MSF Anthropology Reports
“You have to feel that body touch”: Adolescents’ perception of and access to sexual and reproductive health and HIV care in Kasese, Uganda (2016) internal
MSF-OCP’s project in Kasese focuses on reducing mortality and morbidity due to HIV and TB and improving adolescents’ sexual and reproductive health and HIV care in Kasese town. This anthropological study set out to analyse adolescents’ perceptions of their sexual and reproductive health including their health-seeking behaviour and risk perception. The study sought to suggest what messages and ways could be appropriate for raising awareness and enhancing attendance at the Kasese Adolescent-Friendly Centre, by understanding what adolescents would define as an adolescent-friendly centre.
Despite MSF’s long-standing project to provide HIV/AIDS services in Chiradzulu, Malawi, in 2012 there were growing concerns over the ever increasing rate of new HIV infections, the high drop-out rate of patients – mostly men who refused to continue their treatment – and the low turnout of men at HIV testing. The purpose of this anthropology report was therefore to find out about the reasons for low participation of men in the project, to investigate the male gender role / life situation of men in Chiradzulu society, to assess the situation on male circumcision and the level of knowledge of prevention of HIV infection, as well as to find out about the HIV/AIDS activities of local stakeholders and assess their ability for decentralizing / taking over some parts of MSF’s activities.
“You see it, you know it, but you don’t say it” (2012) internal
The purpose of this study was to provide insight into the local perception of HIV testing and AIDS treatment in the Shiselweni region of Swaziland and how to involve the communities in becoming active stakeholders in a “Treatment-as-Prevention approach”. Specifically the reports looks at the structure of local communities, the most common beliefs about health, the role of traditional healers, the perception of HIV/AIDS, the main prevention strategies, and the readiness of communities to engage directly in the fight against HIV/AIDS, amongst other aspects.
These four papers from CRASH cover a range of HIV learning. The first paper looks at the different attitudes adopted by MSF over the years in response to human immunodeficiency virus (HIV) epidemics up to the mass-introduction of ARV therapy. The second picks up the historical overview in the early 2000s at the project level, in the Homa Bay district of Kenya. The last two texts offer an anthropological perspective on two issues discussed among the Homa Bay project teams: how caregiver team analyses connect the local culture to the spread of the epidemic, and the conditions for patient access to HIV diagnosis and treatment.
Access for More - Part 1 (2010) internal
The idea for “Access for More” originated from the estimation that there were between 13,000 and 29,000 HIV positive individuals in Homa Bay district without access to HIV/AIDS treatment and care.
The first part in this series focused on gaining an insight into patients’ health seeking behaviour when their health starts to deteriorate due to HIV related infections, the cultural and socioeconomic obstacles that prevent seriously ill HIV patients from accessing care, to assess the perceptions and practices during anti-natal care (targeting improvement of PMTCT), to understand general perceptions of the HIV/AIDS epidemic in the Luo community, and its socio-cultural impact and to assess the culturally-driven spread of HIV and preventive strategies.
Continuing from part 1, this report goes into more depth on the issue of seeking treatment. It uses a comparative approach, to compare “early health seekers” and their motivation forHIV testing with “late health seekers” and their reasons for not doing so.
The final part of the series explored barriers that prevent local communities in the Homa Bay area from making full use of PMTCT (Prevention of Mother to Child Transmission) services.
Men - Taking Risk or Taking Responsibility (2004) internal
The main purpose of this research was to find out what people in Tsholotsho, Zimbabwe district know about HIV/AIDS, how they feel about it and how they cope with it, in order to be able to propose strategies and methodologies for a successful intervention for HIV/AIDS prevention and care. The report also sought to offer ways to build an effective HIV/AIDS programme in a male dominated rural setting.
Coming close through communication (2003) internal
This report looked specifically at the MSF OCBA HIV/AIDS prevention programme in Busia, Kenya. The programme aimed to reduce the prevalence of HIV through an IEC (Information, Education and Communication) intervention in schools and in the community. In particular, the research focussed on analysing the methodologies and strategies of the IEC programme in order to provide recommendations for the future.
As part of a HIV/AIDS programme in Kinshasa, MSF introduced in 2005 an initiative of decentralising HIV services in primary healthcare (PHC). The aim of this initiative is to improve access to care and service quality of the various health facilities in Kinshasa. The decentralisation approach has undergone many changes and adjustments since it was first established, particularly regarding the selection of the centres targeted and the type of support provided. This evaluation analyses the medical outcomes, challenges, and enabling factors of the decentralisation initiative and it focuses mainly on MSF's past experience in Kinshasa and how it has informed the current strategy.
Version française: Évaluation de l’initiative de décentralisation du traitement du VIH, Kinshasa, RDC (2020) public
Since 2014, MSF has been implementing health programs for key populations (KP) mainly along a major transport corridor running through Mozambique and Malawi. This evaluation was conceived to evaluate each program individually, and then to look at all programs comparatively in order to discern which interventions were most effective. Furthermore, the intention was to consider the sum of the MSF experience in these programs to infer an optimal model of care that responds best to the health needs.
Optimizing HIV, TB and NCD treatment in five sub-saharan countries: Evaluation of DGD-funded projects Guinea, Kenya, Mozambique, South Africa and Zimbabwe (2014-2016) (2017) public
MSF OCB has been providing HIV care and supporting MoH HIV programs across Southern, Eastern and Western Africa since 1999.MSF’s long-term objective is to achieve policy and health system change. The short-term objective is to deliver care and treatment while controlling the attrition along the treatment cascade. Routine viral load monitoring combined with differentiated models of care have been at the heart of its strategy.This evaluation was commissioned by the Belgian General Directorate for Development (DGD). It focuses on assessing the treatment cascade, viral load monitoring and differentiated models of care, alongside the impact of MSF's advocacy efforts.
MSF OCB Stop Stock Out Project , South Africa (2016) (2017) public
SSP was formed in the aftermath of a high profile depot crisis in South Africa in 2012/3, with six organisations already dealing with drug stock outs joining forces to tackle the issue. Largely focused on anti-retrovirals (ARVs) and TB medication, from the beginning the SSP has tasked itself to hold government accountable, to perform a watchdog role and to present the patient view on stock outs. The overall objective of the evaluation was to evaluate the impact and effectiveness of the SSP and specific objectives included evaluating the SSP's impact on provincial/national government policy and reform, on community mobilisation to address stock outs, on creating an effective advocacy consortium on health and HIV, on strengthening a regional stop stock outs movement and on assessing replicability regionally and in other service areas.
Evaluation of Different Operational Models for Integration of HIV/TB Services in MSF OCBA Projects (2016) internal
Integration of HIV/TB services is one of the priorities for the MSF movement since 2010 and in particular for OCBA that started hand over of the so-called vertical programs in the same year. Integration aims to provide access to HIV/TB care to all populations in need in locations where MSF has implemented regular projects, regardless of HIV prevalence. This evaluation was conducted in CAR, South Sudan, Niger and Yemen, and was driven mainly to learn from the implemented projects in order to inform future programs and advocacy activities
Evaluation of HIV Counselling MSF OCB, Tete, Mozambique (2016) public
MSF has been active in the provision of HIV care and prevention services in Tete since 2003. From very early on, MSF included counsellors into the HIV and ART services. The purpose of this evaluation was to assess the counselling activities of the project in order to understand better how counselling contributes to patient care and to inform future project orientations.
Evaluation of Decentralisation to and Strengthening of Peripheral Health Structures MSF OCB, Conakry, Guinea (2016) internal
MSF set up HIV care and prevention services in Guinea in 2003 and began to decentralise and invest in peripheral health structures in 2007. However, MSF continued to face challenges in terms of decentralisation because of the limited capacity of the peripheral health structures, and MSF was not satisfied with progress towards withdrawal of its support at the end of 2017. A round table in 2015 decided upon a change of the approach. This evaluation aimed to assess the new approach put in place in terms of relevance, appropriateness, effectiveness, and so on.
Evaluation of Community HIV Testing Modalities MSF OCB in KwaZulu-Natal, South Africa (2016) internal
MSF has been providing 3 modalities of community HIV testing in KwaZulu-Natal since late 2012. Given that community HIV testing is often more expensive than Healthy Facility-based testing, this evaluation aims to fully understand the relative advantages of community testing modalities. The report details five key recommendations aimed at improving the efficacy of the community testing modalities.
In 2013 MSF launched an ambitious project to establish routine viral load (VL) monitoring for patients on antiretroviral therapy beginning in Gutu District. This evaluation of the VL monitoring system was commissioned in order to more fully understand the experience and outcomes of the introduction and scale-up of VL, but also undertaken with a view to the national scale-up of VL monitoring, and the general issue of VL monitoring in sub-Saharan Africa in light of the UNAIDS 90-90-90 targets. The entire VL pathway was examined from the point of requesting a VL measurement at a health facility to the response to VL results in terms of the management of patients on ART.
Evaluation of Homa Bay Handover MSF OCP, KENYA (2016) public
MSF OCP has been working in HIV care in Homa Bay County since 1996. The handover process was initiated in 2013 and scheduled to be completed in December 2015. The main goal of this evaluation was to explore how effective the handover strategy was in contributing to sustainable, comprehensive quality of HIV/TB care in Homa Bay.
Evaluation of the added value, benefits, challenges and risks of the MSF-UNITAID collaboration (2015) internal
MSF began receiving UNITAID grants in 2013. In October 2014 the Medical and Operations Directors Platform took a decision not to seek any further UNITAID funding for a one-year period-ending in October 2015. This evaluation was commissioned in order to provide an understanding of the added value, benefits, challenges and risks of MSF’s collaboration with UNITAID. It assessed the overall relationship between MSF and UNITAID, the influence of UNITAID on MSF’s operations, internal procedures and intersectional work, and the capacity of MSF to influence UNITAID through being an implementing partner.
Evaluation of the OCB Kibera Project Handover Process, Kenya (2015) internal
OCB initiated the Kibera project in 1997 to reduce mortality and morbidity among people living with HIV/AIDS in Nairobi. The handover process was officially conceptualized in early 2014 (following the 2013 evaluation – see below) to be finalized by mid-2017. This evaluation took place mid-way through the handover process in 2015. The objectives of the evaluation were to (i) establish the extent to which project objectives have been achieved in one year of the handover process (2014-2015) (ii) determine the appropriateness and effectiveness of the handover process (iii) identify the challenges faced and lessons learned during the last year of the handover process (iv) make recommendations on adjustments and strategic adaptations to be considered for the handover process to be completed efficiently and within the planned time.
Evaluation of MSF OCB Roma & Semongkong project, Lesotho (2015) internal
The Roma and Semongkong project began in 2011 with the aim to reduce maternal and infant morbidity and mortality in a hyper-epidemic HIV/TB setting. This end of project evaluation was commissioned to assess the impact of the five-year programme and identify lessons learned to support the design and planning of potential future projects in Lesotho.
Since 2012 OCA has been implementing a new approach to HIV/TB programming in Gokwe North district of Zimbabwe, known internally as a ‘light approach’. In September 2014, towards the end of its handover, an evaluation was commissioned with the objective to examine the outcomes and implementation process of the projects and to find out whether the approach could be recommended for use again by MSF-OCA.
To view the internal version of the report, which also covers the City of Harare, see here: New approaches in a new HIV era: ART/TB scale-up in Gokwe North and City of Harare clinics by MSF-OCA (2014) internal
MSF-OCB Matam Project, Guinea: Evaluation of improving access to care for people with AIDS and /or Tuberculosis (2014) public
Between 2011 and end-2013, OCB ran a project in Conakry to improve access to quality health facilities for people with AIDS and/or tuberculosis. The purpose of the evaluation was to assess the implementation and acceptance of the management protocol adopted by MSF and to document lessons learned, bottlenecks and risks that could jeopardize the sustainability of project achievements, for a future extension of the coverage of the city of Conakry and /or others regions.
This report describes the OCB Khayelitsha Project, initiated in 2000, as one of the first MSF projects in Africa to introduce antiretroviral treatment (ART) into the public sector. The evaluation assessed the strategies piloted in Khayelitsha between 2008-2013 (HIV/TB programs and the M&E system), the impact of MSF pilots, operational research and other strategies on local, national, and international policy, and the strategies used to disseminate policies and information about Khayelitsha’s pilots.
Evaluation of handover: strategy implementation in two minds Report of the handover process and replicability of handover tool in Maputo Project, Mozambique Mission (2014) internal
MSF has been supporting the provision of HIV prevention, treatment and care in Maputo, Mozambique since 2001, and the handover process began in 2011. This evaluation aims to assess the appropriateness and effectiveness of the handover strategy and likely outcome in continuity of care, in order to provide a comprehensive overview of the implementation phases of the handover as well as to make clear recommendations towards future improvements and replicability of the handover ‘tool’ itself.
MSF Belgium was active in Thyolo District from 1998, supporting the Ministry of Health (MoH) in the provision of STI and HIV-TB care and treatment. This evaluation takes stock of the two and a half year handover process that started in June 2011. The evaluation highlights both the operational strengths and weaknesses and identifies areas for improvement. The work aims to inform the replicability of the handover tools and approach.
The HIV project in Tsholotsho started in October 2004, focussing on capacity building and support to the PMTCT (preventing mother-to-child transmission) Programme. In September 2005 an OI/ARV8 clinic was opened. Decentralisation of activities started in 2006. The evaluation’s objectives were to document best practices, challenges and lessons learnt and to support MSF teams in defining priorities, including planning for handover and for the remaining project life.
Centro de Referência Alto Maé, Chamanculo health area, Maputo, Mozambique: evaluation of an HIV model of care in an urban setting (2013) internal
In 2009/2010, following the decentralisation of HIV care to primary health care in Maputo City (the evaluation of which can be found below), the former MSF-OCG Alto Maé day hospital was transformed into the chronic care HIV referral centre Centro de Referência Alto Maé (CRAM). After three years of CRAM working as a referral centre, this evaluation was commissioned with the purpose to assess the performance and added value of this model of care as well as how it fitted into the Maputo health network.
Decentralisation of HIV/TB care in Shiselweni region of Swaziland: making a difference- combined evaluation report (2013) public
Five years after the initiation of an HIV/TB decentralisation and integration project in Swaziland, MSF-CH took the opportunity to retrospectively evaluate the appropriateness, effectiveness and efficiency of the decentralised model of care, and to explain lessons learned, including successes and failures, to the entire MSF movement, national authorities and international community.
In 2001, MSF-OCB began supporting the MOH in Mozambique in providing HIV care and treatment and PMTCT. The purpose of this evaluation was to gain a better understanding of how MSF support in Mavalane was perceived by stakeholders in the area and to gain a better understanding and receive recommendations from other stakeholders on the handover strategy proposed by MSF.
French report. MSF began a HIV/TB project in the Carnot region in 2010, with the objective to rehabilitate primary health care services in order to decentralise HIV services. The purpose of this evaluation was to capture the lessons learned from the difficult implementation of this project, to analyse the strategies and operational choices made by MSF and to make recommendations for the future.
The precursor to the 2013 report, this evaluation took place to evaluate the decentralisation of HIV care and treatment to primary health care (PHC) of the five health centres of Chamanculo, a process which began in 2006. The objective was to analyse the appropriateness, effectiveness and continuity of the decentralisation strategy.
MSF-OCB began working in Thyolo in 1997 supporting the MoH in the provision of STI and HIV-TB care & treatment, and began providing ART in 2007. This evaluation was commissioned with the objective of understanding the perception of local stakeholders of the MSF support, as a step towards the creation of a handover strategy.
In January 2006, MSF and the Ministry of Health and Social Welfare of Lesotho launched a joint pilot programme to provide decentralised HIV/AIDS care and treatment at the primary health care level. The Lesotho project is unique within the MSF OCB portfolio in that it was given the specific challenge to envision an exit strategy from the beginning and to utilise relatively limited MSF resources and input, instead emphasising the building of local capacity with a view to ensuring continuity of services over the long-term, independent of MSF. The main goal of the evaluation was to determine whether a handover tool that was implemented during the initial phase of the handover can help the team and the project to ensure some sustainability post MSF departure and if it can / should be replicated in other projects.
Evaluation of handover of care: Nchelenge, Zambia (2010) internal
MSF has been present in the Nchelenge region since 1998. The project in Nchelenge District was started in April 2001 because of lack of access to HIV/AIDS care in an area with an HIV prevalence estimated at 16.5%. The objective was to achieve a high coverage of treatment and care, and at the same time provide a model for decentralised programs to bring HIV/AIDS treatment and care to all people in Zambia and for MSF Holland/OCA more widely. The aim of the evaluation was to document the HIV/AIDS care in place for people living with HIV/AIDS (PLWHA) in Nchelenge District, Zambia, 2 years after the handover of the program from MSF-OCA management, to the Ministry of Health, Zambia (MoH) and the Zambian Care, Prevention and Treatment Program//Family Health International (ZPCT/FHI).
Capitalization and Evaluation of the hand over process of MSFF Phnom Penh KSF Hospital HIV/AIDS Project (2010) internal
The handover of MSF-F Phnom Penh HIV project is a complex process. This HIV cohort is the biggest of MSF OCP to be handed over so far and the hand over is almost directly done to the national health authorities, NGO partners having been identified only for minor parts of the project. In the first part of the report, a narrative description and an evaluation of the main technical aspects of the handover process are presented. In the second part, a capitalization of experience is reported concerning technical aspects of specific interest and good practices identified within this project (decision making, interaction with partners, etc.).
Evaluation of the hand-over of HIV/AIDS projects in OCG (2009) internal
MSF has been running HIV/AIDS treatment programmes since 2001 and began to hand over HIV projects in 2005. This Transversal Handover Evaluation was proposed by OCG to review recent and ongoing HIV/AIDS project handover processes, to analyse elements of continuity and appropriateness of handover strategies, and to make recommendations for policy and practice.
Evaluation of MSF handover strategy in Lesotho after 6 months (2009) internal
After an initial period of three years in Lesotho, MSF has decided to extend its presence in the country for two more years and to launch a second phase of the project primarily focused on intensifying the transfer of responsibility for the programme to local health authorities and partners. The evaluation assessed whether the 7 operational objectives for the handover were being met in Maseru district, and to make recommendations for the future of the handover.
Humera, Ethiopia Lessons Learnt: Handover of the HIV Program to the Bureau of Health- 'Ten Months On' (2008) internal
MSF began working on HIV/AIDS care in Humera in 2001. As funding for HIV/AIDS projects rocketed, there was less need for MSF to continue its project. This report documents the timeline and lessons learned of the handover.
MSF is one of the pioneering organisations to implement HIV & AIDS related interventions including ART in different settings. Understandably, the organisation is thus often solicited to provide information on cost analysis of programs. This is the purpose of this study into 3 different MSF HIV/AIDS programs: Kenya, DRC and Malawi. The present study proposes a detailed description of the cost for the HIV/AIDS program in Thyolo in Malawi for the period of time from 2005 to 2007. The methodology used is inspired by the “Activity based costing” (ABC approach)
MSF closed all operations in Lusikisiki at the end of October 2006. That date marked the end of four years of operations setting up a model of comprehensive and decentralized HIV care in one of the poorest and most underserved rural areas in South Africa with a high prevalence of infection. The model implemented has been widely used in South Africa to influence relevant policies. This report looks at the chain of events following the handover and changes in the model of care.
Evaluation Ex Post: Antiretroviral treatment for people living with HIV in Honduras and Guatemala- MSF-CH 2001-2005 (2007) internal
MSF had been working in Honduras and Guatemala in HIV prevention and care for several years before ART projects were started in 2001. In 2005 the projects were handed over to the National AIDS Programme. This evaluation was planned a year and a half after handing over the project, to document the perception of people regarding lessons learnt; whether the project was handed over properly; and the quality of care for people living HIV.
MSF's HIV/AIDS project in Thyolo district, Malawi was one of the MSF movement's earliest efforts to address HIV/AIDS in sub-Saharan Africa, beginning in 1997. The handover of project responsibilities from MSF Luxembourg to MSF Belgium took place in 2005. MSF Belgium agreed to undertake this external evaluation of the project with the goal of assessing the project's performance, identifying constraints preventing the achievement of its goals, and proposing recommendations to improve overall effectiveness.
Evaluation of MSF AIDS projects in Malawi: a peer review (2007) internal
This evaluation is best understood as a peer review aimed at learning from the experiences of 3 different sections of MSF operating HIV/AIDS programmes in Malawi. The aim was to evaluate how specific differences in objectives might impact on programme strategies and whether these differences would be relevant when assessing programme outcomes. The general issues of interest were decentralisation, simplification and task shifting in relation to the expansion of ART services. There was specific attention paid to various aspects of TB diagnosis and treatment among persons living with HIV, including those on ART.
Following the handover of AIDS treatment programs to the authorities of Guatemala, MSF conducted a study to assess various aspects of the continuity of HIV/AIDS care. This review was conducted 18 months after MSF left the Roosevelt hospital, and examined both the clinical data and opinions of staff and patients.
In 1997, MSF-CH took over and rehabilitated Mundari hospital with the general objective to provide appropriate medical services to the county population and to continue to support the hospital as a referral centre. The hospital provided IPD- (medical, emergency, surgical and paediatric) and OPD services as well as treatment for TB, sleeping sickness and HIV/AIDS. This evaluation was conducted to assess the appropriateness and effectiveness of the hospital programme, of HIV integration, and the handover process.
The political context toward HIV and AIDS in South Africa is particularly difficult with a government denying the seriousness of the epidemic, with a minister of health undermining confidence in HIV program, not supporting policy changes nor fully budgeting for HIV program, promoting beetroots, lemon and olive oil to treat AIDS. This paper examines the organisation of the project and the organisation and results of the handover.
Evaluation Report Lichinga (2005) internal
MSF has been actively involved in health and emergency assistance in Mozambique since 1984 and the Lichinga project started in July 2001 with the objective of increasing access to and quality of care and reducing rates of HIV transmission. The purpose of the evaluation was to assess whether the integration and decentralization strategies were appropriate and efficient in order to reach to overall objective of the project.