National 4 (Spotlight Weekly)

15th International Conference on HIV/AIDS, Bangkok

Funding The Response To HIV/AIDS: Why Are Donors Not Working Together

Two decades fighting this epidemic have taught us a clear lesson: HIV/AIDS is not just a health issue. HIV/AIDS is a development issue. As such it requires a multisectoral response. It cannot be left to health ministries alone. Its impact is just too significant. If you are a public official in the business of education or infrastructure or public administration or just about anything else, this means you too. If there is no national collaboration across a broad front within governments, the fight is doomed to be less than effective.

So we need all disciplines to work together. But we also need all actors to work in concert, national and global. That means donors, governments, and civil society including people living with HIV/AIDS, the scientific community, the business community and often also the religious community. Countries need a coordinated national multisectoral response AND donors need to be an integral part of that response. This understanding has brought us together here in Bangkok. HIV/AIDS challenges us to become true partners. We have different backgrounds, different ideas and different experiences. But we are gathered here as one with a shared goal: we want to reverse this epidemic; we want to prevent new infections; we want to provide care and treatment for those in need.

Today we have increasing resources, an increasing number of donors, and an increasing urgency for rapid and more comprehensive action. So how do we ensure that all resources are used effectively and efficiently?

The core issue then is not whether co-ordination of donor support is a good thing. The question is how to achieve it. What are the barriers to co-ordination? I would argue that if donors are not working together well enough, the issue is leadership.

First on the side of governments. The governments must take the lead in ensuring that donors collaborate and coordinate with each other in the interest of the country. Be tough. Don’t let donors get away with going it alone.

Who are these leaders?

They are the leaders willing to take a firm stand on the fight against HIV/AIDS. And they are at the highest level at both national and provincial levels, in business community, media, and the arts to give some examples.

They are the leaders who will develop a vision and a strategy for their country. They will mobilize all sectors – key line ministries, NGOs, people living with HIV/AIDS, businesses

They are the leaders who will take vision into action

They are the leaders who will demand better results. Leaders who demand accountability from all sectors

And they are the leaders who will exploit the knowledge of external partners. Leaders who value global experiences and lessons learned. Leaders who bring these lessons into their countries without fear of rebuke.

Easier said than done but our world has seen such leaders. Leadership is possible.

Let’s get back to the question: why are donors not working together? I want to argue that donor coordination, if you are lucky enough to have it, is great. But not good enough by itself. First and foremost this effort requires leadership in countries.

And then the question becomes: How can all of us here, with our different roles, different experiences, and help to make the space for this leadership. We can begin, donors and countries alike, by recognizing some serious challenges.

Some countries mistrust donor coordination. Suspicions arise.

Will donors with a unified voice not push their own agendas? A country could rightly fear this, fear losing control. After all, aid dependency is a serious issue for some countries. Would donors’ own interests need subsume a country’s? Would national programs lose flexibility? Would a diversity of views be dampened? These are all real fears.

Many countries are skeptical of the benefits of donor coordination.

To deliver its benefits, donor coordination cannot be a tool for control. Not by governments and not by donors. It should be used to ensure we make best use of all resources available, avoid expensive duplication, ensure that gaps are filled, mobilize financial, technical, and human resources, enhancing our effectiveness in the response. This goes back top the earlier point: a multisectoral effort involving all actors.

And donor coordination needs to ensure accountability. Can we all see results and impact on the ground? And can we see these results through the lens of our partnership, not individual lenses?

Countries need to come to understand that donor coordination with their leadership is fundamental. This challenge is too big, the loss too great for us to waste time or resources in a fight about how we come together.

And for their part donors too need to recognize this leadership -- good leadership, genuine leadership. When that is in place what donors need to be is good partners. Good partners make space for good leaders.

Access to and for ALL

Key messages - Breakthrough in Bangkok

* Economic and human impacts of HIV/AIDS are massive and long lasting

* Money and drugs are necessary but not sufficient

* Epidemically HIV/AIDS is different across the globe – a variety of approaches are required in different settings

* Commitment of leadership was much more emphasized- commitment means putting in place and making arrangement for resource allocation, policy, plans, programs, human resource and monitoring and evaluation mechanism

* HIV/AIDS is not only a health issue – is a development & multi-sectoral issue, is important to break the silos and have a multi-front coordinated response

* Need to put HIV/AIDS as a National agenda for a broad paradigm from prevention to treatment and rehabilitation

* HIV/AIDS is not only ABC (Abstinence, Behavior change and Condom) nor it is only CNN (Condom, Negotiation and Needle)

* Involvement and participation of IDUs (injecting drug users), Youths, Community groups, PWAs (People with AIDS) religious groups, sex workers and other risk groups is highly important. Road to all religion converges for HIV/AIDS. Fighting HIV/AIDS is fighting fear and ignorance by all

* Tackle the challenge of capacity constraints and move beyond the limits of health, trapped by tiny implementation constraints (holding in health - hesitation in relinquishing responsibility, indicating lack of inertia)

* Inject flexibility in rules – financing and procurement and making extensive use of rapid result management model is the demand of the hour

* Coordinated and coherent response for a linked approach with a sustainable plan and program based on human rights encouraging all parties for this global emergency cause

Prominent Leaders’ Message

Kofi Anan, UN Secretary General was specific on leadership, commitments and gender role.

Nelson Mandela called on wealthy countries to fully finance the global fund for AIDS, Tuberculosis, and Malaria, and to better include the voices of young people and women in all dimensions of the fight against AIDS.

Graca Michel, Patron of International AIDS Society, emphasized on accountable commitment and transform it to actions of love and care with supportive programs and financing resources needed.

J.W. Lee, Director General of the WHO, said that the three by five initiative, which aims to treat 3 million people with life-saving drugs by 2005, was moving ahead briskly, and also thanked the World Bank for its commitment to the fight against HIV/AIDS, noting that much has changed at the Bank under Jim Wolfensohn.

Peter Piot, the head of UNAIDS, called for more debt relief for African countries, and the savings to be channeled into greater spending on health and education which he described as ‘the building blocks of the AIDS response.” (Under the existing Heavily Indebted Poor Countries Initiative of the World Bank and the IMF, more than 50 percent of debt savings must be invested in health and education programs).

Jean-Louis Sarbib, Senior Vice President and Head of the HD Network, who led the team in Bangkok, said the conference amplified the Bank’s belief that political leadership was key to confronting the disease; that HIV/AIDS required a cross-sectoral response to what was the most profound development challenge of our times; that prevention still remained highly important even as the world rightly pushed to widen access for people living with HIV/AIDS to the cheapest life-saving drugs; and that women, and young people needed to be fully represented in national and global meetings that decided the future course of AIDS policy and treatment.

Praful Patel, Vice President South Asia Region of the World Bank as a panel member of one of the important session of the Leadership Program, stressed on role of donors’ coordination for promoting collaborated response to HIV/AIDS.

Debrework Zewdie, Director of the Bank’s Global HIV/AIDS Program, also served as a UNAIDS co-chair of the Bangkok summit’s Leadership Program, which brought together senior leaders from the political, business, medical, and NGOs for the first time to underline their special role in leading the fight against AIDS from the top. Her speech made it clear that the promises of new commitment made in Bangkok by leaders of all stripes, would be closely monitored for their results between now, and when the international AIDS community met again en masse, in Canada in 2006.

The global media at this summit was virtually commandeered from the outset by the noisy protests of a wide array of activist groups against Western pharmaceutical companies, the Group of Eight, and in particular the Bush Administration for its AIDS policies and financing of country-based abstinence programs with its Presidential emergency funds.

Nepal HIV/AIDS and immediate lessons that can be applied from XV International Conference

Nepal is already facing concentrated epidemic in risky group of population, lack of action at this point can be alarming as it can help move epidemic into generalized form.

HIV/AIDS is not only a health problem, it is a broader development issue. Losing time in taking decisive action would prove the failure of leadership and commitment.

Place/mobilize HIV/AIDS existing prominent leadership structure to benefit enhanced commitment, legislation, flexible regulation, capacity building and to expedite program implementation efforts.

Steer/implement multi-sectoral coordinated response as an emergency step. HIV/AIDS management needs a much more autonomy and delaying a decision to do so would be fatal to the goodwill and support from a variety of stakeholders including the donor communities.

Scale up advocacy from all fronts inclusive for prevention and cure involving all concerned parties including community groups, religious and faith persons.

(Prepared by Tirtha Rana of The World Bank based on the happenings at the 15th International AIDS Conference in Bangkok on July 16-21)