AEGiS-15IAC: Tracking global fund policy processes in four African countries.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Tracking global fund policy processes in four African countries.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrE1037)

Brugha R, Donoghue M, Starling M, Ndubani P, Ssengooba F, Fernandes B, Walt G
London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom

BACKGROUND: The Global Fund to Fight AIDS, Tuberculosis and Malaria is a new financial instrument providing large resources to disease afflicted countries. 60% of funds have been approved for HIV/AIDS control, most to Africa. While too early to assess its impact, we report findings on the functioning of new country structures, which will be critical to the Fund's success.

METHODS: Semi-structured interviews were conducted in mid 2003 with 137 national level stakeholder representatives, including 65% of Country Co-ordination Mechanism (CCM) members in Mozambique, Tanzania, Uganda and Zambia. Further data collection and interviews will be conducted, February-May 2004.

RESULTS: CCMs were not yet well embedded in country systems, partly due to uncertainties around their purpose once Fund support had been approved. Competitive tensions, as well as lack of clarity, were evident in their remit vis-a-vis national AIDS authorities. The Global Fund was supporting the development of new partnerships between government, private-for-profit and civil society sectors, although the latter's expectations were difficult to contain and mistrust among partners was evident in some settings. The Fund was also catalysing the development of country policies around access to antiretroviral treatment. Governments were attempting to manage multiple new HIV/AIDS financing initiatives, including World Bank MAP and Clinton Foundation which, if well co-ordinated, could improve treatment access and HIV control.

CONCLUSIONS: Greater coherence and co-ordination among financing and technical agencies are required, if global and country HIV/AIDS goals are to be reached. These and further findings from field work in 2004 (on CCM, Principal Recipient, disbursement and Local Fund Agent processes) will provide important early lessons on policy and systems opportunities and obstacles to the Global Fund's success.

Keywords: AEGIS, Financial Management, Acquired Immunodeficiency Syndrome, Public Policy, United Nations, HIV Infections, Tuberculosis, HIV Seropositivity, Malaria, Africa, Zambia, Mozambique, Tanzania, Uganda, economics, organization & administration

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MoOrE1037