Supporting community action on AIDS in developing countries

November 2011

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Policy briefing – HIV and Aid Effectiveness A leadership role for Ministers, government representatives, parliamentarians, civil society organisations and private sector representatives in supporting an effective response to HIV Introduction This paper has been prepared by the International HIV/AIDS Alliance (‘the Alliance’) in the run up to the Fourth High Level Forum on Aid Effectiveness, in Busan, Korea from 29 November – 1 December 2011. The Forum offers a critical opportunity to highlight how the HIV and AIDS response demonstrates the value of the Paris Declaration Principles of aid effectiveness both at the global and country level1

. We learned important lessons from the scale up of HIV and AIDS response that should be reflected in the Global Partnership for Effective Development Cooperation (see box right), which the Forum aims to establish.

International HIV/AIDS Alliance (the Alliance)

The Alliance is a global partnership of NGOs and community-based organisations working in over 40 countries in Africa, Asia, Eastern Europe and Latin America and the Caribbean. This global partnership supports community action to prevent HIV infection, meet the challenges of AIDS and build healthier communities. As a global civil society leader on HIV community mobilisation and practice, with a solid engagement in aid effectiveness processes such as the Country Coordination Mechanism (CCM) model of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the International Health Partnership and related initiatives (IHP+)2

, the Alliance has a wealth of experience and evidence to draw upon. We have prepared this briefing for policy makers and donors to support their efforts to boost the impact of development aid in order to improve lives.

1 The Paris Declaration Principles are: Harmonization; Alignment; Country Ownership; Mutual Accountability; and Managing for Results. 2 International Health Partnership and Related Initiatives seeks to achieve better health results by mobilizing donor countries and other development partners around a single country-led national health strategy, guided by the principles of the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action

The Global Partnership for Effective Development Cooperation aims to be consistent with international agreements on human rights, decent work, gender equality and disability and be based on the following common principles: - Ownership of development priorities

by developing countries and their citizens

- Focus on results - Inclusive partnerships - Accountability to citizens and among

donors and development partners.

Supporting community action on AIDS in developing countries

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1) Apply lessons learned from the HIV and health sector on how to improve alignment to national plans, budgets and M&E frameworks, such as The Three Ones and the IHP+

The effective use of alignment and harmonization models such as the Three Ones (one national HIV and AIDS strategy, one national HIV and AIDS coordinating authority and one national M&E Framework) and the IHP+ contributes significantly to aid effectiveness. IHP+ established in 2007 and coordinated by the WHO and the World Bank follows the principle of the “Three Ones” and seeks to achieve better health results by putting aid effectiveness principles into practice in the health sector. IHP+ encourages support for a single country-led national health strategy through support to national planning processes, joint assessment of national strategies and plans (JANS), country compacts, reporting on a common results monitoring framework, and monitoring progress against compact commitments. Since signing the Global Compact, the 52 IHP+ partners (developing and donor country governments, international agencies and civil society) have committed to aligning the health components of national AIDS plans with national health strategies. IHP+ could potentially offer a model for how to effectively align, harmonise and coordinate the various funding mechanisms – vertical and horizontal- for AIDS and health systems strengthening.

2) Invest in community-based responses to ensure improved health

results Community-based organisations and networks of people living with HIV and AIDS have assumed key roles in planning, co-ordination and implementation of national HIV and AIDS responses. Community systems strengthening contributed to improvement of treatment literacy and adherence, referrals to public health systems, as well as continuing essential support for awareness raising and prevention initiatives. They fill a valuable void in ensuring that social support and care interventions are effective and stretch to hard-to-reach communities, in particular vulnerable and marginalised groups.

Case study: The Alliance and the IHP+ The Alliance, through its membership of the European NGO network Action for Global Health, has been actively contributing to the IHP+ and its implementation at the country level. Since the launch of the IHP+ in the UK in September 2007, the Alliance has been advocating for the meaningful engagement of civil society in the IHP+ at global and country levels. It has also advocated for additional funding to achieve the health MDGs, but through the IHP+ for this funding to result in genuine progress in aid effectiveness and not just a redistribution of resources from the AIDS response to other under-funded areas. The Alliance continues to be actively engaged in monitoring the progress of the IHP+, in particular regarding the alignment of national AIDS and health plans in IHP+ country compacts.

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3) Promote an enabling environment for country ownership that

guarantees the space, transparency and conditions necessary for civil society to meaningfully participate in aid delivery processes

The active participation of communities, key populations groups, households and individuals who are directly affected by HIV – in all stages of programme development, implementation, and monitoring – is central to community action and promotes country ownership. Ensuring meaningful country ownership allows communities to determine what works best, resulting in a strengthened design and delivery of HIV and health programmes. The involvement of people most affected by HIV helps to ensure that aid is effective, relevant and has the greatest impact. The Country Coordinating Mechanisms (CCMs) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is a good example of how to foster broad country level stakeholder engagement in the planning, implementation and monitoring of aid mechanisms (see case study below). Sadly, even though the Global Fund is one of the most effective global mechanisms for promoting aid effectiveness in the health sector, it has been forced to cancel its next funding round for 2012 -2014 due to lack of sufficient donor support. This will have a devastating effect on people and communities affected by HIV and AIDS, as well as TB and malaria, and on overall health outcomes.

Case study: Strengthening community systems in South Sudan

South Sudan has the highest maternal mortality rate in the world: one in every 50 live births results in the death of the mother. The provision of appropriate health care, especially maternal health, is arguably the most pressing issue for the construction and stability of the new Republic.1 Women living with HIV are more likely to die in pregnancy or childbirth than a woman without HIV. HIV and AIDS may be contributing to almost a third of the global maternal mortality rate.2 In order to address the severe health challenges posed by maternal morbidity in the absence of a well-established and functioning public health system, Alliance South Sudan has over the past six years worked to strengthen the capacity of community based organization to deliver community based care in strong partnership with the public sector. Community based organisations contribute to the strengthening of the health system by filling some of its most essential gaps, such as educating women and their families about safe delivery, sexual and reproductive health and prevention of mother to child transmission of HIV, facilitating the uptake of services by women through referral systems and providing transport, and supporting the ongoing treatment, care and support of both mother and child. The entire health care system benefits from this partnership. 1 Reuters, “Maternal mortality highest in South Sudan-UN”, 6 June 2007 2 Maternal mortality for 181 countries, 1980-2008: a systematic analysis if progress towards MDG5, The Lancet, May 2010

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4) Use strategic models that promote community involvement, such

as the new Investment Framework3

, to achieve value for money and increase aid effectiveness

Research4

has shown that capacity building and strengthening of community based organisations increases the quality and sustainability of HIV prevention, treatment, care and support programmes, supports stronger linkages between different parts of the local HIV and AIDS response and achieves better value for money.

UNAIDS recently published the Investment Framework for an effective response to HIV and AIDS which explicitly promotes the role of community mobilisation and community centred design and delivery in creating an enabling environment for achieving maximum impact and targeting services at populations with the highest need. Implicit in the framework is the principle of “funding the right thing” as applied to specific country epidemic dynamics and according to the evidence of their effectiveness.

3 Towards an improved investment approach for an effective response to HIV/AIDS (read the full article here), UNAIDS and others (2011) 4 Evaluation of the Community Response to HIV and AIDS (read the summary here), A World Bank – DFID Partnership (2011)

Case study: Global Fund Country Coordinating Mechanisms

Country Coordinating Mechanisms (CCM) are a country-owned coordination body which includes stakeholders from different constituencies. It is central to the commitment of the Global Fund to country ownership and participatory decision-making. The CCMs include representatives from governments, multilateral or bilateral agencies, non-governmental organisations, academic institutions, private businesses and people affected by HIV and AIDS. They lead in the development of the Global Fund proposals and oversee progress during implementation of national programmes supported by the Global Fund. For example, 23 of the countries in which the Alliance works have CCMs that include people living with HIV and AIDS. In Latin America specifically, six of the countries in which the Alliance works (Ecuador, El Salvador, Peru, Colombia, Bolivia and Mexico) have representatives of people affected by HIV on CCMs, mainly through the participation of sex workers and transgender people. Participation of people affected by HIV has helped to ensure more effective use of resources because funding started to be channelled to populations most affected by HIV and AIDS.

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Summary of key messages • Ensure civil society and local communities are placed at the heart of Global

Partnership for Effective Development Cooperation • Promote an enabling environment for country ownership that guarantees the space,

transparency and conditions necessary for civil society to meaningfully participate in aid delivery processes

• Use strategic models that promote community involvement, such as the new Investment Framework5

• Apply lessons learned from the HIV and health sector to improve alignment to national plans, budgets and M&E frameworks, such as The Three Ones and the IHP+

, to achieve value for money and increase aid effectiveness

For more information, contact Olga Golichenko, Global Health Advocacy Officer: ogolichenko@aidsalliance.org (attending the Forum) www.aidsalliance.org

5 Towards an improved investment approach for an effective response to HIV/AIDS (read the full article here), UNAIDS and others (2011)

Case study: Assessing value for money of community-based action in India In response to the growing urgency to effectively demonstrate value for money and cost efficiency and effectiveness, the Alliance has been piloting a methodology based on measuring and valuing social and health outcomes against investment. The social return on investment (SROI) is a framework to measure and account for the value created by a programme or series of initiatives, beyond financial value. It incorporates social, health, environmental and economic costs and benefits. In October 2010, Alliance conducted a SROI study, Social Return on Investment: CHAHA Programme. It assessed a child-centred home-and community-based care and support initiative, a 3.5 year Global Fund programme being implemented by Alliance India and the community based partners. The results of the study of work in Maharastra State illustrated that for every $1 invested in CHAHA from 2008-2010, $4 of social, health and financial value was generated. More than half (52%) of this value was accrued to parents and caregivers with just under half (45%) benefitting children directly. Most value was created through improvement in livelihood status, improved health status of the child, children having better income prospects and improved educational attendance and status.