Final performance evaluation : AIDS, population and health integrated assistance, people-centered, local leadership, universal access, and sustainability (APHIAplus) Nairobi/coast project

Within the USAID/Kenya Health Implementation Framework 2010-15, the APHIAplus design focused on result 3, "increasing delivery of quality health services," and result 4, "addressing the underlying social determinants of health of this Implementation Framework." APHIAplus Nairobi/Coast covers zone 2, which is described as a moderate-need zone that covers urban areas. Working with the Government of Kenya (GoK) and other partners, APHIAplus service-delivery projects support marginalized, vulnerable, and underserved populations. These include youth, most-at-risk populations (MARPs), persons living with HIV, those on antiretroviral drugs (ARVs), orphans and vulnerable children affected by AIDS, women of reproductive age (pregnant and postpartum women), and highly vulnerable girls, neonates, and infants. The implementation strategy concentrates on achieving two levels of results: (1) at the facility and community levels working through national, provincial, and district GOK structures; and (2) with communities through community-based organizations (CBOs). The purpose of the evaluation is to assess the performance of the APHIAplus, primarily for accountability and learning. Its specific objectives are: (1) to conduct an in-depth qualitative assessment of technical and management approaches, coordination with the host country and other stakeholders, and support to country health systems; and (2) to conduct a review of project achievements based on assigned targets in HIV/AIDS, family planning/reproductive health, and child survival activities. This purpose and objectives of the evaluation will be achieved through answering the following five evaluation questions defined in the scope of work: (1) to what extent has the APHIAplus Nairobi/Coast been effective in contributing to achieving results 3 and 4 [and] were the key expected outcomes achieved [and] if not, why not; (2) what strategies employed within the work plan worked and what did not work for successful implementation and achievement of key outcomes in results 3 and 4 [and] why; (3) to what extent were the project's annual work plans and strategies therein informed by new programmatic evidence in the health sector; (4) to what extent was the APHIAplus model appropriate for achieving key outcomes under results 3 and 4; and (5) what sustainable activities in service delivery and healthcare systems were established and/or strengthened at the district health facility and/or community level? The evaluation team concludes that the complicated structure and multiple formats of project documents, make it difficult to fully understand the project's logic in terms of indicators and how the project intended to demonstrate results. Without a clear causal logic, it is difficult to determine APHIAplus's contribution to key indicators, outcomes, and results. Specific evaluation findings, conclusions and recommendations are provided with detailed analysis for each evaluation question. (Excerpt, modified)