The Africa Multi-Country AIDS Program 2000-2006: Results of the World Bank's response to a development crisis

Gorgens-Albino, Marelize; Nadeem, Mohammad; Blankhart, David; Odutolu, Oluwole

doi:10.1037/e597652012-001

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…While commendable investments were made in advocating for the adoption of MSA, this has not been matched by efforts to review the successes and challenges of implementing MSA, other than a few notable exceptions in Uganda, Senegal, Tanzania and Rwanda [13–15]. The reviews conducted to date were limited to the framework of the World Bank and the Global Fund, which focused more on compliance and the benefits of MSA than on the experiences of implementation.…”

Section: Introductionmentioning

confidence: 99%

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

Mahlangu

Vearey²,

Thomas

et al. 2017

Global Health Action

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Background: A multi-sectoral response is advocated by international organisations as a good strategy to address the multiple drivers and impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and was historically mandated as a condition of funding. In March 2017, the South African National AIDS Council (SANAC) launched the latest 5 year National Strategic Plan (NSP) to address HIV, sexually transmitted infections and tuberculosis. As with previous iterations, the NSP calls for multi-sectoral action (MSA) and mandates AIDS councils (ACs) at different levels to coordinate its implementation. Efforts have been made to advocate for the adoption of MSA in South Africa, yet evaluation of these efforts is currently limited. Objective: This paper assesses the implementation of a multi-sectoral response to HIV in South Africa, through a case study of the Mpumalanga Province. Methods: We identified and reviewed key policy documents, conducted 12 interviews and held six focus group discussions. We also drew on our involvement, through participant observation, in the development of NSPs and in AC meetings. Results: SANAC is struggling to provide much-needed support to provincial, district and local ACs. Therefore, most ACs are generally weak and failing to implement MSA. Membership is voluntary, there is a lack of sustained commitment and they do not include representatives from all sectors. There is little capacity to undertake the activities necessary for coordinating the implementation of MSA, and unclear roles and responsibilities within ACs result in divisions and tension between sectors. There is inadequate senior political leadership and funding to facilitate effective implementation of MSA. Conclusion: We identified three interventions that we argue are required to support the effective implementation of MSA: strengthening and stabilising the SANAC structure; building capacity of ACs; and creating an enabling environment for effective implementation of MSA through political leadership, support and resourcing of the HIV response.

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Section: Introductionmentioning

confidence: 99%

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

Mahlangu

Vearey²,

Thomas

et al. 2017

Global Health Action

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“…An internal evaluation of the World Bank [62] stated that poor performing projects had no targeting mechanism for reaching the poor and recommended that the World Bank create new incentives for monitoring and evaluation for both the Bank and the borrower. This would include requirements for baseline data, evaluation designs for pilot activities as well as evaluation of main project activities on an ongoing basis.…”

Section: Discussionmentioning

confidence: 99%

“The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia

Walsh

Mulambia

Brugha

et al. 2012

Globalization and Health

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BackgroundWhile sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn.MethodsIn-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011.ResultsFunding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce.Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics.Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced.ConclusionsWhilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground and accurate costings for sustainable service delivery, building on existing community strengths, are needed before projects commence. This study highlights the importance of enabling and building the capacity of existing CBOs and community structures, rather than creating new mechanisms.

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“…Community-Driven Development programs, which aim to empower local communities, include HIV/AIDS crisis management programs, while including stigma reduction strategies [46]. In Rwanda, for instance, increased funding in local NGOs allowed for culturally relevant and appropriate policies resulting in the adoption of innovative programs which invested in empowering women both economically and socially [47]. Political and social pushback towards initiatives which seek to challenge the status quo are inevitable.…”

Section: Community-based Approaches As Channels For Enhancing Women's...mentioning

confidence: 99%

Where boys don’t dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices

Demir

Vissandjée

Jacobson

et al. 2020

BMC Int Health Hum Rights

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Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women’s rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women’s rights language, notably for causing violations of women’s right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women’s rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women’s rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women’s capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.

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The Africa Multi-Country AIDS Program 2000-2006: Results of the World Bank's response to a development crisis

Cited by 4 publications

References 2 publications

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

“The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia

Where boys don’t dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices

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