Can communities influence donor money for HIV? Evidence from eight African countries.
Presenter(s): Gemma Oberth (CSSR)
Abstract / Description:
Background: The Global Fund to fight AIDS, Tuberculosis and Malaria is the largest funder of the three diseases worldwide. One fifth of Global Fund grants are implemented by civil society organizations. However, the degree to which civil society and community groups are able to shape the content of those grants through the initial proposal (called a “concept note”) is uncertain and hard to measure.
Methods: Global Fund concept notes from Kenya, Malawi, Swaziland, Tanzania, Uganda, Zanzibar, Zambia and Zimbabwe were systematically measured to assess the inclusion of civil society priorities. National Civil Society Priorities Charters were used as indicators for civil society priorities. Each priority in the country’s Charter was assessed for its inclusion in the Global Fund concept using a three-point scale (2=included, 1=partially included and 0=not included) and weighted based on its level of importance in the Charter.
Results: The percentage of civil society priorities that were included in Global Fund concept notes were as follows: Malawi (87%), Kenya (76%), Tanzania (67%), Zanzibar (67%), Uganda (64%), Swaziland (50%), Zimbabwe (40%) and Zambia (38%). Across the eight countries, civil society priorities on key populations were the most likely to get included in the concept notes (68%), while priorities on voluntary medical male circumcision were the least likely to get included (15%). Several contextual factors help explain these results. Using Afrobarometer survey data, civil society had greater influence over Global Fund concept notes in countries where people often attend community meetings (CI 95%, P=0.041), often join others to raise an issue (CI 95%, P=0.017) and feel completely free to say what they think (CI 95%, P=0.030). Using World Bank Governance Indicators, civil society had greater influence over Global Fund concept notes in countries where there is a greater degree of freedom of association and freedom of expression (CI 90%, P=0.083). In countries where civil society was more effective at influencing Global Fund concept notes, HIV prevalence was lower (CI 95%, P=0.021).
Conclusions: This is some of the only statistical evidence to demonstrate that open and inclusive dialogue spaces are linked to a more effective HIV response.