Investments to strengthen regional cooperation and integration (RCI) in the Greater Mekong Subregion (GMS) have helped catalyze economic growth among GMS countries. However, enhanced connectivity and the movement of people within and across borders created increased vulnerabilities for the transmission of infectious diseases, including HIV/AIDS. The GMS Capacity Building for HIV/AIDS Prevention Project aimed to develop national and regional capacity to mitigate HIV risks and vulnerability linked to RCI in the Lao People’s Democratic Republic (Lao PDR) and Viet Nam. It was approved by the Asian Development Bank (ADB) in October 2012 for a $5 million grant to the Lao PDR and a $15 million loan to Viet Nam.
As impact, the project’s aimed to help achieve and sustain Millennium Development Goal 6a by halting and reversing the spread of HIV/AIDS in the Lao PDR and Viet Nam. Its expected outcome was increased coverage and quality of services for targeted populations, to be achieved through four outputs: (i) strengthened planning and management capacity at national, provincial, and district levels; (ii) enhanced capacity to provide quality and accessible services to people vulnerable to HIV transmission; (iii) improved access to HIV prevention outreach among target populations in communities and cross-border areas; and (iv) effective and sustainable regional collaboration to strengthen HIV response established. At completion, the project fully achieved outputs (i) and (iv) and substantially achieved the other two.
National HIV strategies were reviewed and updated, and institutional mechanisms and capacities were strengthened. The capacity of provincial and lower-level service providers to deliver comprehensive HIV prevention services was enhanced. HIV/AIDS prevention service coverage was expanded. In the Lao PDR, national guidelines and standard operating procedures for comprehensive HIV prevention services targeting high-risk populations were also updated and an antiretroviral therapy center established in a provincial hospital. In Viet Nam, the project improved access to high-quality services by supplying mobile clinics for outreach services, equipment for district laboratories and methadone treatment centers, and consumables. However, both countries fell short on targets to improve quality assessment scores. The development of quality assessment tools and the baseline quality assessment as part of the baseline survey was severely delayed because of weak technical capacity within the executing agencies (EAs) and the late recruitment of consulting firms.
Targeted community-based behavior change communication (BCC) activities for high-risk and vulnerable populations, including migrants and mobile populations in remote and border districts, were carried out but fell short of targets. In Lao PDR, BCC outreach activities were implemented in all the target villages, only 4% of ethnic village populations participated, well below the target of 80%. In Viet Nam, a BCC training program for village health workers was conducted; but the number of participants was below the target . Nevertheless, BCC activities reached more than 50% of the target ethnic population in the country’s project areas.
Innovative models of community-level cross-border collaboration were encouraged. A bilateral memorandum of understanding (MOU) between Lao PDR and Viet Nam and a draft joint strategy for regional cooperation, 2015–2017 were facilitated. These agreements led to each country adopting a detailed action plan, 2016–2017, focusing on four areas of cross-border collaboration: (i) developing policies and mechanisms to strengthen cooperation on HIV response; (ii) strengthening cooperation in interventions at border areas; (iii) strengthening cooperation to develop community-based strategies to minimize the effect of HIV/AIDS; and (iv) strengthening cooperation to exchange information and knowledge. The project’s paired provinces likewise ratified provincial level MOUs for cross-border collaboration.
The project initially planned to engage nongovernment organizations (NGOs) to implement the project interventions and deliver services to hard-to-reach populations through a block grant mechanism. But this was unsuccessful, prompting the EAs in both countries to award the block grants for service delivery to local branches of state agencies. Targeted cross-border benefits in the paired provinces were realized. Activities generating these cross-border benefits had been incorporated into the provincial annual operational plans of each paired province by 2018. A series of knowledge products, including border province profiles and case studies were completed. These knowledge products were publicized through the GMS website to further enhance and implement regional cooperation and collaboration.
Substantial output deliveries enabled the project to effectively achieve its country-specific outcome targets. In both countries, the increased use of HIV preventive services for male and female target groups, including ethnic minorities, well exceeded the targets. Targets in improving knowledge of HIV transmission and means of prevention, particularly among ethnic villagers, migrants, mobile populations, and injecting drug users in Viet Nam were achieved. In the Lao PDR, the targets for ethnic villagers, migrants, mobile populations, and the general population, were likewise met, but fell slightly short of that for female sex workers.
As a result, the project succeeded in achieving its intended impact. In the Lao PDR, it contributed to reducing by 43% the number of new HIV infections between 2010 and 2018. In Viet Nam, it helped reduce the number of new HIV infections by 64% between 2010 and 2018. The ministries of health in both countries were the executing agencies. The Center for HIV/AIDS and STI and the eight provincial committees for the control of AIDS in the Lao PDR and the Ha Noi School of Public Health and the departments of health in 15 project provinces in Viet Nam served as implementing agencies.
