/Beneficiaries:

  • High risk and vulnerable groups:

 Youth

 Marginalized group known as Al Akhdam

 Refugees

 Fishermen

 Truck drivers

 Prison inmates

  • General population of Yemen
  1. Implementation Strategy

As outlined in project document, the overall strategy for implementing the HIV/AIDS program (see annex I) is to boost the existing capacities in the public and within Civil Society Organizations (CSO) to enable the program to be implemented effectively. The following strategies were applied in the implementation of the HIV/AIDS program during 2008-2010:

  • To take advantage of all existing capacity in the public and Civil Society Organizations at the national, Governorate and district level;
  • To design comprehensive capacity building plans by WHO, UNFPA and WHO to strategically build local capacity to support expansion of the HIV/AIDS services;
  • To activate the National Task Force


Objective / Indicators Number / Service Delivery Area / Indicator / Baseline (if applicable) / Original Cumulative Targets for Year 5 / Targets if No-Cost Extension is granted / Actual Targets cumulative till December,2010
Value / Year / Source / June 2010 / December 2010 / December,2010
1 / Supportive Environment: Human resources / Number of service deliverers trained in IEC, BCC community outreach, counseling, STDs, care and support / 12 / Mar,05 / NAP / 1650 / 2,800 / These include resource persons/focal points from govt. depts, NGO staff, teachers and peer educators. Through international technical assistance / 3,274
2 / Treatment:Antiretroviral treatment(ARV)and monitoring / Number of people with advanced HIV infection rceiving antiretroviral combination therapy / 0 / Apr,05 / NAP / 400 / 500 / Through international Technical assistance / 531
3 / Treatment:Prophylaxis and treatment for opportunistic infections / Number o f PLW HA receiving opportunistic infection prophylaxis and treatment / 0 / Apr,05 / NAP / 500 / 800 / This refers to one patient as a case irrespecteive of the no. of visits; thus no. of PLWHAs and not episodes of OIs. / 924
4 / Prevention: Testing and Counseling / Number of people who receive HIV testing and counseling (incl.provision of test result) / 28 / Nov,04 / NAP / 4000 / 6,000 / Through international Technical assistance / 10,224
5 / Supportiveenvironment: Strengthening of civil society and institutional capacity building / Number of local NGOs participating in a formal civil society coordination network for HIV/AIDS activities / 0 / 2005 / NPC / 28 / 40 / Through international Technical assistance / 39
6 / Prevention: BCC - community outreach / Number of sites offering services to high risk groups ( IEC, STI counseling and condom access) / 0 / Apr,05 / NAP / 8 / 8 / Services as indicated will include IEC , STI;s, counselling and condom distribution / 5
7 / Supportive environment: Stigma reduction in all settings / Number of national and governorate leaders and decision makers reached by advocacy activities / 0 / 2005 / NPC / 5500 / 5,750 / Through international Technical assistance / 4,657
8 / Prevention: BCC - community outreach / No. of high risks and vulnerable persons (marginalized group known as Al Akhdaam, refugees,fishermen, truck drivers, prison inmates, etc.) reached with IEC / 0 / 2005 / NPC / 10000 / 15,000 / Through international Technical assistance / 16,743
9 / Information system & Operational research / Number o f sentinel sites for HIV surveillance operational / 0 / Apr,05 / NAP / 10 / 11 / Through international Technical assistance / 15
10 / Supportive Environment: Human resources / Number of staff trained on HIV/STIs Bio-behaviuoral surveillence / 0 / Apr,05 / NAP / 50 / 80 / Through international Technical assistance Targets take into account delays in the bio-behavioral survey. / 93
11 / Prevention: Blood safety and universal precaution / Number and percentage of blood units transfused in the last 12 months that have been adequately screened for HIV according to national guidelines / 0 / Apr,05 / NBTRC / 210000
(100%) / 210,000 / Through international Technical assistance / 102,166
12 / Prevention: Blood safety and
universal precaution / Number of service deliverers trained on blood safety / 0 / Apr,05 / NBTRC / 290 / 350 / Targets take into account the revised national guidelines and needs on blood safety / 180

The project was successful in delivering the planned program activities and resources and managed to achieve 10 out of 12 program indicators. Some of the targets set for indicators were achieved many fold and hence the performance framework agreed at the time of the program signing were revised to address/ accommodate the significant achievements made under the grant. A reprogramming exercise was carried out to address the 2 program indicators related to blood safety, which could not be achieved due to inherent challenges in the National Blood Transfusion and Research Centers i.e. change in NBTRC leadership, lack of planning / flexibility regarding MBBU and severe human resources limitations which was mainly adequate to run the center (NBTRC) rather than a national program. The amount dedicated for two MBBU’s for NBTRC was reprogrammed in consultation with the SRs, LFA, CCM and Global Fund to set up 8 Regional Blood Transfusion and Research Centers which would enhance the reach of the blood safety services geographically across the country on a more sustainable basis.


(i) Overall progress towards the CPAP outcome and output(s)

The Global Fund grant was the single largest funding to address HIV/AIDS in the Yemen. The Government of Yemen contribution to HIV AIDS program was less than 1 percent of the grant. WHO, UNAIDS and UNICEF contribution to the HIV / AIDS program was limited to providing technical assistance and localized support. MSF was supporting emergency ARV procurement for the capital city Sana’a and capacity building for the ART in Sana’a. The project set up the main frame of the HIV/AIDS program in the country and operationalized it under the grant. The project was focused on developing national capacities in terms of service sites, equipment’s, training of human resources. The project met all its programmatic, technical and financial obligations under the grant.