46279 HIV/AIDS M&E - Getting Results These reports describe activities, challenges and lessons learned during the World Bank Global Global AIDS Monitoring and Evaluation Team's (GAMET) work with countries and other partners. HIV/AIDS Program Results-Oriented Monitoring: A Successful Transition in Madagascar National HIV/AIDS Council in Madagascar (SE/CNLS), Global Aids Monitoring and Evaluation Team (GAMET) and AIDS Strategy and Action Plan (ASAP) the Republic. Madagascar has adopted two national HIV Madagascar launched three initiatives to collect strategic strategic plans. The first plan, 2001-2006, relied on a data needed to refine and improve the efficiency of its multisectoral approach to respond to the country's response against HIV and other sexually transmitted specific needs, to plan interventions according to local diseases, drawing on lessons learned. The three tools are: priorities, and to reinforce community ownership of the An HIV/AIDS epidemiological profile response. Vulnerability mapping Figure 1: Madagascar and its regions Strengthening the monitoring and evaluation system to obtain the information needed for planning. Dealing with an unusual epidemiological situation and inadequate data for planning Madagascar is one of the few sub-Saharan African countries with an HIV prevalence rate below 1% among the general population. The epidemiological situation in Madagascar is unusual. Although HIV prevalence is low, other sexually transmitted diseases (STDs), such as syphilis, have a high prevalence rate. This represents a threat for the country, particularly as many STD risk and vulnerability factors ­ most especially persistent high risk sexual behaviors ­ can also spread HIV. National epidemiological data exist, but are incomplete and not conducive to planning at regional, district and communes levels. To remedy this, specific surveys could be done at the different levels, but Madagascar's low HIV prevalence rate makes surveys very expensive. The alternative is to use tools to assess the vulnerability of communities through simplified data collection, which provides useful, relevant information. This note describes three initiatives to develop tools to build capacity to better understand Madagascar's epidemiological context. The methods and results are discussed of: compiling HIV epidemiological profiles; mapping vulnerability; and strengthening the monitoring and evaluation system. Source: World Bank, 2008. (See final page for information on Madagascar "in brief") Solid planning underlines program success. Aware of this, Madagascar began analysis and planning to respond to Based on the experience of implementing the first plan, HIV. HIV and AIDS are among the national development and taking into account its weaknesses and the lessons priorities, and political commitment to the response at the learned, Madagascar intensified efforts to ensure the highest level of the Government is led by the President of best use of the available resources. In particular, the Giving priority to the most vulnerable areas and importance was recognized of the following: targeting high-risk groups Results-oriented management (see Figure 1) Reinforcing community participation for better Using data to inform the response ownership of the response. Figure 1: The results cycle applied to HIV strategic planning Introducing the Results Cycle RESULTS CYCLE Applied to HIV Use the Strategy Planning Evidence for the Next Strategy 7 1 Formulate/Revise the HIV Strategy Analyze HIV Specify Evaluation Epidemic and National Of Changes Response Data in the Epidemic 2 6 Identify Results Select Critical Specify -Outcomes & Indicators- Interventions ­ Cost Monitoring Them ­ Identify of Results Resources 3 5 4 Select Strategic Programs Source: R. Rodriguez-García, J. Zall Kusek, GHAP, World Bank, 2007 The second national strategic plan, "Madagascar Action The HIV/AIDS epidemiological profile (phase 1) Plan for an effective response to HIV/AIDS 2007-2012" was prepared following these principles.1 Given the The vulnerability mapping (phases 3 and 4) importance of planning and monitoring activities for an Strengthening the monitoring and evaluation system effective response to HIV/AIDS, the year 2007 was to obtain the information needed for planning declared "The HIV and AIDS response monitoring and (phases 5 and 6). evaluation year". These three initiatives are part of a pragmatic approach The three initiatives undertaken in 2007 to develop tools to that encourages the use of new research methods to build capacity to better understand Madagascar's strengthen program planning and management, thus epidemiological context, correspond to various phases of ensuring an effective response at national and peripheral the results cycle: levels. This note describes the initiatives and the lessons learned during the preparation and use of the tools. 1During the review of the plan, ASAP ranked the plan The epidemiological profile among the best it had reviewed. ASAP ­ the AIDS Strategy and Action Plan service of UNAIDS ­ provides Taking into account the realities of the epidemic in the technical assistance to countries who request it, in Strategic Plan is crucial for the success of a national preparing AIDS strategies and action plans with clearly response. And yet, many countries rely on generic defined priorities, based on evidence, and that are results- approaches which do not necessary respond to their oriented and with detailed cost estimates. ASAP began specific epidemic. It is crucial to understand the operations in January 2006, and is hosted by the World country's epidemic, and particularly the factors driving Bank Global HIV/AIDS Program on behalf of UNAIDS. (www.worldbank.org/ASAP) 2 HIV transmission ­ in short, to know where and how the The planning workshop gathered national and last 1000 infections occurred. international key actors to decide, through a participatory approach, upon the procedure to follow in defining the Many studies on HIV prevalence, sexually transmitted epidemiological profile of HIV/AIDS in Madagascar. The diseases, high-risk behaviors, and the drivers of the HIV workshop helped to define the roles and responsibilities epidemic have been carried out in Madagascar since of the various actors, and to prepare in a spirit of 1985. However, these studies had not been carefully consensus, the document plan, the various chapter looked at together, to review essential elements of the outlines, and the road map. different studies, and link, cross-check, and reconcile the various data to get a comprehensive and consistent The literature review found that studies of HIV in analysis of trends in the epidemic and to define the main Madagascar2 followed different methodological factors driving HIV transmission. approaches: random sampling or not, different sites and survey years, samples of varying sizes, used different To rectify this, the Executive Secretarial of the National HIV tests, and had varying quality control. Key Council HIV/AIDS of Madagascar (SE/CNLS) decided to information ­ STD/HIV prevalence, knowledge on HIV, compile all existing data, and develop a coherent age of sexual initiation, multiple partners, condom use, epidemiological profile that would enable the policy, STD treatment, and HIV epidemic determinants ­ was financial and political implications to be drawn out. The summarized. study was carried out with support from ASAP and the World Bank's Global HIV/AIDS Monitoring and Evaluation The analysis was done in two phases: Team (GAMET), with technical support from UNAIDS, USAID, and WHO international experts. An initial sub-analysis examined the data and assessed methodological strengths and weaknesses Figure 2: A market in Madagascar and data comparability in order to make a rigorous summary of study results. Data triangulation cross-referenced the main data gathered in the literature search, and main conclusions were drawn out. The modeling identified the main sub-populations at risk as well as their size and the prevalence level in each group, in order to estimate the overall national prevalence. (If data are available for regions or separately for urban/rural areas, modeling can be done for each geographical area, and a national prevalence rate computed. If data are available for different years, the epidemic modeling can also estimate a prevalence trend line and the epidemic's future potential.) Methodology A validation workshop was held with national and international experts and stakeholders, to present the The epidemiological context analysis aims to rigorously preliminary results of the study and discuss the analysis, assess the HIV epidemic in Madagascar, understand its suggest ways to fill gaps, draw out policy implications, evolution, define the main transmission factors, identify the and prepare a survey schedule. It was decided to set up most affected geographical areas, analyze the reach of two review committees, a national and international one, existing programs, and define some thematic priorities. each tasked with rigorous peer review of the document. The methodology used to analyze the characteristics of Results the HIV/AIDS epidemic in Madagascar proceeded through the following steps: The national HIV prevalence rate was 0.13% in 2007. A planning workshop The study found low HIV prevalence rates overall, although rates vary from 0.29% to 1.47% among most- A literature search Analysis Modeling 2The available literature was identified through the key actors A validation workshop in HIV in Madagascar, research institutions and independent Determining the scope of new surveys to be done researchers, NGOs, HIV-related associations, development partners, and searching the internet. 3 affected groups, and there are indications of increasing prevalence in some groups. HIV prevalence is highest in The local response is defined in Madagascar as big coastal towns that attract a lot of tourists. These "response by the people where they live and work". At coastal areas where HIV is concentrated appear to have the commune level, Local Committees for the Control of many risk factors for HIV transmission among the general AIDS (CLLS) have been created. The CLLS prepare population. Local Plans for the Control of HIV and AIDS (PLLS), based on the National Strategic Plan. The PLLS respond Prevalence of syphilis is high compared to other countries to local realities of risk and vulnerability to HIV, and are in Africa. In 2005-2006, syphilis prevalence was 5.6% in translated into subprojects called Small Feasible Actions Madagascar against 0.95% in Botswana. On the other (in French, « Petites Actions Faisables » or PAF). hand, syphilis has fallen sharply; among pregnant women, Different stakeholders from the public sector, sectoral it fell from 12% in 1995 to 5% in 2005. ministries, civil society, NGOs, associations, and other grassroots community organizations and the private A thorough review of about 200 publications enabled the sector set up the PAFs. epidemiological profile of HIV in Madagascar to be refined. It also helped identify data and surveillance gaps that need Civil society interventions aim mainly at reducing HIV to be filled. A survey and research agenda was developed, risk (Abstain, Be faithful, and use Condoms) and social that gives priority to studies of specific sub-populations mobilization for use of clinical services. Funding is identified in the National Strategic Plan (NSP), to collect through the Prevention Support Fund under the Multi- baseline data that will be used to monitor progress under sectoral Project for AIDS Prevention (PMPS) supported the NSP. by the World Bank. For transparency, efficiency, and equity, funding provided for PAFs must follow the Studies on biological and behavioral aspects and on HIV principle of establishing clear priorities to achieve the determinants among other groups will later on increasingly expected results. strengthen the HIV and AIDS epidemiological profile in Madagascar. Since 2004, the SE/PNLS has identified 20 areas considered highly at risk for the spread of HIV and Figure 3: Prevention being discussed in a village focused interventions in these areas at risk. However, the inadequacy of data makes it difficult to identify the groups most at risk as well as their precise location. The risk mapping was therefore revised in 2006 to support more effective prevention. The final output is a risk mapping in which communes identified to be at risk are communes where "bridge groups" are located, which puts the general population at increased risk for HIV transmission. Methodology The primary aim of the study is to classify communes according to their degree of vulnerability and use this to identify communes to prioritize in strengthening the HIV response. This tool enables stronger program planning The vulnerability mapping and management at national and peripheral levels. The study methodology proceeded in several phases: In Madagascar and other countries with low HIV prevalence, a targeted response geared to the most-at-risk Literature research populations in areas where they are concentrated is the Design of tools for data collection at the commune cost-effective way to prevent HIV spreading. Decentralized level response management coupled with concentrated efforts in high risk areas will also enable strong ownership of the Data collection response by the beneficiaries. The more the response is Data analysis felt to respond to their needs, the more likely people are to participate. Decentralization to the level that is best for Use of the data to prioritize the communes for planning and implementing the response ­ the district and enhanced prevention efforts. commune level ­ enables better coordination, and synergy among activities. 4 The literature review aimed to identify the factors that consultants under the supervision of the technical negatively impact individual capacity to take care of their coordinators (TC) of that region in cooperation with local health. These factors include availability and access to HIV authorities. The technical coordinators in cooperation prevention, care and treatments services. The literature with the Head of the Region and the Regional Director of review also helped identify most at risk populations Health analyzed the data according to a standard (MARPs), and bridge groups (groups with close method. Cross-checking was done at the central level interactions between MARPs and the general population). before the results were released. Data were collected at central level for 576 communes Figure 4: Information and education of a village chief and at commune level for 655 communes (thus the survey covered 1231 communes -- 80% of the 1557 communes in Madagascar). At the central level, only the presence or absence of sites identified as having concentrations of high risk groups was listed. At the commune level, detailed information was collected on the commune profile and on vulnerability factors, using the tools developed for this purpose. This local data collection covered communes that could be easily accessed with the resources available. In the analysis phase, scores were assigned to the vulnerability factors in each commune. For data collected at the central level, every factor was assigned a score of 0 or 1, depending on the presence or absence of that factor in the commune. For the detailed data collected at the commune level, each factor was assigned a score on a scale of 0 to 3 -- 0 if the factor was not evident in the Results commune, 1 if the vulnerability factor had a low rate, 2 for The data analysis identified 119 highly vulnerable a high rate, and 3 if the vulnerability factor was very high. communes and 338 moderately vulnerable communes, Demographic weight was also taken into account in the respectively representing 10% and 28% of all communes final analysis for prioritizing communes. surveyed. The sum of the scores obtained for all the factors was The 119 communes located in 22 regions that were used to indicate communes' vulnerability levels. High identified as being highly vulnerable constitute pilots scores identified communes considered most vulnerable to areas for intensified field activities. They have common STDs, HIV, and AIDS. In other words, what makes a risk factors: commune vulnerable is not necessarily the presence of many factors but the combined "weight" or intensity of Sex work -- existence of "pick-up joints", brothels, factors. Thus, communes with a score of 3 on four factors and other places and locations frequented by sex would be regarded as more vulnerable than communes workers and clients with a score of 1 on, say, eight factors. Using these Specific socio-economic activities related to the scores, communes were classified into three groups geographical environment like tourist sites, mining according to their degree of vulnerability: activities, and zebus cattle markets Highly vulnerable communes (scores higher than 16) Social habits conducive to risky behaviors such Moderately vulnerable communes (scores ranging as some customary feasts from 10 to 15 points and Non-availability or difficult access to HIV Weakly vulnerable communes (0 to 9 points). prevention, care or treatment services. The implementation of the study attracted the participation The main output is a set of descriptive cards that provide of many stakeholders at different levels. A national an overview of each of the 119 communes. The cards consultant prepared the literature review and the data summarize information on the demography, economic, collection at the central level. The unit responsible for cultural, health, and social situation (population, supporting the SE/CNLS local response and the unit in activities, transportation and communication, health and charge of monitoring and evaluation at the central level social infrastructure) and vulnerability factors identified prepared the basic structure for the data collection and for for each commune. monitoring the launch of data collection at the local level. Data were collected at the commune level by local 5 Limitations of the study resources, a pragmatic assessment of the situation, and involvement of all stakeholders. The study was unable to estimate the size of the groups affected by the risk factors. This makes it difficult to Setting up a monitoring and evaluation system acts on measure the importance of the risk factors in each region Madagascar's commitment to the UNGASS of the country and population. On the other hand, the recommendations, implementing the "Three Ones" study aims did not include research into risk factors in the principle of "one national monitoring and evaluation population. Consequently, the questionnaires on system". behavioral factors are not dealt with by the study. Methodology During the collection of the data, progress was noticed in HIV programs. As with all dynamic situations, over time, The aim is to have an effective and efficient monitoring discrepancies can develop between the study data and and evaluation system that is used for managing and current conditions. improving the STD, HIV and AIDS response in Madagascar. Figure 5: Voluntary counselling and HIV testing A participatory approach is the foundation of the Monitoring and Evaluation plan. The small group working on monitoring and evaluation comprised someone from GAMET3 (World Bank) and various stakeholders at all levels and sectors, consulting with national and international experts. The plan was designed to meet the requirements of a multisectoral, community-based, and decentralized response. The design of the monitoring and evaluation system followed the following steps: Identify and select indicators Identify partners and structures Identify the flows of information needed Identify the data sources Define the information system National Monitoring and Evaluation System 2007- Develop a data dissemination strategy 2012 Prepare the monitoring and evaluation An effective program should be able to demonstrate that implementation plan. the results expected at the beginning, have been achieved. This requires effective management, careful In identifying and selecting indicators, variables were work towards achieving the expected results, and access defined that could measure the changes that occur to good information. Reliable data need to be collected during the activity and/or the results to be achieved by and used for monitoring and managing. Clearly defined the planned activities. Every indicator maps to a clear results and reliable, up-to-date information enable and practical objective, enabling baseline comparisons evaluation of the performance of prevention and care with the results achieved. programs, and help officers and other stakeholders to take important decisions to improve program implementation As well as identifying the partners and structures and/or the organization management. These are the involved in implementing the monitoring and evaluation challenges that monitoring and evaluation address. system, everybody's roles and duties were defined. The Aware of the crucial importance of monitoring and 3Created in 2002, the Global AIDS Monitoring and evaluation activities within the HIV and AIDS program, Evaluation Team (GAMET) is part of the World Bank Global Madagascar actively mobilized, in cooperation with HIV/AIDS Program. GAMET works closely with UNAIDS and technical and financial partners, to set up a monitoring and other partners to support national capacity building and evaluation system. Preparation of the tools for the system development of HIV monitoring and evaluation systems in relies on the principle of optimal use of the available countries, and most importantly, supports use of the data collected. 6 main tasks that must be fulfilled are clearly described as Madagascar selected two types of indicators: well as who is responsible, so that the planned objectives can be met. 30 key indicators considered the most important and reflecting progress achieved in implementing the The definition of the flow of information schematically National Strategic Plan. These are used in presents the data and information flow among the various communication to the general population. categories of actors at different levels. The plan covers 39 complementary indicators which enable more collection and sharing of data as well as information feed- specific analysis of the results. These are mainly back to each level. used by service providers for detailed program monitoring. The information system designs steps and tools that enable easy data collection, transmission, and use across The new system is results-oriented. It has more results the decentralized and central levels. The information indicators that were agreed by consensus among system is composed of data collection tools, data storage stakeholders, than the previous indicator set. The actors and analysis software, as well as a plan for building the have a better understanding of the objectives and value capacities needed to operate the system. of data and of monitoring and evaluation. The data dissemination strategy defines the various Figure 6: Awareness raising activity in a village channels available for disseminating information to the different target groups, decision-makers, partners and wider population, so that the data can be the foundation of decision-making. The Monitoring and Evaluation system implementation plan documents activities in detail, and estimates the budget needed for implementation. All the system components were validated at the national level during working sessions that brought together representatives of the Executive Secretariat/ National HIV/AIDS Council, national and international partners, civil society, and representatives of People Living with HIV. Results The National Monitoring and Evaluation Plan 2007-2012 for Madagascar is available. It comprises the main components described above. There are also data collection tools for use at all levels. Wide dissemination has been undertaken in each region to build local Lessons learned and challenges ownership. The importance of appropriate research tools to The Monitoring and Evaluation system is decentralized collect the information needed for program planning and enables data to be used not only at the level at which and evaluation they are collected, but also in order to manage and/or to take decisions. Capacity building for various partners was The data and tools described in this article -- the an important part of implementing the system. commune vulnerability mapping, the epidemiological profile, and the monitoring and evaluation system -- are Data collection is done at the grassroots level and the flow not an end in themselves. They provide the elements of data is clearly defined, whereas, previously, officers at needed to be able to prioritize geographic areas and the regional level were responsible for compiling target groups for HIV interventions. This is the basis for information and transmitting it to the central level. Under strategy development. the new system, every level is informed about the M&E plan, the flow of data, and standardized tools are used at Limited financial resources and time prevented data every level. This all makes the data more and more collection in all communes. However, the research comprehensive and precise. Nevertheless, efforts are still enabled a good number of vulnerable communes to be needed to build capacity to use the data collection tools identified. Missing information was recorded, and used and to improve the reporting rate. to establish a roadmap for activities and list of surveys to 7 be undertaken in future. This information will be useful for understand the national strategy preparation process as updating the risk mapping and for refining the country well as their own responsibilities within the strategy. epidemiological profile. Indeed, all coordination structures at all levels must play Epidemiological profiles need regular updating. One of the their appropriate roles. The role of the national ways to measure vulnerability is to look at variations over coordination body is to stimulate, facilitate, and time and across different areas. A certain amount of supervise. The decentralized structures ensure the information is still lacking to establish a comprehensive contributions needed to achieve objectives that need a epidemiological profile for Madagascar. Consistent broad ownership among local authorities and local monitoring work is needed. officers. The commitment of the local population is shown by their determination and motivation to face the Some progress has been achieved, and Madagascar challenges that HIV presents. continues to make efforts to improve data collection. Difficult methodological decisions on HIV Conclusion surveillance One cannot expect everything to be perfect, or all the tested scientific methods to be available for an effective In a low HIV prevalence country such as Madagascar, response to STDs, HIV, and AIDS. But HIV does not there are important methodological decisions to make in wait and we must respond rapidly. We must select a monitoring the epidemic in a way that is most conducive to pragmatic approach and be ready to learn through good strategic decision-making: careful actions based on available evidence. It is crucial Should we continue to rely on the HIV prevalence rate to understand how HIV is spreading and to prepare among pregnant women? relevant response strategies. For this, we must put in place the research tools needed for reporting the results Should we monitor high risk groups such as sex achieved and to capture and learn from best practices. workers and men who have sex with men? Given the unusual epidemiology in Madagascar and the Every method has its advantages and disadvantages. inadequacy of relevant data, the vulnerability mapping Presently, the only data available are national level data tool, the epidemiological profile and the products of the that are not very useful for planning at the grassroots monitoring and evaluation system are important levels (region, district, and commune) where things really information tools to be used strategically. happen. Carrying out more specific surveys at regional, district or commune level would require significant financial Based on these data, particular attention is being given resources which the country does not have. In addition, to the communes classified as highly and moderately even if the financial resources were available, rational vulnerable, and the groups identified to be at most risk. decisions on their allocation would have to ensure that Prevention activities are being strengthening in those resources are used where they can really help save lives communes and among the targeted groups without in order to ensure that we "make the money work" well. neglecting prevention activities in the other communes and general population. The new data enabled priorities Sharing experiences and creating strong technical to be set and resources to be allocated according to the teams for the analytical phase are crucial for achieving criterion of vulnerability of communes and sub- results. populations. The national and international experts' who provided In conclusion, these analytical tasks sparked renewed technical support and drew on similar experiences gained prevention activities and mobilized various stakeholders in other countries made all the difference to achieving the at the grassroots level. From now on, program activities expected results. Every actor contributed specifically will be guided by the results of evaluations of how well according to their particular expertise and experience. It is various interventions are performing. important to set up, at the national level, a strong technical team to be responsible for the analytical work. The involvement of all decentralized structures is key in the HIV response. The participatory approach used in the various actions undertaken has been successful. This approach enables different actors to "own" the response and better 8 Madagascar in brief Human Development Index: With the HDI at 0.533 in Location: Madagascar is located in the South-West of the 2007, Madagascar ranks 143 out of 177 countries. Indian Ocean and is separated from the African continent However, it should be noted that the index has been by the Mozambique Channel. improving (it was only 0.400 in 1975). Surface: the surface of the "Great Island" is 587,401 square kilometers. It is 1,500 kilometers long and 500 wide Figure 7: A small port in Madagascar in its widest point and has 5,000 kilometers of coastline, washed on the west by the Mozambique Channel, and on the east by the Indian Ocean. There are a number of small islands, the most important of which are Nosy Be and Saint Mary. Population: On June 30, 2006, the estimated population of Madagascar was 17.8 million inhabitants. About 70% of the population lives in rural areas, 5% in the capital city and 25% in other urban areas. The population is mainly composed of African and Indonesian population groups with sub-groups of Indian and Chinese origin. The country is unified in its diversity by a single language, Malagasy, which has few dialectal variations. Administrative Structure: Until 2003, the Island was divided into six autonomous administrative provinces. It now has twenty-two administrative regions. The regions are in turn subdivided into 116 districts and 1549 communes which are themselves divided into quarters (Fokontany) forming the basic administrative unit. . Life expectancy: Continuous declines in infant and child mortality have contributed to improvements in the Malagasy population life expectancy. From 52.1 years in 1993, life expectancy at birth reached 55.5 years in 2005. Total fertility rate: Despite declines, Malagasy women's fertility remains high, at an average of 5.2 children per woman. However, there is an important difference between urban and rural areas: the total fertility rate is 3.7 children per woman in urban areas and 5.7 in rural areas. Literacy Recognizing that education and literacy are the foundation of sustainable human development, the country has made considerable efforts in this field. The literacy rate among the adults rose from 58% in 1990 to 63% in 2005. The gap between the urban and rural areas is great but the gender disparity is relatively low. GDP/inhabitant: With GDP at (PPP $) 923 in 2005, Madagascar is confronted by a major challenge of poverty reduction. In 2003, 74% of the population lived below the absolute poverty line, with the great majority living in rural areas. A national poverty reduction strategy (PRSP) was developed in 2003. The "Action Plan for Madagascar 2007-2012" reinforces the PSRP and integrates HIV/AIDS. The Action Plan also embodies the strong determination of the country to address poverty. 9 References Authors : Comité National de la Lutte contre le Sida/Secrétariat Fenosoa ATSIMANETRIMANANA, Executive Secretary, Exécutif, « Plan stratégique national de la lutte contre National HIV/AIDS Council of Madagascar (SE/CNLS) le VIH et le Sida à Madagascar, 2007 ­ 2012 ». Madagascar 2007. D. Hajarijaona RAZAFINDRAFITO, Assistant Executive Secretary in charge of Strategies and Operations, Comité National de la Lutte contre le Sida/Secrétariat SE/CNLS Exécutif, « Plan de suivi évaluation national de la lutte contre le VIH et le Sida à Madagascar ». Madagascar Patricia RAKOTONDRABE, Head of the Monitoring and 2007. Evaluation Unit, SE/CNLS Comité National de la Lutte contre le Sida/Secrétariat Exécutif, « Document sur les communes vulnérables Anicet RANDRIANTSALAMA, Head of the face à la propagation du VIH à Madagascar ». Communication Unit of SE/CNLS contributed to the Madagascar 2007. writing of this article Professeur Justin Ranajalahy Rasolofomanana, The authors appreciate the rich contributions of: Docteur Andriamampianina Ralisimalala. « Guide méthodologique de la cartographie du risque de Jacqueline Dubow, Eric Gaillard, Ando Raobelison, diffusion des IST/ VIH / SIDA a Madagascar, les Adjaratou N'Diaye, Rosalia Rodriguez-Garcia, Maryanne facteurs de vulnérabilité lies a la mobilité Sharp of GAMET and ASAP, World Bank. géographique», INSPC (Institut Sanitaire Publique Sétou Kaba, Yves Bourny, Karianne Bye - UNAIDS, Communautaire), Madagascar 2006. Madagascar. UNDP (United Nations Development Program) "Guide Jocelyne Andriamiadana, Jean-Paul Tchupo - USAID on Monitoring and Evaluation for results" UNDP, 2002. Nicolas Meda - UNAIDS, ASAP UNAIDS, "The Three Ones Principles", 2004. Spes Ntabanga ­ WHO Rosalía Rodriguez-García and Jody Zall Kusek, "Planning and Managing for HIV/AIDS Results - A Handbook", Global Program on HIV/AIDS, World Photographs by SE/CNLS-Madagascar 2007 Bank, 2008 For more information/suggestions about the series "HIV/AIDS - Getting Results", or to request hard copies, please contact: Joy de Beyer jdebeyer@worldbank.org Global HIV/AIDS Program www.worldbank.org/aids > Getting Results March 2008 10