PartnersGF - 2004-06-28
International HIV/AIDS Alliance Discussion Paper for:
"Questioning the Community Sector: Are We Making a Difference?"
Satellite Meeting, Bangkok International Conference
"Who Will Take the Money and Run with It?"
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[Part 1 of 2]
Introduction
After years of passionate advocacy informed by solid policy work on the ground, we are finally in a position where the global response to HIV/AIDS is better resourced and politically supported. In his State of the Union Address last year, President Bush announced his Emergency Plan for AIDS Relief (PEPFAR) that provides $15 billion, including nearly $10 billion in new funding, to fight the HIV/AIDS epidemic over the next five years. Meanwhile, The Global Fund for AIDS TB and Malaria continues to garner financial commitments with current projections suggesting that some $900 million will be available for the fourth round of grant funding. While still not enough, these new millions and the political sea change that they represent - are very welcome. However, they bring a number of urgent and complex dilemmas for the community sector.
This paper is designed to contribute to a reflection on some of the pitfalls and questions that the community sector must respectively avoid and answer in order to ensure best use of the new HIV/AIDS money. This document begins by exploring the type of money that is being offered for AIDS work and how to address the blockages that prevent funds reaching community groups on the ground: is it lack of capacity to absorb or disburse in effective ways? We then move on to an analysis of the type of race we are running in our efforts to outpace the epidemic: is it a 100m sprint or a marathon? Finally this paper asks with whom or against who are we running and are government/community partnerships 'marriages of convenience' or committed relationships?
These are all issues which the International HIV/AIDS Alliance is struggling with at the moment. Having supported community responses in partnerships with NGOs and CBOs from over 40 countries, we believe that future success in curbing the epidemic depends on how we collectively answer these questions.
1. New money: Capacity to absorb or capacity to disburse?
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"Absorptive capacity" is used in this text to refer to the ability of a society to deal effectively with sudden inflows of capital. In the present HIV/AIDS context, we can interpret it as referring to the capacity of organizations and sectors to use the forthcoming influx of funds to have a significant effect on the epidemic and on peoples lives.
More money in the pipeline has triggered many questions. Have we, for example, got enough people in institutions which have appropriate infrastructures in the countries which most need to scale up their response? And have those people not only got the professional knowledge and skills, but the all-important personal compassion, creativity and commitment? Lack of absorptive capacity of local NGOs has, for example, been given as partial explanation of low disbursement rates of World Bank funds in Mozambique.
There have also been voices signalling that local civil society processes might be undermined by the sudden increase of resources. On the one hand, this can reduce incentives to be more accountable and to adopt good policies which reform inefficient institutions, while corruption, can escalate and the development of a healthy civil society be impeded (i). On the other hand, when these resources are channeled to civil society through government institutions, there is a risk that the necessary community mobilization and activism may be reduced rather than enhanced.
As such, absorptive capacity is a very real challenge; but "should it be an excuse for inaction or a mandate for focused action?" (ii). There is increasing evidence that poor countries could readily absorb considerably higher levels of aid (iii). To make the most of the increase in funding we need to start to re-equip ourselves for the challenges ahead. In particular, the community sector needs to continue to use its collective imagination to identify and catalyze local groups and organizations that can make an impact on HIV/AIDS.
We can do this by expanding the existing programs of organizations that have the potential to make the greatest difference. Sevanilayam, Alliance India's lead partner in the state of Tamil Nadu, has been working with communities for more than two decades on issues of development. Over the last few years it has integrated health programs into its existing development work and established community health centres where there was no previous access to primary health care. This has significantly increased the services available within the local community and Sevanilayan is now a 'centre of excellence' for training village health care providers in home-based care.
The ongoing provision of relevant and high quality technical support is, from our experience, crucial for increasing the capacity and effectiveness of community based organizations. This is because practical skills (e.g. peer education and home based care), appropriate attitudes (e.g. compassion and being non-judgmental) and organizational development (e.g. strategic planning and budgeting), form the bedrock of effective community action on HIV/AIDS.
It has also been demonstrated that increased spending on commodities, such as ARVs has relieved some health systems that were formerly over-stretched by HIV/AIDS. This includes reducing the number of beds occupied by people living with HIV/AIDS (PLHA), enabling HIV positive staff to continue their work and helping to preserve institutional knowledge (iv). This is the experience of Brazil.
Indeed, in parallel to absorptive capacity, we need to address the equally pressing question of the disbursement capacity. In the present HIV/AIDS context, this refers to the ability of governments and international agencies to disburse funds so as to have a significant effect on the epidemic and on peoples lives.
According to recipient countries' and communities' points of view, more money in the pipeline has also triggered many questions. National AIDS agencies are asking how can they be expected to cope with all the visitors, requests for separate accounts, different strategies, indicators, sustainability strategies, etc
that donors bring with them? Small NGOs and community groups have, of course, similar questions i.e. when they manage to get the information that the money is there in the first place!
The "Three Ones" (v) is an attempt by donors and national governments to make progress on this issue. This is a strategy supported by UNAIDS and others that promotes: one national AIDS strategy; one national governing body; and one way to monitor and report on progress. With the active involvement of civil society in their development and management, such strategies have great potential for harmonizing national systems and, in turn, reducing duplication and increasing efficiency.
Alliance's partners are working with innumerable NGOs/CBOs that are doing highly effective work and are ready to do more, but lack access to even minimal resources, even in countries where the millions are pouring in. Burkina Faso is a good example of where PLHA networks and community groups with enormous potential and capacity to contribute to ARV service provision are confronted with enormous difficulties accessing resources in the way they are being made available; there are, of course, many more. Is it about absorptive capacity, disbursement capacity or a combination of both?
[continued in Part 2, which follows shortly]