Who benefits from demand‐driven distribution of HIV/AIDS services? An analysis of the emerging CBO sector in Malawi

Abstract

SUMMARYCommunity-based organisations (CBOs) play a key role in Malawi's multi-sector programme for responding to the HIV/AIDS pandemic. In this programme they are funded in a demand-driven manner-which means that only those areas that apply for funds to CBO services are blessed with programme benefits. This paper argues that this funding mechanism is not conducive to either distributing CBO services to areas most in need or enhancing downward accountability. Because areas most in need of services generally also lacked the capacity to attract project funding, the programme did not reach them. Instead, it tended to reach those areas with the greatest capacity to attract funding, though not necessarily the greatest need for it. Furthermore, those CBOs that were funded were unable to facilitate collective action in their communities because of elite capture of decision making. The programme, however, was relatively responsive to the communities' thematic demands. Thus, all in all, the elites were relatively more successful in representing the communities' wishes than in caring for all geographical areas in their constituencies.

The role of community health workers in supporting South Africa’s HIV/ AIDS treatment programme

“…In general, the way our informants spoke about the NGOs that managed them did rather suggest that many of them were primarily formed in response to the government's need to contract out the role of managing these ancillary workers. Insights from other settings suggest "demand driven" local agencies are very susceptible to elite capture (Schou, 2009). However, these predispositions can be challenged effectively when a strong local culture of activism exists as was evident from the testimony we collected.…”

Local Demand for a Global Intervention: Policy Priorities in the Time of AIDS

“…A practical question relevant to misaligned policy preferences asks whether we will see diversion of resources earmarked for HIV/AIDS at the local level because villagers and their headmen fail to prioritize the same issues as international and national actors. A study of HIV/AIDS Community-Based Organizations (CBOs) in Malawi highlighted the weak accountability of these organizations, particularly how the local community had little influence on CBO decisions or day-to-day work (Schou, 2009). In one of the districts of Schou’s study, four of the 25 CBOs funded by the National AIDS Commission to provide HIV/AIDS programing in the community were financially mismanaged, and one of those organizations was suspected to be a fake (2009, p. 163).…”

“…A study of HIV/AIDS Community-Based Organizations (CBOs) in Malawi highlighted the weak accountability of these organizations, particularly how the local community had little influence on CBO decisions or day-to-day work (Schou, 2009). In one of the districts of Schou’s study, four of the 25 CBOs funded by the National AIDS Commission to provide HIV/AIDS programing in the community were financially mismanaged, and one of those organizations was suspected to be a fake (2009, p. 163). Even if misaligned priorities may not ease the opportunity for corruption of HIV/AIDS resources, misalignment can potentially impact intervention effectiveness.…”

Governing the Geographies of the Nongovernmental Organization Sector: Analyzing Coverage Challenges in the HIV/AIDS Campaign in Malawi

“…A study of a selection of NAC-funded CBOs in 2006 found low distributional equity in two rural districts councils. More than a third of the funded CBOs were located in one traditional authority area, and several areas were not serviced at all (Schou, 2008). Little is known about the NGO presence in, and within, Malawi's 28 districts.…”