HIV/AIDS policies in Mozambique and the new aid architecture: successes, shortcomings and the way forward

Aurre, Eduardo Bidaurratzaga; Jaén, Artur Colom

doi:10.1017/s0022278x12000031

Cited by 8 publications

(3 citation statements)

References 13 publications

(18 reference statements)

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“…There is little knowledge about what the concept of ownership means for the recipient countries themselves, and how they put it into practice [ 36 ]. Based on a rapid review of the concept, we identify four main indicators of government ownership: political commitment by demonstrating leadership at the highest levels of government [ 34 , 45 ], effective engagement of technical levels of government [ 46 , 47 ], ability of the government to coordinate international actors within public bodies [ 45 , 48 – 50 ], and the government’s mobilization of domestic resources to finance the policy in the long term [ 48 , 51 ]. Because the UHC goal will continue to gain global traction, we critically assessed the extent to which recipient countries have owned financing policies aiming to achieve this goal.…”

Section: Introductionmentioning

confidence: 99%

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Gautier

Ridde

2017

glob health res policy

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BackgroundThe rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The “donor-driven” push for policies aiming at UHC raises concerns about governments’ effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process.MethodsWe conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. Thirty-five (35) results were retrieved. We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation.ResultsThe majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist.DiscussionFuture research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors.Electronic supplementary materialThe online version of this article (doi:10.1186/s41256-017-0043-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Gautier

Ridde

2017

glob health res policy

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“…Though Malawian policy is, in general, ‘donor driven’, the NAC distributes centralised pooled donor monies, illustrating the tensions and possibilities that obtain within the international aid/AIDS industry's infrastructure (cf. Bidaurratzaga-Aurre & Colom-Jaén 2012; Esser 2012; Wroe 2012). As the passageway between donors and Malawian citizens, NAC acts as a gatekeeper, arbitrating the worthiness of subcultural populations, risk groups and organisations on the ground.…”

Section: Risky Culture In the Time Of Aids And Homophobiamentioning

confidence: 99%

‘Aid for gays’: the moral and the material in ‘African homophobia’ in post-2009 Malawi

Biruk

2014

J. Mod. Afr. Stud.

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In recent years, ‘African homophobia’ has become a spectacle on the global stage, making Africa into a pre-modern site of anti-gay sentiment in need of Western intervention. This article suggests that ‘homophobia’ in post-2009 Malawi is an idiom through which multiple actors negotiate anxieties around governance and moral and economic dependency. I illustrate the material conditions that brought about social imaginaries of inclusion and exclusion – partially expressed through homophobic discourse – in Malawi. The article analyses the cascade of events that led to a moment of political and economic crisis in mid-2011, with special focus on how a 2009 sodomy case made homophobia available as a new genre of social commentary. Employing discourse analysis of newspaper articles, political speeches, the proceedings of a sodomy case, and discussions about men who have sex with men (MSM) as an HIV risk group, I show how African homophobia takes form via interested deployments of ‘cultural’ rhetoric toward competing ends. This article lends a comparative case study to a growing literature on the political and social functions of homophobia in sub-Saharan Africa.

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“…Donors in development assistance for health (DAH) play a significant role in shaping health policies in many low- and middle-income countries [ 1 – 9 ]. They exert their influence through financial resources, knowledge transfer, technical expertise, inter-sectoral leverage, and indirect financial and political incentives [ 5 , 6 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Development assistance, donor–recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank–UK and Global Fund in China

Huang,

Zhao,

Cao

et al. 2024

glob health res policy

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Background This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor–recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability. Methods We conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998–2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010–2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson’s health policy analysis model and the World Health Organization’s health system building blocks. We used process tracing for analysis. Results According to the collected data, our case study identified three reemergent, interrelated aspects of donor–recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases. Conclusions Given the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor–recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international–domestic expert partnerships to identify and respond to contextual enablers and barriers.

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HIV/AIDS policies in Mozambique and the new aid architecture: successes, shortcomings and the way forward

Cited by 8 publications

References 13 publications

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

‘Aid for gays’: the moral and the material in ‘African homophobia’ in post-2009 Malawi

Development assistance, donor–recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank–UK and Global Fund in China

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