UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay and Kathleen McLaughlin, Director, McKinsey & Company, co-moderators of the satellite session at AIDS2012, Country Ownership: Using Global Partnerships to Accelerate Health System Transformation
Credit: UNAIDS/Y.Gripas
Country ownership and leadership provide a solid foundation for developing national AIDS responses that are effective, efficient, sustainable and, ultimately, successful. How can this be achieved and reinforced in a meaningful way? During the International AIDS Conference a high-level series of panel discussions explored, on 23 July, how countries can play more of a central ownership and leadership role in responding to their epidemics and how partners can support this process to increase the sustainability of national AIDS responses.
The satellite session, Country Ownership: Using Global Partnerships to Accelerate Health System Transformation, was hosted by the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, McKinsey & Company, and the governments of Rwanda, Nigeria and Botswana.
In his opening remarks, UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay reminded delegates that assuring a sustainable response to AIDS is a shared responsibility among countries, donors, civil society organizations, people living with HIV and other key stakeholders. “Each partner has a specific role to play in supporting national AIDS responses and all partners are mutually accountable to each other in maintaining their commitments,” said Dr De Lay.
The first panel discussion revolved around the current status of country ownership of national AIDS responses, and examined the successes and challenges in accelerating ownership. Participants acknowledged that despite recent progress, more efforts were needed to achieve ambitious international targets such as those set out in the 2011 UN General Assembly Political Declaration on AIDS. These goals could only be reached, it was agreed, through countries fully owning and leading their responses.
“Rwanda owns it AIDS response and it has been successful,” said Dr Agnes Binagwaho, Rwandan Minister of Health. “We developed a vision of where we want to go in responding to AIDS and have chosen the path to get us there. We need to align ourselves internally first and before we start worrying about aligning our partners,” she added.
During the discussion, there was a consensus that a number of necessary conditions for true country ownership exist. These include: strong political engagement and inclusive leadership; high-quality strategic information; effective coordination; capacity development; robust national strategic plans with smart investment decisions; integration of HIV into broader health and development strategies; and full engagement of civil society and people living with HIV.
“Civil society organizations need to own the response. They have the potential to play major roles in developing, implementing and monitoring national strategies, but often are not fully welcomed by governments and are thus not fully engaged,” said Rolake Odetoyinbo, Executive Director, Positive Action for Treatment Access of Nigeria. “Without full engagement of civil society organizations, there is no country ownership,” she added.
In the second panel, the idea of shared responsibility was explored in more depth. It was noted that there is a growing appreciation by countries, donors and other key stakeholders that a long-term response to the epidemic requires just such a mechanism. This is especially the case as strong partnerships have been, and will continue to be, the backbone of national AIDS responses. Countries and their partners now acknowledge that ‘we are all in this together’.
Each partner has a specific role to play in supporting national AIDS responses and all partners are mutually accountable to each other in maintaining their commitments
UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay
“For sustainability, we now need to transition programs from PEPFAR implementing partners over to governments,” said Ambassador Eric Goosby, US Global AIDS Coordinator. “This is not an attempt to ‘cut and run’ but to ensure that the life-saving and life-prolonging services that we have put in place will be there for the people who need them for the rest of their lives. Countries need to diversity the resources that support these programs, including increased funding from domestic sources,” he added.
The principle of shared responsibility encompasses the need for countries to achieve stable and predictable financial flows, from both domestic and international sources. This is particularly the case in sub-Saharan Africa where two-thirds of AIDS expenditures come from external sources.
“A major risk to AIDS programs in Africa is lack of long-term funding. Many African economies, however, are growing rapidly. This provides an opportunity for countries to increase domestic financing of the national AIDS responses,” said Professor John Idoko, Director General of the National Agency for the Control of AIDS in Nigeria. “We can and must increase domestic investments for AIDS” he added.
If this shared responsibility and global solidarity is to be attained, it was agreed, countries should demonstrate political leadership through the articulation of a national AIDS, health and development vision that pulls partner efforts into alignment. Development partners and governments can work together to fill the HIV investment gap together, through both traditional and innovative means, investing their ‘fair share’ based on ability and prior commitments. Resources can then be allocated according to countries’ needs and priorities for greatest impact.
“The Global Fund is working closely with countries to help them invest in those activities with the highest return on investment,” said Mark Edington, Head of Grant Management at the Global Fund to Fight AIDS, TB and Malaria. “The Global Fund is committed to country ownership and assuring financial sustainability of national programs. In this regard, we are increasingly working with Ministries of Finance to discuss long term financing,” he added.
Great progress has been made in responding to the global AIDS pandemic, but many challenges remain. Assuring country ownership and acknowledging that responding to AIDS requires a shared responsibility will help countries and partners move towards achieving the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
