The overall purpose of M&E is to inform about the status of the HIV epidemic in Pakistan and to track the progress of the national response to HIV. It includes programme M&E and the use of surveillance and research to provide information regarding the outcomes and impacts of responses. For this reasons these activities are housed under one M&E, Surveillance and Research Unit.

The principal role of the NACP M&E Unit is to coordinate surveillance and M&E activities all over the country and between provinces etc. In this regard its role is 3-fold:

The national surveillance is currently conducted by the HIV/AIDS Surveillance Project (HASP), with Canadian funding, and is functionally distinct from the NACP/ PACPs. Going forward, this unit will be made part of the NACP M&E unit (please the attached organogram) with much of the support for the surveillance and research ontinuing to be provided by the Canadian International Development Agency (CIDA). In national consultations during 2007, the organograms of the national and provincial surveillance units were agreed upon. In this organogram, some positions were to be paid for the next 5 years by the CIDA and the remainder by the GoP.

These units are set up in all NACP and PACPs and are to be headed by a public health specialist or epidemiologist who provides the overall coordination for programme M&E and the surveillance teams. The unit is charged with the development of the annual HIV report which includes details of surveillance data and interfaces it with the available programme, financial and research data on HIV in Pakistan, in addition to other eports that are outlined in the National M&E Framework.

Programme M&E activities of the unit include the need to channel quarterly payments to SDPs, to perform/ coordinate periodic assessments and to report on the progress of these SDPs. In addition the unit will also coordinate 3rd party (independent) evaluations of all SDPs in the country.

The programme M&E responsibilities will include appropriate visits and review of programme performance to be able to process requests for quarterly payments and to inform about the overall progress of these projects. Building on the lessons from the first Enhanced programme, the scope of the independent 3rd party evaluation is being expanded to include all services being provided nationwide. Those services to be included are: IDU and (female and male) sex worker SDPs, Advocacy and Communication Campaign, the Truckers projects and HIV Treatment, Care and Support. An independent firm/s will be hired to conduct these assessments annually. It will verify data provided by the implementing agency (i.e. the NGO or the company) and perform an independent assessment of the work performed by the implementing agency including the quality of services rendered.

The reporting function of the unit includes collation of all (surveillance, research and programme M&E) information about HIV SDPs, to process/ analyze such information and to report it via specific reports (reference: The National Monitoring and Evaluation Framework).

The nation has implemented HIV surveillance since 2004 using 2nd Generation Surveillance that integrates biological and behavioural surveillance at the level of individual subjects. This is a powerful epidemiological tool and is one of the most advanced surveillance mechanisms available today. The support for this surveillance has been provided by the Canadian International Development Agency (CIDA). The CIDA has agreed to provide additional support to GoP. In the next 5 years the CIDA will support a new project of surveillance which will be integrated within the structures of the NACP and PACPs. It will continue and build on the previous experience but will also add newer dimensions of research and surveillance related to programme delivery. The surveillance will include IBBS, research and other epidemiologic assessments. The sustainability of the project has been integrated into the project design. Sustainability of a project depends on the availability of trained personnel as well as continuation of financial support. According to an agreement between the CIDA and the NACP, the CIDA will fund all activities for the duration of the project (5 years), thereafter these activities will be picked up by the NACP. All project positions, except a few, will be funded by the government (using either the BPS plus project allowance or via market based salary mechanisms). CIDA will only provide the most senior positions; usually these are specialists with skills in surveillance and research that are somewhat difficult to find in Pakistan. The remaining positions, including some of the senior specialists that can be recruited from within the country, will be hired on funding from the GoP. The capacity of these individuals will be developed via a “hands-on” approach; in which they will be directly involved in surveillance activities while being mentored by CIDA provided experts in the field. Once the CIDA funding for the project ends, these individuals will be sufficiently trained to continue surveillance in Pakistan and the government will then assume all financial responsibility for their support as it does for surveillance activities.