Dissertation

On

Assessing the Importance of Project Management Skills in the Context of Project

Success Rate in Africa Aids

Student Name

Lecturer Name and Course Code

Date Submitted: 26 Feb, 2019

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 DECLARATION

I hereby declare that this thesis on “Assessing the Importance of Project Management Skills in
the Context of Project Success Rate in Africa Aids” is my original work and has not been put
forward to any publication, journal, college or university for any academic credit.

Signed: ______________________ Dated: _____________________

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 DEDICATION

I dedicate this research to my Father AAA and Mother BB and my family members for their
support and wishes for my struggle for this degree. Their contribution towards my prosperous
future was really immeasurable.

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 ACKNOWLEDGEMENT

I am thankful to my supervisors, Dr. AAA and Dr. BB, whose supervision, encouragement and
support from the preliminary to the concluding stage makes it possible for me developing a clear
understanding of my subject. I would have not been able to do so without their support and the
constructive criticism they have shown to me.

I also appreciate the efforts of all of my lectures who helped me through the course. They truly
made everything interesting and easy for me. I also acknowledge the efforts of extra-mural
studies department for the training and support.

Lastly, I offer my great regards to all my fellows of MS Project Management, who supported and
helped me during completion of the project.

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Table of Contents
DECLARATION ........................................................................................................................................ 2
DEDICATION ............................................................................................................................................ 3
ACKNOWLEDGEMENT ......................................................................................................................... 4
LIST OF TABLES ...................................................................................................................................... 8
LIST OF FIGURES .................................................................................................................................... 9
ABBREVATIONS .................................................................................................................................... 10
ABSTRACT .............................................................................................................................................. 11
CHAPTER I: INTRODUCTION ............................................................................................................ 12
1. Introduction....................................................................................................................................... 12
1.1. Statement of Problem ................................................................................................................. 15
1.2. Aims and Objectives ................................................................................................................... 16
Aims.................................................................................................................................................... 16
Objectives ........................................................................................................................................... 16
1.3. Research Questions..................................................................................................................... 17
1.4. The Significance of Study .......................................................................................................... 17
1.4.1. HIV/AIDS Program Managers ........................................................................................... 17
1.4.2. The Donor Community ....................................................................................................... 17
1.4.3. The Government ................................................................................................................. 17
1.4.4. Academicians and Researchers ........................................................................................... 17
1.5. The Scope of the Study ............................................................................................................... 18
1.6. Terminologies Definition............................................................................................................ 18
1.6.1. Viral Load ........................................................................................................................... 18
1.6.2. Human Immunodeficiency Virus (HIV) ............................................................................. 18
1.6.3. HIV Prevalent Rate ............................................................................................................. 18
1.6.4. HIV Incidence ..................................................................................................................... 18
1.6.5. Project ................................................................................................................................. 19
1.6.6. Antiretroviral (ARV) .......................................................................................................... 19
1.6.7. Stigma ................................................................................................................................. 19
1.7. Chapter Summary ....................................................................................................................... 19
CHAPTER II: LITERATURE REVIEW .............................................................................................. 20
2. Introduction....................................................................................................................................... 20
2.1. Strategic Issues Affecting HIV Programs ................................................................................... 20
2.1.1. Strategic Planning ............................................................................................................... 21
2.2. Monitoring and Evaluation Practices and Project Implementation ............................................ 23
2.3. Training on Project Management and Project Implementation .................................................. 25

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 2.4. Risk Management and Project Implementation .......................................................................... 26
2.5. Theoretical Framework ............................................................................................................... 28
2.6. Conceptual Framework ............................................................................................................... 28
2.7. Chapter Summary ....................................................................................................................... 31
CHAPTER III: RESEARCH METHODOLOGY................................................................................. 32
3. Introduction....................................................................................................................................... 32
3.1. Research Design ......................................................................................................................... 32
3.2. Population and Sampling Design................................................................................................ 32
3.2.1. Population ........................................................................................................................... 32
3.2.2. Sampling Design ................................................................................................................. 33
3.3. Data Collection Methods ............................................................................................................ 34
3.4. Research Procedures ................................................................................................................... 34
3.5. Data Analysis Methods ............................................................................................................... 34
3.6. Chapter Summary ....................................................................................................................... 35
CHAPTER IV: RESULTS AND FINDINGS ......................................................................................... 36
4. Introduction....................................................................................................................................... 36
4.1. Response Rate ............................................................................................................................... 36
4.2. Demographic Data ...................................................................................................................... 36
4.2.1. Gender................................................................................................................................. 37
4.2.2. Age Bracket ........................................................................................................................ 37
4.2.3. Level of Education .............................................................................................................. 37
4.2.4. Category of Employment .................................................................................................... 38
4.2.5. Duration of Employment in EDARP .................................................................................. 38
4.3. Strategic Issues Affecting HIV Programs ................................................................................... 39
4.3.1. Strategic Planning ............................................................................................................... 39
4.3.2. Employee Involvement ....................................................................................................... 40
4.3.3. Customer’s Focus ............................................................................................................... 41
4.3.4. Political Interference ........................................................................................................... 42
4.4. Donor’s Influence on the Program’s Performance ..................................................................... 44
4.4.1. Conflict on Host Government and Donor Policies ............................................................. 44
4.4.2. Strict Funding Regulations from the Donor........................................................................ 45
4.4.3. Goals and Objectives of Donors ......................................................................................... 46
4.5. Characteristics and Behavior of PLHIV’s Influence on the Program’s Performance ................ 49
4.5.1. Adherence to Long Term HIV/AIDS Treatment ................................................................ 49
4.5.2. Economic Status of PLHIV ................................................................................................ 51
4.5.3. Gender................................................................................................................................. 52

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 4.5.4. Level of Knowledge on HIV by PLHIV ............................................................................. 53
4.5.5. Correlations and Regression Analysis ................................................................................ 53
4.6. Chapter Summary ....................................................................................................................... 55
CHAPTER V: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS.............................. 56
5. Introduction....................................................................................................................................... 56
5.1. Summary ................................................................................................................................. 56
5.2. Discussion ................................................................................................................................... 57
5.2.1. Strategic Issues Affecting HIV Programs ........................................................................... 57
5.2.2. Donor’s Influence on Program’s Performance. .................................................................. 58
5.2.3. Characteristics and Behavior of PLHIV’s Influence on the Program’s Performance ........ 59
5.3. Conclusion .................................................................................................................................. 60
5.3.1. Strategic Issues Affecting HIV Programs ........................................................................... 60
5.3.2. Donor’s Influence on the Program’s Performance ............................................................. 60
5.3.3. Characteristics and Behavior of PLHIV’s Influence on the Program’s Performance ........ 60
5.4. Recommendations....................................................................................................................... 60
5.4.1. Recommendations for Improvement .................................................................................. 60
5.4.2. Recommendations for Further Research............................................................................. 61
References.................................................................................................................................................. 62

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 LIST OF TABLES
Table 3.1: Population Distribution… ........................................................................ 32
Table 3.2: Sample Size Distribution… ..................................................................... 33
Table 4.1: Gender of Respondents… ........................................................................ 37
Table 4.2: Highest Education Level… ...................................................................... 38
Table 4.3: Category of Employment… ..................................................................... 38
Table 4.4: Duration of Employment… ..................................................................... 38
Table 4.5: Employee Awareness of Organization’s Strategic Plan… ....................... 39
Table 4.6: Funding Cycle and Strategic Planning ..................................................... 39
Table 4.7: Awareness of Personal Responsibility ..................................................... 40
Table 4.8: Respondent are Awareness to Performance Matrix ................................. 40
Table 4.9: Use of Technical Expert to Run Technical Areas… ................................ 40
Table 4.10: Training on Project Management… ....................................................... 41
Table 4.11: Customer Satisfaction Surveys… .......................................................... 41
Table 4.12: Technology Adoption to Improve Services ........................................... 42
Table 4.13: Community Support Program Activities… ............................................ 42
Table 4.14: Government Involvements in Running the Program… ......................... 42
Table 4.15: Donor Funding and Politics… ............................................................... 43
Table 4.16: Local Politics and Program Management… .......................................... 43
Table 4.17: Local Political Decision and Funding Sustainability ............................. 44
Table 4.18: Donor Policies and Government Policies Conflict… ............................ 44
Table 4.19: Status of Donor Funding to National Budget… ..................................... 44
Table 4.20: Donor Involvement in Running the Program… ..................................... 45
Table 4.21: Donor’s Expatriates and Program Management… ................................ 45
Table 4.22: Donor Flexibility in in Adopting Local Solutions… ............................. 46
Table 4.23: Use of Monitoring and Evaluation… ..................................................... 46
Table 4.24: Funding and Target Achievement… ...................................................... 46
Table 4.25: Compliance with Minimum Standards of HIV Care .............................. 47
Table 4.26: Timely Reporting ................................................................................... 47
Table 4.27: Program Recognition… ......................................................................... 48
Table 4.28: Target Achievement… ........................................................................... 48
Table 4.29: Donors Satisfaction with Our Achievement…....................................... 48

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Table 4.30: HIV Positive Results Acceptance .......................................................... 49
Table 4.31: Promptness of Starting HIV Care .......................................................... 49
Table 4.32: Clients Come at Early Stages to Seek Care ........................................... 50
Table 4.33: Positive Living and Adherence .............................................................. 50
Table 4.34: HIV Stigma and Drug Adherence .......................................................... 51
Table 4.35: Drug Resistance and Psychosocial Support… ....................................... 51
Table 4.36: Financial Constraints and Treatment Outcome… .................................. 51
Table 4.37: Engagement in Transactional Sex to Meet Obligations… ..................... 52
Table 4.38: Gender Belief and Access to HIV Care and Treatment… ..................... 52
Table 4.39: Improved Information Access and Treatment Outcomes… .................. 53
Table 4.40: Correlations ………...…………………….…………….…………… 53
Table 4.41: Model Summary..................................................................................... 54
Table 4.42: ANOVA ................................................................................................. 54
Table 4.43: Coefficients… ........................................................................................ 55

LIST OF FIGURES
Figure 2.1: Conceptual Framework ........................................................................... 30
Figure 4.1: Response Rate ......................................................................................... 36

Figure 4.2: Respondents age distribution… .............................................................. 37

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 ABBREVATIONS

AIDS - Acquired Immune Deficiency Syndrome

ART - Antiretroviral Therapy

CDC - Centers for Disease Control and Prevention

EDARP -Eastern Deanery Aids Relief Programme

EMTCT - Elimination of Mother to Child Transmission

HIV - Human Immunodeficiency Virus

MAP - Multi-Country AIDS Program

MDG - Millennium Development Goals

NAC -National Aids Council

NASCOP - National AIDS and STIs Control Programme

PEPFAR - President's Emergency Plan for AIDS Relief

PHDP - Positive Health, Dignity, and Prevention

PLHIV - People Living with Human Immunodeficiency Virus

UN - United Nations

UNAIDS - Joint United Nations Programme on HIV/AIDS

UNICEF - United Nations International Children's Emergency Fund

WHO - World Health Organization

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 ABSTRACT
This research paper aimed to determine the main factors affecting the performance of HIV/AIDS
programs in African and sub-Saharan regions. The research and study was carried according to
following questions; what are the main strategic issues affecting the performance of HIV/AIDS
programs, how the stakeholders or donors influence the HIV/AIDS programs performance, and
what is the impact of effective planning and evaluation on project performance in HIV/AIDS
services. The study was based on the descriptive survey design. 50% of the respondents were
taken as the sample; they were then classified into two categories; project management staff and
clinical staff. This was performed to make it sure that our sample frame is relevant and complete
to achieve the study objective. The research is based on secondary data from different
government databases and literature reviews. For the secondary data purpose, where needed, we
considered the researches of West Africa Aids Foundation, Orphans and Vulnerable Children’s
Project (2004-18), Self-sufficiency for Persons Living with HIV (2004-15), Empowering Persons
Living with the Disease (2014-15), and National Strategic Plan (2014-16). The researcher
analyzed the collected data using percentages, frequencies, correlation and regression. The
research found that most of the respondents, approx. 66%, could not confirm their knowledge
regarding strategic planning programs or not, majority of respondents, approx. 52%, agreed that
they have been provided with trainings on project management, while only 10% stated they carry
out sufficient customer satisfaction surveys with 87% stated they have experienced no political
interference in HIV/AIDS project management programs. The study also highlighted that
employees’ role in strategic planning is really important and they must be aware of what they are
expected to perform and how their performance can be enhanced through project management
skills. The study also concludes the perceptions of customers on how well the value delivered by
the organisations or institutions should be monitored consistently. They study concludes there
are some conflicting project management areas between host government policies and donor
policies and that donor demand for implementing monitoring and evaluation as performance
measurement tool for ensuring that program goals and objectives are being met are justified. The
study in the end recommends main thing that information dissemination about HIV/AIDS needs
to be enhanced.

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CHAPTER I: INTRODUCTION

1. Introduction
In the absence of a vaccine or cure for Acquired Immune Deficiency Syndrome (AIDS), the
spread of Human Immunodeficiency Virus (HIV) must be controlled through programs designed
to distribute antiretroviral therapy (ART) and encourage adherence. This is in addition to
prevention strategies such as Elimination of Mother to Child Transmission (EMTCT), voluntary
medical male circumcision and Pre and Post-exposure prophylaxis. To mitigate and eventually
eliminate HIV epidemics around the world, it remains essential to develop and implement HIV
prevention interventions that modify individuals’ behaviors and practices. These are as essential
as developing technologies, such as vaccines, microbicides, and antiretroviral drugs, which
attack and immobilize the virus and reduce the risk of its transmission. It is also is necessary to
legislate social and policy changes that transform social structures and environments that
constrain individuals’ ability to reduce their vulnerability to HIV infection. Such intervention
would address fundamental social drivers of HIV vulnerability, such as economic dependence,
poverty, gender inequality, lack of education, stigma, and discrimination, including sexism,
racism, and homophobia. Such interventions have produced some evidence of effectiveness
(Auerbach, 2009).

The implication of HIV/AIDS has varying severity across the world. Effective management of
interventions undertaken to curb severity is paramount to ensure the desired outcomes are
attained. This also advises the stakeholders to make informed decisions. It is only in proper
management that the sixth Millennium Development Goal (MDG 6) which is to combat HIV &
AIDS, malaria and other diseases can be achieved. This research will seek to explore the factors
affecting the management of HIV/AIDS programs in African and Sub-Saharan regions.

According to the World Bank (2008), HIV/AIDS remains a fundamental development challenge
in many African countries that threaten growth, livelihoods, and human capacity and inflicting
tragedy on millions of families. The environment for combating HIV/AIDS keeps on changing
dramatically, with new donors, increased funding, more affordable treatment, a better
understanding of the disease and its transmission, and a new appreciation of gender inequality in
the feminization of the disease in Africa.

According to United Nation (2014), about 35 million people were living with HIV by the end of
2013, with HIV incidence of 2.1 million HIV infections in 2013 and about 1.5 million deaths
caused by HIV in the world. The United Nations noted that the new HIV infections continued to

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exceed the number of AIDS-related deaths and as a record number of people have been receiving
antiretroviral therapy, keeping them alive longer. It is estimated that in 2012 there were 1.6
million new infections with about 1.2 million HIV related deaths in sub-Saharan Africa. Sub-
Saharan Africa carries the greatest burden of the epidemic throughout the world with 71% of
PLHIV worldwide. Though there has been a decline in some HIV related deaths, Sub-Saharan
Africa accounts for 70% of HIV related deaths worldwide. It is also reported that more than 90%
of the children who acquired HIV infection in 2011 live in sub-Saharan Africa (UNAIDS, 2012).
In sub-Saharan Africa, which is home to 92% of pregnant women living with HIV worldwide,
the percentage of pregnant women living with HIV who received antiretroviral therapy or
prophylaxis was 59% (53–66%), this is way below the Caribbean where the coverage levels were
at 79% (67–97%) in 2011 (UNAIDS, 2013).

Many African countries have struggled in the past 30 years to get the best, most effective and
responsive programmes, strategies, policies, and approaches to tackling the menacing HIV/AIDS
pandemic. The effects range from villages being wiped out to severe loss of employees within
organizations and government ministries as well as the private sector. Many families, institutions
and departments have over the past decade lost valuable sons and daughters, earnings and their
best-trained workers at the prime of their working lives. The disease has not spared any country
in the world. It has affected both rich and developing countries. The only difference is in the way
each country responds, which much depends on their social-economic and political environment
(Ndambuki, 2006).

The HIV/AIDS is increasing ill-health and mortality of large numbers of 'prime-age' adults who
play a fundamental role in income generation, the protection of assets, and social reproduction.
The composition of households is transformed, and dependency ratios increase as adults grow
sick and die, and as orphans are taken in to be cared for. This places enormous pressure on
resources. Furthermore, households are more likely to be headed by the elderly or by children,
many of whom are ill-equipped to cope with such situations. Over the long term, the
transmission of knowledge concerning livelihood strategies and cultural and family heritage can
be negatively affected (Morton, 2005).

According to National AIDS and STIs Control Programme (2014), about 1.2 million people are
living with HIV aged 15 to 64 years in African and Sub-Saharan regions, Out of PLHIV, only
700,000 are taking the lifesaving ARVs. The HIV prevalence rate was indicated to be 5.6% of
adults and adolescents aged 15 to 64 years with HIV incidence in 2012 estimated to be 106,000.

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According to Poku and Alan (2007), there is need to address the effectiveness of global and
national responses to HIV/AIDS as well as mapping out the contours of the crucial debate
regarding the direction and scope for future governance. He argues that the global HIV/AIDS
epidemic is a long-term event whose impact unfolds over a long duration of time. Over thirty
years after seeing the first HIV case, the epidemic has left an increase in worried faces of
women, especially young women; orphans who will have to grow up without the nurturing of
parents; and the rising number of people living with HIV/AIDS. More worrying still, there is no
convincing evidence to suggest that the epidemic is significantly slowing down anywhere in the
world. Each day HIV/AIDS continues to spread therefore adding to the ramifications and
duration of its likely impact. The prevalence of HIV is high in countries with extreme poverty,
conflict, and weak institutional and physical infrastructure, inadequate educational and health
care systems. Such conditions are rife in Sub Saharan Africa. The struggle to get the desired
intervention outcomes is challenging as there are fears that if HIV/AIDS epidemic is not
contained, it will reverse the development gains achieved over the past generations (Poku &
Alan, 2007).

According to the World Bank (2008), despite intensified national and global responses, much
remains to be done in strategy development and building the wherewithal to implement a
cohesive strategy with sufficient funding, human and institutional capacity, and attention to
prevention. According to the United Nation (2014), risky behavior and insufficient knowledge
about HIV remain at alarmingly high levels among youth in developing countries. Among the
most severe gaps noted by the World Bank is the absence of sustained management of
HIV/AIDS programs to achieve desired outcomes in the most acutely affected countries in
Africa.

The Joint United Nations Programme on HIV/AIDS believes that a world without AIDS can only
be achieved through renewed and sustainable commitment, solidarity and only if the available
evidence and limited resources are used as efficiently and effectively as possible. The challenge
is to ensure the uptake of HIV tests is scaled up. This will ensure that People living with HIV can
access the required care and treatment at the right time. On the other hand, those found to be
without HIV can be given targeted messages on how to prevent themselves from acquiring HIV.
The timely and organized intervention of HIV will ensure that the burden is reduced (UNAIDS,
2012).

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 1.1. Statement of Problem
A well-performing project is one that achieves deliverables that are prior agreed upon to satisfy
the project customer. Organization successful performance is dependent on multiple factors,
which are either internal or external to the firm (Kloppenbotg, 2009). A firm’s operating
environment is a significant determinant of how successful a firm can be. For a business to
strategically position itself, opportunities and the threats in the external environment have to be
matched with the firm’s resources and capabilities in the internal environment (Ansoff, 1990).
The business model should match the expectations of the shareholders and the needs of
customers (Worth, 2014). In project management, the environment that affects the project
consists of three major pillars. They include project owners, project beneficiaries and project
management (Müller & Turner, 2007).

The shareholders’ interest in a business is the return on equity. Shareholders influence the
operation of the business to protect their interest (Burrow & Kleindl, 2008). In project
management, the project owners have a clear vision of the project in their mind (Müller &
Turner, 2007). As the financier, they are the shareholders who look for value for their
investment. According to Joanne (2009), in non-profit organizations, the project owners are the
donors, who contribute funds to pursue a course. Regan and Rhoads (2013) in a case analysis
done in India in the education sector found out that the donors, as the project owners, had a
significant influence on service delivery. Though donors have been described as influencers of
program performance, little has been done to study their influence on the performance of
HIV/AIDS programs in African and Sub-Saharan regions.

Firms develop strategic plans to ensure that their products or services remain competitive in the
market place. Customer’s response is a crucial determinant of strategy success or failure (Kotler,
2006). According to Drucker (1992), non-profit organizations need to create a want that pulls
their customers. Like in for-profit business firms, customers are studied to establish the behavior
to enhance sales. In HIV/AIDS programs People Living with HIV (PLHIV) characteristics and
behavior need to be studied too to enhance service delivery and consequently the performance of
the programs. According to a survey done in African and Sub-Saharan regions by National AIDS
& STI Control Programme (NASCOP), provision of Care and treatment services to PLHIV is a
key building block towards containing the scourge of HIV/AIDS (NASCOP, 2014). The study,
however, did not bring out the characteristics and behavior of PHLIV that are likely to influence
the performance of the HIV/AIDS programs. Further, the Joint United Nations Programme on

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HIV and AIDS (UNAIDS) on a global report on HIV/AIDS noted that PLHIV have a major
stake in the management of HIV/AIDS.

For a project to be well executed there is need to strike a balance between the project processes
and the people. People as resources are needed to do and manage the work. Resources with the
right skills and knowledge that is adequate for the needs of the project, starting with the project
manager (Kerzner 2006). According to Czuchry and Yasin (2003), people are dependent on
organizational processes. The management of the process and resources available calls for skills
in strategic management. The study sought to bring out the strategic issues that affect the
performance of an HIV/AIDS program. While the majority of previous studies concentrated on
clinical care and treatment of people living with HIV/AIDS, there seems to be a little study done
on strategic issues that affect the performance of programs such as HIV/AIDS programs in
African and Sub-Saharan regions, which are used as vehicles for providing clinical care and
treatment to PLHIV. There is a need to clearly get the factors that will accelerate the positive
performance of HIV/AIDS programs in African and Sub-Saharan regions to accelerate reduction
on new HIV infection. It is with this background that the study sought to bring out the strategic
program issues that affect performance, the donor influence on performance and how the
characteristics and behavior of PLHIV affect the performance of HIV/AIDS program in Africa
and Sub-Saharan region.

1.2. Aims and Objectives

Aims
The research aims to examine the factors influencing the performance of HIV/Aids projects as
implemented in the healthcare sector in Africa. The research also aims to highlight the
importance of project management for the success of large scale projects in the African mission
to fight HIV/Aids.

Objectives
The objective of the research is the identify the factors impacting the project performance as
implemented in the healthcare sector with the main focus on the HIV/Aids projects in African
and Sub –Saharan regions. Following are the main objectives of the study:

 To establish whether the involvement of the stakeholder impacts the performance of

projects operating in HIV/Aids services
 To determine the impact of strategic planning on the implementation of HIV/Aids
projects in African and Sub-Saharan regions
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  To establish to what extent the monitoring and evaluation processes impact the
implementation of HIV/Aids projects in African and Sub-Saharan regions

1.3. Research Questions

The research will mainly emphasis on the following research questions:

 Does effective planning and evaluation impact the project performance in HIV/Aids
services in African and Sub Saharan regions?
 Does the involvement of stakeholder impact the performance of HIV/Aids projects in
African and Sub-Saharan regions?
 Does strategic planning impact on the HIV/Aids projects in African and Sub-Saharan
regions?

1.4. The Significance of Study

The study is a valuable input to HIV/AIDS program managers, the donor community,
government, academicians and researchers.

1.4.1. HIV/AIDS Program Managers

Program managers can learn the factors that surround the running of HIV/AIDS programs. This
will enable them to successfully tackle different factors appropriately and timely to ensure that
the desired outcomes of the program are achieved.

1.4.2. The Donor Community

The findings of the study provide donors with information related to the management of such
programs in African and Sub-Saharan regions. The donor community can set realistic outcomes
depending on their influence on the management of the program.

1.4.3. The Government

With the primary role of providing health care to all, the government can use the findings to
advocate for proper management of HIV/AIDS program in the country.

1.4.4. Academicians and Researchers

The study is useful to other scholars interested in Program management as it will help them in
understand the factors that affect the running of programs in African and Sub-Saharan regions.

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 1.5. The Scope of the Study
The study analyzed the factors affecting the performance of the Eastern Deanery AIDS Relief
Program (EDARP). Eastern Deanery AIDS Relief Program is a faith-based Nongovernment
Organization (NGO), located in Eastern side of Nairobi County. The organization was started in
the year 2003. The organization is a medical facility offering the following services, Provider-
Initiated HIV Testing and Counseling, Voluntary Counseling and Testing, HIV/AIDS
comprehensive care, TB testing, and treatment. The program runs 14 facilities across the city’s
low-income settlements.

Eastern Deanery AIDS Relief Program has about 350 employees who compose of Project
Managers, Clinical staff and support staff. The daily operation of the program involves clinical
management of HIV/AIDS patient. The organization has ever served about 80,000 patients who
have ever come to seek HIV care and treatment. There are about 24,000 active clients enrolled in
long term care of HIV/AIDS.

1.6. Terminologies Definition

1.6.1. Viral Load

Also known as a viral burden, is a measure of the severity of an active viral infection, and can be
calculated by estimating the live amount of virus in an involved body fluid. HIV treatment aims
to reduce the amount of viral load to undetectable levels (AidsMap, 2014).

1.6.2. Human Immunodeficiency Virus (HIV)

This is a lent virus that causes the acquired immunodeficiency syndrome, a condition in humans
in which progressive failure of the immune system allows life-threatening opportunistic
infections and cancers. HIV affects specific cells of the immune system, called CD4 cells,
destroying such that the body cannot fight off infections and disease. This is what leads to AIDS
(CDC, 2015).

1.6.3. HIV Prevalent Rate

This is the measure of the relative burden of disease in the population. HIV prevalence is the
percentage of the population living with HIV (NASCOP, 2014).

1.6.4. HIV Incidence

This is the measure of new HIV infections in a population over time, usually within the previous
year. Incidence is theoretically the best way to evaluate the HIV epidemic’s proliferation, and a
combination of these figures would provide the most accurate representation of the HIV/AIDS

18
burden. It provides important information on the status of the HIV epidemic and can be used for
effective targeted HIV prevention planning in groups that are most vulnerable to recent infection
and to measure the impact of HIV prevention programs (NASCOP, 2014).

1.6.5. Project
A project is a unique, transient endeavor, undertaken to achieve planned objectives, which could
be defined in terms of outputs, outcomes or benefits (Project Management Institute, 1996).

1.6.5.1. Program
A program is a group of projects managed in a coordinated way to obtain benefits not available
from managing them individually; Programs have an element of ongoing operations (Project
Management Institute, 1996).

1.6.5.2. Project Management

This is the application of processes, methods, knowledge, skills, and experience to achieve the
project objectives (Project Management Institute, 1996).

1.6.6. Antiretroviral (ARV)

These are drugs used to strengthen the immune system of people living with HIV & AIDS. This
drug aims to reduce the rate at which the virus multiplies in the CD4 cell or T-helper cell (CDC,
2015).

1.6.7. Stigma
This refers to discrimination and prejudice, negative attitudes and abuse directed at people living
with HIV and AIDS (NASCOP, 2014).

1.7. Chapter Summary

This chapter introduced the subject matter of the study. Chapter 2 will cover in details the factor
that affects the performance of HIV/AIDS programs. Due to the great importance of managing
HIV/AIDS globally, much research has been done on related issues. The next chapter will seek
to establish how those factors affect the performance of a program. Chapter 3 will cover a
description of the research design, sampling procedures, and procedures that will be used to
collect the data for the study. It will include a description of how the study will be carried out
and the reasons for the choice of the methodology will be outlined. Chapter 4 presents and
explains the finding of the study by the research questions. The last chapter, chapter 5 delves on
discussion highlighting conclusions and recommendations.

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CHAPTER II: LITERATURE REVIEW

2. Introduction
This chapter provides a background of the key components of the study; this was done by
reviewing existing literature of researchers on areas of performance and studies on HIV/AIDS
programs. The major concepts that regard performance and HIV/AIDS programs were described.
At the end the factors that interact with the organization and have the potential of affecting
performance were reviewed, in line with the research questions; the first question sought to
examine the strategic issues that affect the performance of HIV/AIDS programs. The second
question sought the donor's influence on the performance of HIV/AIDS programs, and the third
question sought the characteristics and behavior of PLHIV's influence on the performance of
HIV/AIDS programs.

There has been an increase in complaints about the inefficiency and ineffectiveness of nonprofit
organizations. This increase has caused a decrease in public trust, which has prompted a demand
for higher performance on nonprofit organizations (Liket & Maas, 2015). In delivering their
mission, nonprofit organizations, like for-profit organizations need to meet their set objectives,
which are key determinant of their performance (Drucker, 1992).

2.1. Strategic Issues Affecting HIV Programs

According to Pearce and Robinson, (2011) Strategic management is defined as the set of
decisions and actions that result in the formulation and implementation of plans designed to
achieve a company’s objectives. He describes the process as long term, future-oriented and
complex decision making that requires considerate resources and participation of top
management. He stresses that the strategic management process centers on the belief that a
firm’s mission can be best achieved through a systematic and comprehensive assessment of both
its internal capabilities and its external environment. According to Mintzberg (2007), strategy
brings in clarity in the organization as it presents the perspective and the plan the organization is
pursuing. The strategy works to help the organization establish its position in the competing
world and presenting it with tactics or maneuvers to attract more resources. According to
Stanleigh (2007) strategy helps an organization to define its scope which becomes the basis of
project decisions. This clarifies the areas of agreement between the project team, the project
customer and the project sponsor, by identifying both the project goal and major project
deliverables.

20
Having a strategy ensures that shifting organizational priorities do not adversely affect the
implementation of the project. When project implementation is intermittent due to changing
priorities, and the project team is told to put it aside for a while and work on other newer
priorities, strategy ensures focus is not lost when implementation resumes. Since the project
manager has little control over such occurrences, proper plans should be put in place during the
planning phase. The plan should highlight the communication channels of changes to ensure
team support (Stanleigh, 2007).

Strategic issues are the fundamental policy challenges that affect the organization's mandates,
mission, stakeholders, resources, structure, processes, management, or product or service level
and mix. Strategic issues are issues that must be addressed in order for an organization to achieve
its vision. Identification of strategic issues is one of the key milestones to developing a strategic
plan (Pearce & Robinson, 2011). According to Worth (2014), nonprofit organizations add
vitality to the communities and provide essential services that enhance and protect our wellbeing.
However, like for-profit firms, nonprofit face strategic issues and turbulence forces of economic,
social, political and technological changes.

2.1.1. Strategic Planning

According to the U.S. Department of Health (2011), strategic planning affects performance as it
is the process that involves setting goals and regularly checking progress toward achieving those
goals. The process includes activities that ensure organizational goals are consistently met
effectively and efficiently while ensuring that the organizations and its subsystems are optimally
working together to achieve the desired results. According to Drunker (1992), argues that like
for-profit organizations, nonprofit organizations need to have a sound mission statement that
they seek to pursue. The mission, which is a product of strategic planning, should be operational
as it provides the basis of measuring their performance.

There are various perspectives to performance measurement in nonprofit organizations that have
been developed over time. Whichever the perspective, the emphasis is on the importance of
understanding the working environment to enhance effectiveness and efficiency. Balanced
Scorecard since its development has gained popularity as a tool to measure performance. The
balanced scorecard seeks to integrate internal, external and program variables to produce a
comprehensive picture of organizational performance (Lee & Nowell, 2014). According to
David (2009) the balanced scorecard analysis requires that a firm seeks answers to critical
questions like how well is the firm continually improving and creating value along measures
such as innovation, technological leadership, product quality, or operation efficiency? How well
21
is the firm sustaining and even improving upon its core competencies and competitive
advantages? Moreover, how satisfied are the firm’s customers?

The Balanced scorecard works as a system that enables an organization to clarify its strategies
and translate them into action. The approach supports the strategic planning and implementation
by integrating all the activities of the organization around a common understanding. The
Balanced scorecard enables the companies to develop a more comprehensive view of their
operations and to better match all operating and investment activities to long- and short-term
strategic objectives (Punniyamoorthy, 2008). According to Bradford (2015), it is critical for
employees to understand the organization’s strategy. Employees who understand the strategy can
make better decisions that support the organization’s vision. He urges that the strategy should be
effectively communicated to ensure all employees well internalize it. The World Bank as a donor
has a cycle of 3-5 years; Global fund has a cycle of 2-3 years while PEPFAR has the shortest of a
cycle of 1 year. President's Emergency Plan for AIDS Relief’s annual process of obligating
money can make long-term planning difficult for recipient organizations which must operate
with a degree of uncertainty about future year funding levels (Bush, 2017). President's
Emergency Plan for AIDS Relief which is the major donor in HIV/AIDS programs is a US
Government program, which receives all funding from the US Treasury at the direction of
Congress through the federal budget process. President's Emergency Plan for AIDS Relief is
bound by the Congressional budgetary cycle – it cannot legally commit money that has not
already been approved (i.e., appropriated) by Congress during the annual budget process. As a
result, PEPFAR implementing agencies cannot make legally binding multi-year funding
commitments (Bernstein & Sessions, 2007).

When implementing projects sustainability is a key factor. It starts with organizations vision and
mission (Brent & Petrick, 2007). When the leaders of a non-governmental organization share a
compelling vision and a clear mission, the non-governmental organization has a much better
chance to be successful. Without a vision, a non-governmental organization will find it hard to
inspire others to join its cause. Writing vision and mission statements is one of the most
important things, the founders of a non-governmental organization, do. Vision and mission
statements set the tone for your future work (Doppelt, 2003).

Community-based organizations have been known to face some challenges in running their
programs. A study conducted on the sustainability of community-based projects in African and
Sub-Saharan regions revealed that the major challenges that these organizations face include
poor leadership, inadequate skills, and under-capitalization (Bateman & Chang, 2009). Further,
22
the study showed that there is a vast gap between these organizations and donors. Thus, unless
these organizations are strategically positioned, it is challenging for them to address not only the
critical issues facing communities today but also the very challenges threatening their survival.
This forms the basis for this strategic plan (Wanjohi, 2012).

2.2. Monitoring and Evaluation Practices and Project Implementation

Monitoring and evaluation tend to be understood as the same thing. Though related, however,
they are two different sets of organizational activities. Monitoring is the routine collection and
analysis of information to track the progress of a project against set plans and check compliance
to established standards. It helps to identify trends and patterns and help project implementers to
make informed decisions. Gudda, (2011) defines monitoring as the art of collecting the necessary
information with minimum effort in order to make a steering decision at the right time. This
information also constitutes an important and necessary database for analysis, discussion,
evaluation, and reporting. According to Gebremedhin, Getachew and Amha, (2010), Monitoring
involves the collection of routine data that measure progress towards achieving
project/program/policy objectives. It is used to track changes in intervention performance over
time.

On the other hand, evaluation involves identifying and reflecting on the effects of what has been
done and judging their worth. Evaluation basically aims to determine as systematically and
objectively as possible the effectiveness, efficiency, relevance, sustainability, and impact of a
project or programme. Mulwa (2008) defines evaluation as a process that involves the systematic
collection, analysis, and interpretation of project related data. It aims to provide valuable
management information, judge the value and merits of an intervention, and draw lessons which
can be used to decide the future.

Monitoring and evaluation contribute to the strengthening of institutions, human resource

capacity building, and professional financial management. Through the application of monitoring
and evaluation (M & E) techniques, civil society organizations will improve their overall
capacity for efficient and effective project management and implementation. Even if an
organization has a good plan and a good budget in place, you cannot expect project
implementation without problems along the way. It is therefore that during project
implementation, project implementers monitor and control project progress based on the
objectives that were established in the project plan. It is also important to make necessary
adjustments to address unforeseen challenges, obstacles, and opportunities as they arise that may
occur. Monitoring, therefore, should be done in parallel with the donor’s reporting requirements.
23
It is also essential that during project implementation, actual costs should be constantly
compared with the planned budget in order to note any significant deviations from the plan.

Because monitoring and evaluation are basic functions essential to the effective management of
disaster preparedness and emergency response programs and the achievement of program
objectives, these inter-related functions should be planned for in the project document. The
document should specify when and how project monitoring and evaluation will occur including
what indicators will be used to monitor progress and determine the success of the project or
programme. Holden, (2004) emphasizes that monitoring and evaluation is a weak component of
much development work, and mainstreaming HIV/Aids is, so far, no exception. However, M&E
is critical for learning about what is effective, for ensuring that modifications resulting from
mainstreaming do not do more harm than good, and for assessing the impact of mainstreaming
HIV/Aids.

Mulwa (2008) states the need for monitoring and evaluation as follows; monitoring and
evaluation provides project staff with a clear basis for decision making, enables project staff to
strengthen the performance of their projects thus increasing the impact of project results to the
beneficiaries, M&E provides the project manager to maintain control of the project by providing
him with information on the project status at all times, it promotes greater transparency and
accountability in terms of use of project resources, and information obtained through M&E can
be used in the future for project planning and development.

Government officials, development managers, and civil society are increasingly aware of the
value of M&E of development activities. Monitoring and evaluation provide a better means of
learning from experience, improving service delivery, planning and allocating resources and
demonstrating results as part of accountability to key stakeholders (World Bank, 2004). Civil
society organizations play a key role in response to the AIDS pandemic in many countries. The
wide range of strategic and tactical expertise with civil society organizations makes them ideal
partners in global, regional and national processes of M&E. Through a consultative process
outlined in the UNAIDS guidelines on the construction of core indicators, civil society can be
fully engaged in the production of a genuinely national report (UNAIDS, 2004).

A learning-focused M&E system builds on what people already know and do, using and
developing their existing abilities and skills to monitor their progress. It is a cyclical process in
which communities and civil society organizations reflect continuously on the effects of their
actions and where the process is leading them. It is this learning process that creates conducive
conditions for change and action. Combined pressures to improve the quality and adequacy of
24
performance, while working more efficiently and effectively, are also encouraging agencies and
projects to ask the question of how they can learn better to improve their work – not just account
for it. The core questions shift from what has happened to why has there been success or failure
and so what are the practical and strategic implications (Hilhorst & Guijt, 2006). With increased
resources made available to respond to the epidemic, it has become mandatory for the national
response to having timely and accurate data for assessing whether the interventions are making a
difference and whether the resources are being used effectively to achieve the desired effect
(NACC, 2004).

2.3. Training on Project Management and Project Implementation

The ultimate aim of every training and development program is to add value to human resource.
Any training and development program that would not add value should be abandoned.
Organizations should, therefore, make training and development of their employees a continuous
activity (Obisi, 2011). Without training, it will be complicated to acquire skills, and without
skills, organizations will not achieve their objectives through people. However, some
organizations usually see training as an expensive venture, and therefore the management may
put an embargo on training and utilize the money for other projects in the organization. Most
people do remarkably well in managing projects, even though most of them have never thought
of themselves as project managers or taken part in any kind of project management training.
Schwalbe (2006), emphasizes that some organizations spend a great deal of time and money on
training efforts for general project management skills, but after the training, a project manager
might still not know how to tailor their project management skills to the organization’s particular
needs. Because of this problem, some civil society organizations have developed their own
internal project management methodologies.

Project management has sometimes been called the accidental profession because many project
managers take on their first project management duties without the benefit of formal training
(Shackelford, 2004). The benefits of project management training include; project teams and
customers do not have to learn procedures and new jargon with each new project, it becomes
easier to compare projects over time when they involve similar measurements and approaches,
and consistent tracking and reporting helps uncover inefficiencies in the overall project
management approach.

Dinsmore and Cabanis-Brewin (2011) emphasize that most training in project management still
resides within corporate training, consulting, and professional organizations-entirely outside
higher education. In project management today, there are some largely voluntary certification
25
approaches in project management raging from knowledge-based assessment to competency
standards based on practice. Taylor (2006) argues that in the 1980s, it was rare that a project
manager had any prior formal project management training; all project management training was
done on the job. However, there is more to running a project successfully than just understanding
how to schedule work or prepare progress reports. A project manager needs a whole host of
skills. A project manager must have a strong, active, and continuous interest in teaching,
training, and developing subordinates (Taylor, 2006).

Lytras, De Pablos and Avison, (2010) say that in project management, a training session could
aim at developing or improving one of the project manager competencies. A training session
could refer to one or more, thus having an impact on the duration of the training. Improving the
capacities of local technical staff, training and workshops activities will allow the staff is
working in civil society organizations and public institutions involved, to improve their know-
how and practical experience. This, in turn, leads to a more effective and efficient operating civil
society sector local staff (Civil Society Facility, 2012).

2.4. Risk Management and Project Implementation

A risk is an event or occurrence that may negatively impact the project. Royer (2002) defines
risk as the potential events or circumstances that threaten the planned execution of the project.
Having the best people execute the plan does not guarantee success. There are many external
factors which may play a role in determining the outcome regarding whether a project has been
successful and able to meet the objectives or not. Risks can be mitigated and even prevented.
However, this risk mitigation and prevention require a good amount of understanding of the risks
and planning. Kendrick (2009) states that to avoid a project doomed to failure, you must
consistently use the best practices available. Royer (2002), classifies risk into the following nine
categories; customer associated, contract, project requirements, business practice expertise, work
estimates, project constraints, complexity and scale deliverables, and contractors.

Grau (2003) states that risk is inherent to life. The future is always uncertain and the outcomes of
events unpredictable. Furthermore, for development non-governmental organizations, risks
cannot be avoided and indeed must be embraced. Innovation for human development in project
implementation requires risk-taking. However, many organizations consider risk as something
negative or as the danger of something undesirable occurring and likely to affect the project
implementation. Project implementers should know that risk is also positive-there is an upside
and a downside. It is therefore important for an organization for daring to succeed and dare to
fail.
26
Grau (2004) argues that the global environment in which NGOs operate is changing quickly, as
is the very nature of the risk management function and the process for making decisions about
risk. These changes affect not only NGOs and the public that is served, but also the organizations
that fund them. Keeping pace with changes in the overall economic, political, and cultural
environment in risk management practice and in leading thinkers understanding of risk is vitally
important to every NGOs success in carrying out its mission and accomplishing its long-term
goals.

These are hard, challenging times for non-governmental organizations around the world.
Whether service or social change oriented, non-governmental organizations operate in dynamic
economic, political, technological, and institutional environments. Grau (2004) emphasizes that
for NGOs devoted to development in both the North and South, with increasing frequency, their
legitimacy is questioned and accountability demanded. Stakeholders and the broader society and
governments are frequently asking non-governmental organization leaders about their impact on
society. These changes require that non-governmental organizations modify how they respond to
the world and seek to shape it. Consequently, many development non-governmental
organizations are altering their strategies, as the shift to rights-and results-based approaches
exemplifies. Moreover, they are varying their strategies more frequently than in the past.
Change, of course, has always been important in every organization’s life. Indeed, for non-
governmental organizations, change is essential; every non-governmental organization’s mission
statement commits it to improve some unacceptable aspect of the world. Change, however,
brings with it uncertainty and risk (Grau, 2004).

Following the decision to proceed with a project, detailed project planning begins. During this
process, you must assess and mitigate potential risks to the project. Risk management planning is
the process of identifying risks and developing mitigation strategies and contingency plans to
minimize their impact (Royer, 2002). Managing project risk depends upon the project team
understanding the sources of variation in projects, and then working to minimize threats and to
maximize opportunities wherever it is feasible (Kendrick, 2009).

Cooper, Grey, Raymond and Walker (2005) say that project risk management process is needed
to ensure that; all significant risks to the success of the project are identified, identified risks are
understood, with both the range of potential consequences they represent and the likelihood of
values in that being determined as far as necessary for decision making, assessment is
undertaken of individual risks relative to other risks to support priority setting and resource
allocation, strategies for treating the risks take into account opportunities to address more than
27
one risk, and the process itself and the risk treatment strategies are implemented cost-effectively.
Civil society organizations should come up with ways of managing risks. This is because risk
management increases the probability that the organization will survive for a long time and be
able to work towards its vision. This is because risk management; increases the probability that
the organization with being compliant with laws, regulations, and contracts; reduces the exposure
of employees to health and security risks; makes organizational processes more efficient due to
fewer disruptions; improves planning and decision-making due to a better understanding of the
future; and increases confidence of donors and grant-makers that funding goals and objectives
will be met (Klaus, 2012).

2.5. Theoretical Framework

This study will be based on the theory of constraints. This theory has been applied to production
planning, production control, project management, performance measurement as well as in not
for profit facilities (Blackstone, 2010). This theory helps in identifying the most important
bottleneck in the processes and systems so that that performance can be improved. Theory of
constraints is based on the fact that, like a chain with its weakest link, in any complex system at
any point in time, there is most often only one aspect of that system that is limiting its ability to
achieve more of its goals. For that system to attain any significant improvement that constraint
must be identified and the whole system must be managed with it in mind.

This theory is based on five steps which include; identify the system constraints; decide how to
exploit the system constraints; subordinate everything else to the above decision; elevate the
system constraints; and if in the previous steps a constraint has been broken, go back to the first
step, and do not allow inertia to cause a system’s constraint (Rand, 2000). Typically, all projects
are managed by focusing on the delivery of the tasks that make up the project, in the seemingly
reasonable belief that if these tasks are done on time, the project will be done on time as well.
However, all too often, project management becomes a chaotic exercise, resulting in inordinate
pressure to meet task due dates and frequent re-planning of the project. Apparently, in too many
cases, and for a variety of reasons, the long-established strategy of focusing on task completion
does not seem to work too well.

2.6. Conceptual Framework

Figure 2.1 showed the conceptual framework that had significant variables and their influence on
each other. Conceptual framework clarifies the relationship between independent and dependent
variables. It provides a clear concept of the areas in which meaningful relationships are likely to
exist (Cargan, 2007). It is linked to the problem statement and sets the stage for the presentation
28
of the specific research question that drives the investigation being reported. In this research, the
researcher intended to find out the influence that strategic planning; adoption of information
technology; monitoring and evaluation practices; training on project management; and risk
management had on project implementation.

29
 Figure 2.1: Conceptual Framework Figure

Independent variables Moderating Variables Dependent Variables

Strategic Planning

Vision Government policies

S
Project implementation
Mission

Work plans
Successful
Adoption of Information technology completion of
projects
Type of information technology
facilities available Number of
completed
Time spent using of computers projects

Better decision
Monitoring & Evaluation practices making

Progress reports Community

participatio
Evaluation reports
n

Users of M&E reports

Training

Number of trainings Donor regulations

Community
Areas covered
attitude

Mode of training
Intervening variables
Risk Management

Type of risks

Risk mitigation

30
 2.7. Chapter Summary
This chapter broadly reviewed the literature on the factors affecting performance of HIV/AIDS
program. The first research question reviewed the strategic issues that affect the performance of
HIV/AIDS programs. The second research question reviewed donor’s factors that affect the
performance of HIV/AIDS program. The last research question addressed the characteristics and
behavior of PLHIV that affect the performance of HIV/AIDS program. Chapter three outlined
the research design and methodology. Elaborating the design used for this research in order to
achieve the set aims and objectives. It also listed all the instruments used in this study and how
data was analyzed.

31
CHAPTER III: RESEARCH METHODOLOGY

3. Introduction
This chapter focuses on the research design, target population, sampling procedure, methods
which were employed to collect data, validity, and reliability of data collection instruments,
operational definition of variables, and methods of data analysis. Throughout our research will
use the research of Eastern Deanery AIDS Relief Program Report 2018 and some existing
literature reviews for secondary research purpose. We will also consider will consider the
researches of West Africa Aids Foundation, Orphans and Vulnerable Children’s Project (2004-
18), Self-sufficiency for Persons Living with HIV (2004-15), Empowering Persons Living with
the Disease (2014-15), and National Strategic Plan (2014-16).

3.1. Research Design

In this study, the researcher used descriptive research design to assess the influence of project
management practices on the implementation of HIV/Aids in African and Sub-Saharan regions.
Descriptive research design helped the researcher to gather both qualitative and quantitative data
on how project management practices influence the implementation of HIV/Aids projects in
African and Sub-Saharan regions. Through this design, the researcher was able to link project
management practices to the implementation of HIV/Aids projects.

3.2. Population and Sampling Design

According to Cooper and Schinder (2014), the population is the total collection of elements
about which the researcher wish to make some inference. The target population of the study
comprised of clinical staff and Program managers who work in the Eastern Deanery AIDS Relief
Program. The clinical staff comprised of Medical officers, Clinical officers, and nurses who
directly interact with PLHIV on a daily basis.

3.2.1. Population
According to Cooper and Schinder (2014), the population is the total collection of elements
about which the researcher wish to make some inference. The target population of the study
comprised of clinical staff and Program managers who work in the Eastern Deanery AIDS Relief
Program. The clinical staff comprised of Medical officers, Clinical officers, and nurses who
directly interact with PLHIV on a daily basis.

Table 3.1: Population Distribution

Number %
Clinical Staff Nurses 170 73.7

32
 Clinical Officers 30 13.0
Medical Officers 3 1.3
Program Manager Top Level Managers 14 6.0
Middle-Level 14 6.0
Managers
Total 231 100
Source: Eastern Deanery AIDS Relief Program Report 2018

3.2.2. Sampling Design

3.2.2.1. Sampling Frame

According to Cooper and Schinder (2014), the sample frame is the list in the population from
which the sample is drawn. A working sampling frame was developed, based on EDARP Report,
2018.

3.2.2.2. Sampling Technique

The study employed a stratified sampling technique. This ensured that all subgroups in the
population were included in the study. Stratified random sampling technique is cited as having
increased sample’s statistical efficiency and provides adequate data for analyzing the various
subpopulation (Cooper & Schinder, 2014). To ensure adequate representation, the population
was first clustered in two main categories, i.e. Clinical staff and Program managers. Each
category was further stratified as follows: - under clinical staff, there were nurses, clinical
officers, and medical officers, under program managers there were both middle and top-level
managers.

3.2.2.3. Sample Size

Generalization about a population from data collected using any probability sample is based on
probability, the larger the sample size, the lower the likely error in generalizing to the population.
The choice of sample size is be governed by the confidence one needs to have in data, the
tolerable margin of error and the kind of expected analysis (Saunders, 2003). A sample size of
50% of the population was used in the study. This sample size was sufficient to produce results
among significantly different variables.

Table 3.2: Sample Size Distribution

Number 50% Sample Size

Nurses 170 85
Clinical Staff Clinical Officers 30 15

33
 Medical Officers 3 1
Top Level Managers 14 7
Middle-Level 14 7
Program Manager Managers
Total 231 115
Source: Eastern Deanery AIDS Relief Program Report 2018

3.3. Data Collection Methods

The study utilized the data of EDARP Report, 2018, West Africa Aids Foundation, Orphans and
Vulnerable Children’s Project (2004-18), Self-sufficiency for Persons Living with HIV (2004-
15), Empowering Persons Living with the Disease (2014-15), and National Strategic Plan (2014-
16). The researcher used this method to conduct secondary research over the research topic.

3.4. Research Procedures

Boit, Wangare, & Magero, (2009) states that reliability is concerned with consistency in the
production of the results and refers to the requirement that, at least in principle, another
researcher, or the same researcher on another occasion, can be able to replicate the original piece
of research and achieve comparable evidence or results, with similar or same study population. A
measuring instrument is reliable if it provides consistent results (Kothari, 2006). To enhance
reliability of the data collected the researcher employed split-half technique. This method
estimated internal consistency by dividing the scale into halves, and then correlating the scores
on these two halves. A high correlation indicates that the two sets yield consistent information
(Hayes, 2008).

3.5. Data Analysis Methods

Data analysis is the process of systematically searching, organizing, and breaking data into
manageable units then synthesizing the data to search for patterns. Data collected from the
researches of EDARP Report, 2018, West Africa Aids Foundation, Orphans and Vulnerable
Children’s Project (2004-18), Self-sufficiency for Persons Living with HIV (2004-15),
Empowering Persons Living with the Disease (2014-15), and National Strategic Plan (2014-16)
was first checked for completeness and comprehensiveness. It was then coded to classify into
meaningful categories to bring out their essential pattern. The data was analyzed using both
quantitative and qualitative techniques which involved creating a description of the statistics, i.e.
percentages, frequencies, correlation, and regression analysis. Data were presented in graphs and
tables where necessary. Summary of findings were weighed against the research objectives, and

34
some meaning derived. The researcher used statistical software, to do data analysis. The analysis
helped the researcher in making valid inferences about the topic under study.

3.6. Chapter Summary

This chapter identified and described the research design and the methodology that was used
when carrying out the research. It also highlighted the population sampling design, data
collection methods, research procedures, and the data analysis methods. The data collected from
the researches of EDARP Report, 2018, West Africa Aids Foundation, Orphans and Vulnerable
Children’s Project (2004-18), Self-sufficiency for Persons Living with HIV (2004-15),
Empowering Persons Living with the Disease (2014-15), and National Strategic Plan (2014-16)
were analyzed using both quantitative and qualitative techniques.

35
CHAPTER IV: RESULTS AND FINDINGS

4. Introduction
This chapter presents the findings and the analyzed results of factors that affect the performance
of HIV/AIDS programs in African and Sub-Saharan regions. The data was collected using
secondary research approach, then analyzed and presented in the form of tables and graphs. The
chapter covers the results and findings from the analysis. The analysis of the respondent’s
background information is presented first and then followed by the results of the findings of the
questions that seek to answer the research questions.

4.1. Response Rate

The research of EDARP Report, 2018, West Africa Aids Foundation, Orphans and Vulnerable
Children’s Project (2004-18), Self-sufficiency for Persons Living with HIV (2004-15),
Empowering Persons Living with the Disease (2014-15), and National Strategic Plan (2014-16)
in general accumulated the response of respondents. This gave a response rate of 77%.
According to Mugenda and Mugenda (2003), a response rate of 70% and over is excellent for
analysis and reporting on the opinion of the entire population.

Figure 4.1: Response Rate

Response Rate

23%

Response
Non-Response

77%

4.2. Demographic Data

This section describes the general characteristics of respondents.

36
 4.2.1. Gender
Table 4.1 below shows the gender distribution of the respondents. Based on the study majority,
67% were female while 29% were male.

Table 4.1: Gender of Respondents

Gender Frequency %
Male 29 33
Female 59 67
Total 88 100

4.2.2. Age Bracket

From the finding of the study majority of the respondents, 34% were aged between 36 years to
45 years, 29% were aged between 18 to 25 years, 25% were aged between 26 to 35 years, 11%
were aged 65 years and above while 1% were aged 18 years and below. The age group
distribution was as shown in Figure 4.2 below.

Figure 4.2: Respondents Age Distribution

Age Distribution
1%

34% 29%
Below 18
18-25
26-35
36-45

25% Above 65

34%

4.2.3. Level of Education

The respondents were asked to indicate the highest level of education they had attained. 78%
indicated to have achieved a college Diploma, 15% have attained a University degree with 7%
had attached post university level. The responses were as shown in Table 4.2.

37
Table 4.2: Highest Education Level

Level of Education Frequency %

College Diploma 69 78
University 13 15
Post University 6 7
Total 88 100

4.2.4. Category of Employment

The majority, 80% of the respondents were nurses followed by clinical officers at 1%, Program
managers at 9% and medical officers at 1%. Table 4.3 shows the distribution of respondent’s
category of employment.

Table 4.3: Category of Employment

Category of Employment Frequency %

Nurse 70 80
Clinical Officer 9 10
Program Manager 8 9
Medical Officer 1 1
Total 88 100

4.2.5. Duration of Employment in EDARP

The study sought to establish the duration the respondents have been in the organization. 43%
have been in the organization for duration between 6 to 10 years, 30% have been with the
organization for between 2 to 5 years, 26% have been in there for over 10 years, and 1% has
worked there for less than 2 years. Table 4.4 shows the respondent’s distribution according to the
duration of employment in the program.

Table 4.4: Duration of Employment

Duration of Employment Frequency %

Less than 02 Years 1 1
2-5 Years 26 30
6-10 Years 38 43

38
 Over 10 Years 23 26
Total 88 100

4.3. Strategic Issues Affecting HIV Programs

4.3.1. Strategic Planning

The study sought to establish whether EDARP has a strategic plan that the respondents are aware
of. 66% were neutral as for whether the organization has a strategic plan that they are aware of,
28% agreed, and 5% disagreed. Table 4.5 shows the level of agreement to the statement that the
respondents are aware of the organization's strategic plan.

Table 4.5: Employee Awareness of Organization’s Strategic Plan

Level of Agreement Frequency %

Strongly Disagree 2 2
Strongly Agree 3 3
Neither Agree or Disagree 58 66
Agree 7 8
Strongly Agree 18 20
Total 88 100
According to the study, 45% of the respondents agreed that the funding cycle does affect the
strategic planning of the organization with 16% strongly agreeing to the same with 25% were
neutral and 9% strongly disagreeing and 5% disagreeing. Table 4.6 shows the respondents level
of agreement with the statement that the short funding cycle affects the strategic planning of the
program.

Table 4.6: Funding Cycle and Strategic Planning

Level of Agreement Frequency %

Strongly Disagree 8 9
Strongly Agree 4 5
Neither Agree or Disagree 22 25
Agree 40 45
Strongly Agree 14 16
Total 88 100

39
 4.3.2. Employee Involvement
According to the study, 57% of the respondents strongly agree that they are aware of their
responsibility towards meeting the organizational objectives with 33% agreeing, 8% disagreeing
and 2% neither agreeing or disagreeing. Table 4.7 shows the level of agreement with the
statement that they are aware of their responsibility towards meeting the organizational
objectives.

Table 4.7: Awareness of Personal Responsibility

Level of Agreement Frequency %

Disagree 7 8
Neither Agree or Disagree 2 2
Agree 29 33
Strongly Agree 50 57
Total 88 100
The study also sought to know the level of awareness the respondents were to the matrix used to
measure their performance. According to the study, 56% of the respondents strongly agree that
they are aware while 23% agree, with 14% disagreeing and 7% strongly disagreeing. One%
neither agreed nor disagreed. Table 4.8 shows the respondents’ level of agreement with the
statement that they are aware of the performance matrix used to gauge their performance.

Table 4.8: Respondent Awareness to Performance Matrix

Level of Agreement Frequency %

Strongly Disagree 6 7
Strongly Agree 12 14
Neither Agree or Disagree 1 1
Agree 20 23
Strongly Agree 49 56
Total 88 100
The study sought to know whether technical experts are used to running the technical areas in the
organization. According to the study, 27% strongly agree that technical experts are employed to
run the technical areas in the organization while 63% agree, 5% strongly disagree, and 1%
disagreed.

Table 4.9: Use of Technical Expert to Run Technical Areas

40
 Level of Agreement Frequency %
Strongly Disagree 4 5
Disagree 1 1
Neither Agree or Disagree 4 5
Agree 55 63
Strongly Agree 24 27
Total 88 100
From the study 52% agree with the statement that they are taken to training on project
management while 47% disagree with the statement, 2% were neutral. Table 4.10 shows the
level of agreement with the statement that the respondents are taken to training on project
management.

Table 4.10: Training on Project Management

Level of Agreement Frequency %

Strongly Disagree 6 7
Disagree 35 40
Neither Agree or Disagree 2 2
Agree 34 39
Strongly Agree 11 13
Total 88 100

4.3.3. Customer’s Focus

According to the study, 56% of the respondents strongly disagree with the statement that they
consistently carry out customer satisfaction surveys, with 33% disagreeing with the same and 5%
agreeing and another 5% strongly agreeing and 2% being neutral. Table 4.11 shows the levels of
agreement with that statement.

Table 4.11: Customer Satisfaction Surveys

Level of Agreement Frequency %

Strongly Disagree 49 56
Disagree 29 33
Neither Agree or Disagree 2 2
Agree 4 5
Strongly Agree 4 5

41
 Total 88 100
33% of the respondents could not agree or disagree with the statement that the latest technology
is adopted to help improve service delivery. 25% agreed with the statement with 16% strongly
agreeing while 18% disagreed and 8% strongly disagreed. Table 4.12 shows the distribution of
the level of agreement on the same statement.

4.12: Technology Adoption to Improve Services

Level of Agreement Frequency %

Strongly Disagree 7 8
Disagree 16 18
Neither Agree or Disagree 29 33
Agree 22 25
Strongly Agree 14 16
Total 88 100
The study found out that, 58% strongly agree that that the community supports the program
activities with 26% agreeing with the same. 5% disagreed, and 1% strongly disagreed with 10%
being neutral on the statement that community support program activities.

Table 4.13: Community Support Program Activities

Level of Agreement Frequency %

Strongly Disagree 1 1
Disagree 4 5
Neither Agree or Disagree 9 10
Agree 23 26
Strongly Agree 51 58
Total 88 100

4.3.4. Political Interference

59% strongly disagree with the statement that the government is directly involved in running the
routine activities with 28% disagreeing with the same statement. Table 4.14 shows the level of
agreement with the same statement.

Table 4.14: Government Involvements in Running the Program

Level of Agreement Frequency %

42
 Strongly Disagree 52 59
Disagree 25 28
Neither Agree or Disagree 10 11
Agree 1 1
Total 88 100
The study sought to establish whether funding is based on need or political orientation. 47% of
the respondents disagree with this, an indication that funding is based on political orientation
with 11% strongly disagreeing with the same. 35% agreed to the statement with 5% strongly
agreeing while 2% were neutral. Table 4.15 show levels of agreement with the same statement.

Table 4.15: Donor Funding and Politics

Level of Agreement Frequency %

Strongly Disagree 10 11
Disagree 41 47
Neither Agree or Disagree 2 2
Agree 31 35
Strongly Agree 4 5
Total 88 100
The study sought to establish whether local politics manifest in program management. From the
study, 34% disagree, with 15% strongly disagreeing while 19% strongly agreed with 11%
agreeing and 20% being neutral. Table 4.16, shows the level of agreement with the statement that
local politics manifest in the program management and funding.

Table 4.16: Local Politics and Program Management

Level of Agreement Frequency %

Strongly Disagree 13 15
Disagree 30 34
Neither Agree or Disagree 18 20
Agree 10 11
Strongly Agree 17 19
Total 88 100
On investigating whether local political decisions cause a threat to the sustainability of funding,
42% strongly agreed that there are instances of the threat of funds withdrawal depending on local

43
political decisions with 18% agreeing and another 18% disagreeing and 8% strongly disagreeing
while 14% were neutral. Table 4.17 shows the results.

Table 4.17: Local Political Decision and Funding Sustainability

Level of Agreement Frequency %

Strongly Disagree 7 8
Disagree 16 18
Neither Agree or Disagree 12 14
Agree 16 18
Strongly Agree 37 42
Total 88 100

4.4. Donor’s Influence on the Program’s Performance

4.4.1. Conflict on Host Government and Donor Policies

From the study 48% of the respondents neither agreed nor disagreed on whether donor policies
conflict with the government policies, 28% disagreed with 9% strongly disagreeing while 10%
strongly agreed with 5% agreeing. Table 4.18 shows levels of agreement with the statement that
donor policies conflict with host government policies.

Table 4.18: Donor Policies and Government Policies Conflict

Level of Agreement Frequency %

Strongly Disagree 8 9
Disagree 25 28
Neither Agree or Disagree 42 48
Agree 4 5
Strongly Agree 9 10
Total 88 100
The study sought to know the perspective of the donor funds to the government, 58% of the
respondent strongly disagreed with the statement that the donor funding received act as
supplement and not a substitute in the national government budget on HIV/AIDS with 25%
disagreeing and 10% being neutral while 5% strongly agreed with 2% agreeing. Table 4.19
shows the results.

Table 4.19: Status of Donor Funding to National Budget

44
 Level of Agreement Frequency %
Strongly Disagree 51 58
Disagree 22 25
Neither Agree or Disagree 9 10
Agree 2 2
Strongly Agree 4 5
Total 88 100

4.4.2. Strict Funding Regulations from the Donor

36% strongly disagree with the statement that the funders are directly involved in running the
routine activities of the program and 34% disagree, with 7% agreeing and 23% being neutral.
Table 4.20 shows the levels of agreement with the same statement.

Table 4.20: Donor Involvement in Running the Program

Level of Agreement Frequency %

Strongly Disagree 32 36
Disagree 30 34
Neither Agree or Disagree 20 23
Agree 6 7
Total 88 100
The study sought to know whether the donors assigned expatriates to run the program. From the
study, 60% of the respondents strongly disagreed that expatriates are not used in running the
program activities with 17% disagreeing with the same while 14% were neutral and 7% agreed
with 2% strongly agreeing with the statement. Table 4.21 shows levels of agreement with the
statement that expatriates are used in running the program activities.

Table 4.21: Donor’s Expatriates and Program Management

Level of Agreement Frequency %

Strongly Disagree 53 60
Disagree 15 17
Neither Agree or Disagree 12 14
Agree 6 7
Strongly Agree 2 2
Total 88 100

45
According to the study, 53% of the respondents strongly agreed that donors are flexible in
adopting local solutions that are cost-effective even if they are not applicable in the donor
countries with 26% agreeing and 10% disagreeing, 6% strongly disagree with 5% being neutral.
Table 4.22 shows the result of the same.

Table 4.22: Donor Flexibility in Adopting Local Solutions

Level of Agreement Frequency %

Strongly Disagree 5 6
Disagree 9 10
Neither Agree or Disagree 4 5
Agree 23 26
Strongly Agree 47 53
Total 88 100

4.4.3. Goals and Objectives of Donors

On ascertaining whether donors use monitoring and evaluation as a control measure to ensure
that funds are well used. 48% agreed that donors use monitoring and evaluation with 31%
strongly agreeing on the same with 15% being neutral and 7% disagreeing. Table 4.23 shows the
results.

Table 4.23: Use of Monitoring and Evaluation

Level of Agreement Frequency %

Disagree 6 7
Neither Agree or Disagree 13 15
Agree 42 48
Strongly Agree 27 31
Total 88 100
According to the study, 39% of the respondents, which were the majority, disagree that funding
depends on the achievement of targets with 15% strongly disagreeing with the same. 28% agree
with the statement with 16% strongly agreeing while 2% were neutral. Table 4.24 shows the
results.

Table 4.24: Funding and Target Achievement

Level of Agreement Frequency %

46
 Strongly Disagree 13 15
Disagree 34 39
Neither Agree or Disagree 2 2
Agree 25 28
Strongly Agree 14 16
Total 88 100
The study sought to ascertain whether the program is meeting the set minimum standards in the
provision of HIV care in African and Sub-Saharan regions. 38% of the respondents strongly
agreed that the program meets the minimum standards set for provision of HIV care in African
and Sub-Saharan regions with 31% agreeing with the same while 15% disagreed with 14%
strongly disagreeing. 3% were neutral to the statement. Table 4.25 shows levels of agreement to
the statement that they meet the set minimum standards in the provision of HIV care in African
and Sub-Saharan regions.

Table 4.25: Compliance with Minimum Standards of HIV Care

Level of Agreement Frequency %

Strongly Disagree 12 14
Disagree 13 15
Neither Agree or Disagree 3 3
Agree 27 31
Strongly Agree 33 38
Total 88 100
The study aimed to establish whether there is timely reporting to the donor. The majority, 65%
strongly agreed that there is timely reporting to donors with 25% agreeing to the same. 9%
disagreed, and 1% was neutral. Table 4.26 shows the levels of agreement to the statement that
they send the donor reports on time.

Table 4.26: Timely Reporting

Level of Agreement Frequency %

Disagree 8 9
Neither Agree or Disagree 1 1
Agree 22 25
Strongly Agree 57 65

47
 Total 88 100
On inquiry whether the program is recognized for its contribution to community service, 58%
strongly agree that the program is recognized for its contribution in community service with 30%
agreeing while 6% disagreed and 2% strongly disagreed, and 5% were neutral. Table 4.27 shows
the results.

Table 4.27: Program Recognition

Level of Agreement Frequency %

Strongly Disagree 2 2
Disagree 5 6
Neither Agree or Disagree 4 5
Agree 26 30
Strongly Agree 51 58
Total 88 100
The study sought to establish whether the program can meet its annual targets, 65% which was
majority agree that they can meet their annual targets with 25 strongly agreeing with 6% being
neutral and 3% disagreeing and further 1% strongly disagreeing. Table 4.28 shows the results of
the same.

Table 4.28: Target Achievement

Level of Agreement Frequency %

Strongly Disagree 1 1
Disagree 3 3
Neither Agree or Disagree 5 6
Agree 57 65
Strongly Agree 22 25
Total 88 100
The study sought to establish whether donors are satisfied with the achievements of the program.
The majority, 47% of the respondents could not ascertain whether the donors are satisfied with
their achievement. 23% agreed with 6% strongly agreeing while 18% disagreed with 7% strongly
disagreeing. Table 4.29 shows the results of the same.

Table 4.29: Donors Satisfaction to Achievement

48
 Level of Agreement Frequency %
Strongly Disagree 6 7
Disagree 16 18
Neither Agree or Disagree 41 47
Agree 20 23
Strongly Agree 5 6
Total 88 100

4.5. Characteristics and Behavior of PLHIV’s Influence on the Program’s

Performance

4.5.1. Adherence to Long Term HIV/AIDS Treatment

According to the study, 36% disagree and 9% strongly disagree with the statement that PLHIV
readily accepts their HIV results, while 34% agree with the statement and 7% strongly agreeing
with 14% being neutral. Table 4.30 shows levels of agreement to the statement that PLHIV
readily accepts their HIV results.

Table 4.30: HIV Positive Results Acceptance

Level of Agreement Frequency %
Strongly Disagree 8 9
Disagree 32 36
Neither Agree or Disagree 12 14
Agree 30 34
Strongly Agree 6 7
Total 88 100

According to the study, 70% of the respondents agreed that client who turns HIV positive are
started on care and treatment immediately with 22% strongly agreeing with the same and 7%
being neutral and 1% disagreeing. Table 4.31 shows levels of agreement to the statement that the
client who turns HIV positive are started on care and treatment immediately.

Table 4.31 Promptness of Starting HIV Care

Level of Agreement Frequency %
Disagree 1 1
Neither Agree or Disagree 6 7

49
 Agree 62 70
Strongly Agree 19 22
Total 88 100

The study also sought to establish the stage at which clients come to seek care for HIV/AIDS.
The study found out that majority, 38% of the respondents indicated that clients come to seek
care at early stages of AIDS disease with 24% agreeing to the same statement with 17%
disagreeing and 11% strongly disagreeing and 10% remaining neutral. Table 4.32 shows the
respondents result on the statement clients come to seek care for HIV at early stages of the
disease.

Table 4.32 Clients Come at Early Stages to Seek Care

Level of Agreement Frequency %
Strongly Disagree 10 11
Disagree 15 17
Neither Agree or Disagree 9 10
Agree 21 24
Strongly Agree 33 38
Total 88 100

According to the study, 64% of the respondents strongly agree with the statement that positive
living enhances adherence to HIV/AIDS treatment with 20% agree with the same statement, with
3% disagreeing and 2% strongly disagreeing and 10% remain neutral to the statement. Table
4.33 shows the level of agreement on the same statement.

Table 4.33 Positive Living and Adherence

Level of Agreement Frequency %
Strongly Disagree 2 2
Disagree 3 3
Neither Agree or Disagree 9 10
Agree 18 20
Strongly Agree 56 64
Total 88 100

50
The study sought to establish whether stigma towards HIV/AIDS contributes to the level of drug
adherence of People living with HIV. The respondents were almost halfway split in agreement
and disagreement of the statement. 44% disagreed with the statement with 3% strongly
disagreeing whole 38% agreed with 9% strongly agreeing and 6% being neutral about the
statement. Table 4.34 shows the results.

Table 4.34: HIV Stigma and Drug Adherence

Level of Agreement Frequency %
Strongly Disagree 3 3
Disagree 39 44
Neither Agree or Disagree 5 6
Agree 33 38
Strongly Agree 8 9
Total 88 100

The study sought to establish whether psychosocial support has relation with drug resistance.
From the study 65% of the respondents strongly agree that drug resistance is more prevalent to
clients with unstable psychosocial support, 27%% agreed with the same statement while 6%
were neutral on the same and 2% disagreed with the statement. Table 4.35 shows the results.

Table 4.35: Drug Resistance and Psychosocial Support

Level of Agreement Frequency %
Strongly Disagree 0 0
Disagree 2 2
Neither Agree or Disagree 5 6
Agree 24 27
Strongly Agree 57 65
Total 88 100

4.5.2. Economic Status of PLHIV

According to the study, 73% strongly agree that financial constraints often affect the HIV/AIDS
treatment outcomes with 22% agreeing and 6% being neutral. Table 4.36 shows the results.

Table 4.36: Financial Constraints and Treatment Outcome

51
 Level of Agreement Frequency %
Neither Agree or Disagree 5 6
Agree 19 22
Strongly Agree 64 73
Total 88 100

The study sought to establish whether PLHIV often engages in transactional sex to meet their
financial obligations. 38% were neutral on the issues while 27% disagreed with 13% strongly
disagreeing, but 22% agreed with 1% strongly agreeing. Table 4.37 shows the level of agreement
of the respondents on the statement that often PHLIV report engagement in transitional sex to
meet their financial obligations.

Table 4.37: Engagement in Transactional Sex to Meet Obligations

Level of Agreement Frequency %

Strongly Disagree 11 13
Disagree 24 27
Neither Agree or Disagree 33 38
Agree 19 22
Strongly Agree 1 1
Total 88 100

4.5.3. Gender
The study sought to establish whether clients gender has an impact on accessing to HIV care and
treatment. 40% of the respondents strongly agree that gender has an impact on access to HIV
care and treatment with 28% agree to the same statement with 18% disagreeing, 7% strongly
disagreeing while 7% were neutral. Table 4.38 shows the results.

Table 4.38: Gender Belief and Access to HIV Care and Treatment
Level of Agreement Frequency %
Strongly Disagree 6 7
Disagree 16 18
Neither Agree or Disagree 6 7
Agree 25 28
Strongly Agree 35 40

52
 Total 88 100

4.5.4. Level of Knowledge on HIV by PLHIV

The study sought to know whether the availability and accessibility of HIV/AIDS information
have helped in improving treatment outcomes. 49% strongly agreed, 25% agreed, 19% were
neutral, 5% strongly disagreed, and 2% disagreed. Table 4.39 shows the levels of agreement to
this statement.

Table 4.39: Improved Information Access and Treatment Outcomes

Level of Agreement Frequency %

Strongly Disagree 4 5
Disagree 2 2
Neither Agree or Disagree 17 19
Agree 22 25
Strongly Agree 43 49
Total 88 100

4.5.5. Correlations and Regression Analysis

The study sought to establish the correlation between the factors of study. There was a positive
correlation between Performance and Strategic Issues, r = 0.029, p = 0.005. Performance and
donor influence have a positive correlation r= 0.289, p=0.006. Performance and PLHIV
Character and behavior also had a positive correlation r= 0.175, p=0.104. This is as shown in
table 4.40 below.

Table 4.40: Correlations

Performan Strategic _ Donor _ PLHIV

ce Issues Influence CharaterBehavior
Pearson 1
Correlation
Performance Sig. (2-
Tailed)
N 88
Pearson
Correlation .029 1
Strategic _ Issues Sig. (2- .005
Tailed)
N 88 88
Pearson
Correlation .0289 .065 1
Donor _ Influence Sig. (2- .006 .544
Tailed)
53
 N 88 88 88
Pearson
PLHIV Correlation .175 -.1024 .0382 1
CharacterBehavio Sig. (2- .104 .342 .724
r Tailed)
N 88 88 88 88

A regression was carried out. The objective of a regression model was to explain or predict
variations in the dependent variable using the independent variables. Regression was used to test
the relationship between the performance of HIV/AIDS program and the Program strategic
direction, Donor effects, and PLHIV Behavior.

The Model summary table provides information about the regression line’s ability to account for
the total variation in the dependent variable. As seen in table 4.41, R was 0.443, which shows a
relative correlation while R square was 0.1963, which tells us the proportion of the variation in
performance that is explained by the three predictors. The three predictors explain only 19.63%
variation in performance. It gives us the standard error of estimate, which we can use to put
confidence intervals around the unstandardized regression coefficients

Table 4.41: Model Summary

Model R R Square Adjusted R Square Std. Error of the Estimate
1 443a .1963 .1676 .24054

As seen in table 4.42, it is significant evidence that the three factors have a level of effect to the
performance of an HIV/AIDS Program. A linear regression established that Strategic Issues,
Donor Influence, and PLHIV Character and Behavior could statistically determine the
performance of a program with F (3, 84) = 6.84, p = 0.000.

Table 4.42: ANOVA

Model Sum of df Mean F Sig.
Squares Square
1 Regression 1.187 3 .396 6.84 .000b
Residual 4.860 84 .058
Total 6.047 87
a. Dependent Variable: Program Performance
b. Predictors: (Constant), Donor _ Influence, Strategic _ Issues,
PLHIV_CharacterBehavior
Table 4.43 below shows the coefficient of variation, a measure of the degree of the relationship
between the independent variables and the dependent variable. From the table, the regression
equation can be formed with the formulae: Y= C+BX1+BX2+BX3 where Y= Program
54
Performance (dependent factor), C=Constant, B=coefficient, X=Independent Factors, i.e.
X1=Strategic Issued, X2=PLHIV Character and behavior, X3= Donor influence. It is evident that
the said factors affect the performance of the program as shown by the equation Y =1.675
+0.239.Strategic Issue+ 0.174.PLHIV Character and behavior + 0.171.Donor Influence.

Table 4.43: Coefficients of Variation

Unstandardized Coefficients t Sig.
Model B Std. Error
1 (Constant) 1.675 .488 3.43 .001
Strategic_ Issues .239 .079 3.00 .004
PLHIV _ CharacterBehavior .174 .088 1.98 .051
Donor _ Influence .171 .064 2.67 .069

a. Dependent Variable: Performance

4.6. Chapter Summary
This chapter gave out details of the research findings; the first part showed the respondents
details while the second part showed the results of the respondent's responses based on the
research topic, factors that affect the performance of the HIV/AIDS programs in African and
Sub-Saharan regions. The data was analyzed to establish the relationship between program
performances with the strategic issues, donors conduct and people living with HIV
characteristics and behavior. The next chapter provides the conclusion, summary, discussions,
and recommendations.

55
CHAPTER V: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS

5. Introduction

In this chapter, a summary of the study, the conclusions, and the recommendations are presented.
Summary section delves on the purpose of the study, research questions, the methodology and
the findings from the research. The discussion section gives a detailed report of the research
questions of the study. The conclusions are based on the researcher's findings presented in the
previous chapter. The last section covers recommendations by the researcher.

5.1. Summary

The purpose of this study was to establish the factors that affect the performance of HIV/AIDS
programs in African and Sub-Saharan regions. Three research questions guided the research;
what are the strategic issues that affect the performance, how do donors influence the
performance of HIV/AIDS programs and how characteristics and behavior of PLHIV affect the
performance of HIV/AIDS programs.

The study adopted a descriptive research design to collect, analyze and interpret data to useful
information. The descriptive research design was used as it is able to bring out how the various
factors interact to affect the performance in a program. The target population consisted of
EDARP employees, which have a total number of 231 employees. Using probability sampling, a
sample size of 115 employees was selected whose names will remain confidential for this study.
Data analysis was done using SPSS, where data was analyzed using frequencies, percentages,
correlation, and regression. The data was presented using Tables and figures.

The study had a response rate of 77% which was statistically significant to analyze the data. The
study showed there is a significant influence on the performance of HIV/AIDS programs by
strategic issues, donor conduct and People living with HIV characteristics and behavior. On
strategic issues from the study, 66% of the respondents could not clarify whether they are aware
of the programs strategic plan or not, Majority, 52% of the respondents agreed that they are taken
for adequate training on project management and only 10% agreed that they consistently carry
out consistent customer satisfaction surveys with 87% reporting, not political interference is
experienced in the program. On donor influence on program performance, 83% of the
respondents said that the recipient governments treat received funds as a substitute and not as a
supplement to the national budget while the majority of the respondents, 79% agreed that donors
use monitoring and evaluation as a control measure to ensure that donor funds are well utilized.
56
From the study, 84% of the respondents agreed that positive living enhance adherence to
HIV/AIDS treatment which is a key component if measuring the performance of a program with
47% of the respondent saying that HIV drug resistance is prevalent in clients with unstable
psychosocial support. Financial constraints were found to often affect treatment outcomes with
95% in agreement with that. On availability and accessibility of HIV/AIDS information, 74%
agreed this has improved treatment outcomes of PLHIV. A linear regression established that
Strategic Issues, Donor Influence, and PLHIV Character and Behavior could statistically
determine the performance of a program with F (3, 84) = 6.84, p = 0.000.

5.2. Discussion

5.2.1. Strategic Issues Affecting HIV Programs

5.2.1.1. Strategic Planning

As advocated for by Bradford (2015), it is important to have a strategic plan that employee is
aware of as they are the implementing personnel; however from the study majority of the
employees, 66% were neutral on their knowledge of the organization's strategic plan. The
development of strategic planning was found to be affected by the funding cycle of the
organization with 61% agreeing with that. This is in line with Bernstein and Sessions (2007),
findings on limitations of the President's Emergency Plan for AIDS Relief funding cycle and
legal commitment.

5.2.1.2. Employee Involvement

The study was in agreement with Stupac and Leitner (2001) that the employees should be
involved by ensuring they are aware of what is expected on them and the matrix used to gauge
their performance. The majority, 52% of the employees agreed that they are taken for adequate
training on project management. The emphasis of training the project employees was
emphasized by Githika (2013), where he said that good project management skills are pillars to
the success and sustainability of community-led projects. Muller and Turner (2007) also found
out that project managers’ success at managing his or her project is dependent on their
competence.

5.2.1.3. Customer’s Focus

Kloppenborg (2009), found out that organizations should engage in measuring customer’s
perceptions of how well the company delivers value to them, this, however, from the study only
10% agreed that they consistently carry out customer satisfaction surveys. Adoption of
technology to improve customer services delivery has a neutral majority of 33%. According to

57
Kaplan and Norton (1992), leading firms across the world are harnessing information technology
to cultivate customer service as a valuable asset to achieve strategic superiority.

5.2.1.4. Political Interference

The study showed a low level of political interference with 87% disagreeing that the government
is involved in running of the organization. According to Mayhew (2002), political interference is
likely to occur and manifest greatly where the donors have interests in local politics. From the
study, 58% said that funding is based on a need basis and not political orientation; however 60%
said that there had been threats of donor withdrawal depending on local political decisions.

5.2.2. Donor’s Influence on Program’s Performance.

5.2.2.1. Conflict of Host Government and Donor Policies

Majority 48% of the employees were neutral on whether their donor policies conflict with host
government policies. This was different from what Oomman, Rosenzweig, and Bernstein (2010),
argued that as both the donors and government engage there are cases of conflicting policies,
especially where changes need to be affected. From the study, 83% of the respondents said that
the recipient governments treat received funds as a substitute and not as a supplement to the
national budget. Governments have been accused of fungibility, which Farag, Nandakumar,
Wallack, Gaumer, and Hodgkin (2009) argued is a source of conflict with the donors,
governments may have competing needs but they need to strike a balance with donor objectives.

5.2.2.2. Strict Funding Regulations from the Donor

On Donor direct involvement, 77% said that donors are not directly involved in running the
program and 77% said that expatriates are not used in running the program activities. This is
contrary to what Regan - Denham (2013), found that there are donors whose style been criticized
by recipient country for employing ‘hands-on management style’ to run the program giving
universal prescription while ignoring the country experience and inducting expatriate consultants
regardless of need. Oomman, Rosenzweig, and Bernstein (2010), argued that donors have a
primary role in ensuring that funds released are purposefully used. Donors employ rules and
regulations that govern the project especially in terms of measuring the outcome, requiring
results that they can directly attribute to their funding.

5.2.2.3. Goals and Objectives of Donors

Majority of the respondents, 79% agreed that donors use monitoring and evaluation as a control
measure to ensure that funds are well utilized. The uptake of monitoring and evaluation has been
noted to be on the increase as a tool to help the organization keeps track of their projects
58
(PEPFAR, 2014). The study revealed that funding does not necessarily depend on the
achievement of annual targets with 54% agreeing with this.

5.2.3. Characteristics and Behavior of PLHIV’s Influence on the Program’s

Performance

5.2.3.1. Adherence to Long Term HIV/AIDS Treatment

45% of the respondents said that clients receiving HIV positive results do not readily accept
them. On promptness of starting care, the study showed that 92% of clients tested HIV positive
start care immediately, which was in agreement with Wagner, Wu, and Sood (2014) that clients
found HIV positive should be put on care before their health deteriorates. 36% said client come
to seek care at the early stages of the AIDS disease. The study showed that 84% were in
agreement that positive living enhance adherence to HIV/AIDS treatment which is a key
component if measuring the performance of a program. On adherence, 47% said that HIV drug
resistance is prevalent in clients with unstable psychosocial support. These findings support what
Martinez, Harper, Carleton, Hosek, Bojan and Glum (2012), said in support of Positive Health,
Dignity, and Prevention activities which focus on keeping PLHIV physically healthy; keeping
PLHIV mentally and psychologically healthy; preventing transmission of HIV; and involving
PLHIV in HIV prevention activities.

5.2.3.2. Economic Status of PLHIV

Morton (2005) found out that there is a link between HIV/AIDS and poverty in that the impacts
of the epidemic can increase the susceptibility of certain social groups, the study affirmed this
with 95% in agreement that financial constraints often affect treatment outcomes. Nxumalo,
Okeke, and Mammen (2014), also found out that poverty has a causal relationship to HIV/AIDS
where in more impoverished areas women start having sex much earlier, without good education
and empowerment. On checking how often clients engage in transactional sex to meet their
financial obligations, only 23% agreed that this is often reported.

5.2.3.3. Gender
From the study, 68% agreed that gender belief has an impact on accessing to HIV care and
treatment. This was in agreement with the World Health Organization (2009) who cited that
gender inequalities arise hindering access to treatment. Walden 2007 also found out that in
Africa due to cultural traditions and believe women be more vulnerable to HIV than men. He
cited a situation where women, are culturally obliged to have sex, with little option of saying no.

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 5.2.3.4. Level of Knowledge on HIV by PLHIV
74% agreed that the availability and accessibility of HIV/AIDS information have improved
treatment outcomes of PLHIV. According to NASCOP (2014), correct knowledge of HIV/AIDS
and perceptions of personal risk for HIV infection are essential for making behavioral choices
that reduce the risk of acquiring and transmitting HIV/AIDS. National AIDS and STIs Control
Programme, for more than past 15 years have engaged in educational campaigns in African and
Sub-Saharan regions have aimed to disseminate information about the disease, how it is
acquired, and how to prevent new infections.

5.3. Conclusion

5.3.1. Strategic Issues Affecting HIV Programs

The study concludes that it is imperative that employees are aware of the strategic plan, what
they are expected to do and how their performance will be measured. The study also concludes
that it is important to train the implementation staff on project management skills. The study also
concludes that customer’s perceptions on how well the company delivers value should be
consistently monitored.

5.3.2. Donor’s Influence on the Program’s Performance

The study concludes that donors influence the performance of HIV/AIDS programs. The study
concludes that there are areas of conflict between the donor policies and the host government
policies. The study also concludes that donors employ strict funding regulations but are keen to
let locals run the programs. The study further concludes that donors employ monitoring and
evaluation to ensure that goals are met.

5.3.3. Characteristics and Behavior of PLHIV’s Influence on the Program’s

Performance
The study concludes that PHLIV’s adherence to long term ARV treatment affect the
performance of a program with positive living and psychosocial support being a major
determinant of adherence. The study also concludes that financial constraints and gender beliefs
hurt the treatment outcome of PLHIV while availability and access to information about
HIV/AIDS have a positive effect on treatment outcome.

5.4. Recommendations

5.4.1. Recommendations for Improvement

5.4.1.1. Strategic Issues Affecting HIV Programs

The study recommends that all employees should be engaged and be made aware of the strategic
direction of the program. The study recommends that programs offer implementation staff with
60
adequate training on project management issues. To gauge performance in service delivery and
ensure right decisions are being made the study recommends that programs should consistently
carry customer satisfaction Surveys.

5.4.1.2. Donor’s Influence on the Program’s Performance

To avoid conflict between the donor policies and the host government policies, the study
recommends prior agreement of the need that the donor wants to address. The study also
recommends that the implementing staff should comply with the donor requirements especially
employment of monitoring and evaluation within the program.

5.5.1.3 Characteristics and Behavior of PLHIV’s Influence on the Program’s

Performance
The study recommends that the promotion of adherence through positive living and psychosocial
support be intensified. Where applicable, the study recommends that programs adopt a holistic
care approach where there is a concern of livelihood, where clients can be supported in
establishing income-generating activities. The study also recommends that dissemination of
information about HIV/AIDS be enhanced.

5.4.2. Recommendations for Further Research

Recognizing the vastness of the donor’s program areas and variation of beneficiary needs, the
study recommends that further studies can be done in different program areas with different
donors and beneficiaries.

61
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