6. Lessons learned (both project-specific and of wide general application).
Ensure that key actions are taken during project preparation to ensure readiness for important project components. Well implemented TIs are the key to success; therefore, having NGOs in place early on, with a strong NGO capacity building program in place, is essential. The project preparation phase, with the prospect of incoming funds, should be leveraged to convince political and bureaucratic stakeholders of the urgency of taking such crucial actions.
Ensure that available capacity is adequate to handle additional challenges. Leaving the bulk of detailed preparation to project authorities after the project has been declared effective is not advisable, especially when available capacity has already been assessed to be inadequate. Detailed preparation of project components requires technical and managerial capacity which may need to be contracted.
Ensure that institutional development is built on the political will to address the critical needs of the program response to HIV/AIDS. In low prevalence countries such as Bangladesh, political urgency to respond proactively to an HIV/AIDS epidemic could be low. It is crucial that political commitment is demonstrated at the highest level, and a network of champions developed within the system, to ensure that the institutional arrangements put in place have the necessary ownership, technical skill and managerial autonomy to successfully implement the program.
Avoid interruptions in funding to projects. Piecemeal extensions and interrupted funding are disruptive to project implementation; particularly in TIs among high risk groups. At the field level, NGOs lose credibility with the community they are serving; and when the objective is long term behavior change, sudden interruptions in programming can cause irreparable harm. The Bank's own business model of investment support with defined effectiveness and closing dates, is largely to blame for this situation, as it is not well adapted to an ongoing program with a life span which is far longer than the World Bank-financed project's.
Facilitate absorption into the sector program. Having a sector-wide operation in place to absorb the interventions of the current project, as in the case of the HNPSP, is one way to ensure sustainability of project interventions. However, this needs to be planned well so that the start-up difficulties and other constraints being faced by the larger operation do not negatively impact the current project. In this case, if HAPP had been provided a one-time extension of a longer period based on a realistic timeframe for the readiness of HNPSP to absorb it, the disruptions could have been minimized.
Ensure continuity of staff. Having a revolving door with MOHFW officers on short-term deputations occupying technical positions only denies the project technical expertise. In the long-run, there needs to be a strong technical cadre within the PMU that can advice the PD and keep the project on track. In the absence of a dedicated cadre of staff technical assistance for capacity building cannot be expected to yield sustainable results.
Continuity of IDA supervision staff is also important. The relationship between the IDA and government teams is an important one, and one that is built on mutual trust and understanding. Using a problem-solving, partnership approach allows even tough decisions to be taken and subsequently successfully implemented. Making ad hoc changes in supervisory staff, or an adversarial attitude on the part of the supervision team, can break down the channels of communication between the Bank and government and further impede implementation progress.
Partnerships should be carefully assessed for continued relevance. Circumstances sometimes do drive the establishment of partnerships; but over a period of time, such partnerships should be reassessed to ensure that they continue to be relevant. For example, NGO contracting may never become a core competency in government; in this case, establishing a partnership with a contracting agency maybe a more effective strategy. However, when the area of partnership is not the core competency of the partner organization, clearly they should not continue to be responsible for that activity. For example, the partnership with UNFPA was evaluated and terminated because it was not yielding the desired results. In the case of ICDDR, B, the partnership was extremely beneficial, since the technical area was one that was clearly the strong point of the partner organization, and they were performing effectively.
For Future Operations
HIV is a longstanding issue and sustained effort will be required to tackle it. The response to HIV will need to be well orchestrated and long term. With HAPP being mainstreamed into the HNPSP, it is essential that HIV/AIDS issues continue to receive high priority, even though they will form a small part of the larger operation. The Bank Team and GOB should ensure that: (i) TIs focus on the most at risk groups, as identified by the technical review of targeted Interventions--IDU, FSW, MSM, MSW and Hijras--rather than spreading resources thinly among groups that are less crucial to controlling the epidemic; (ii) a comprehensive package is implemented among these groups, ensuring full coverage of core interventions; and (iii) funds from various sources (UNICEF, SC/US, FHI) are coordinated to minimize duplication and at the same time ensure that no group falls between the cracks.