Memorandum submitted by Futures Group
Europe/HIV/AIDS Prevention and Care Project (HAPAC)
We commend the emphasis that is being given
in the new CAP to HIV/AIDS and congratulate DfID on the efforts
to mainstream HIV/AIDS in future assistance plans.
GENERAL COMMENTS
The ERS articulates Kenya's poverty reduction
strategy and outlines government priorities for the coming period.
It influences budget allocations within the Medium Term Expenditure
Framework and acts as a basis for donor assistance to Kenya. Priorities
for the ERS are made after extensive consultation with line ministries,
civil society, development partners and the private sector. Participation
in the process is made possible through working groups, which
are made up of representatives from every sector or "sector
working groups" (SWG).
The lack of recognition in the ERS of HIV as
an economic, governance, security or livelihood issue challenges
any efforts at effective mainstreaming and tends to ensure that
the focus of HIV interventions remain in the field of equity and
socio-economic agenda or human resource development. In an epidemic
such as Kenya's, where it is estimated that over 2.5 million people
are thought to be living with HIV/AIDS (UNAIDS 2002), it is crucial
that HIV is addressed more broadly as a development issue.
In addition, the ERS process tends to be largely
sectoral, for obvious reasons ie each ministry is fighting for
a greater share of limited resources. In Kenya, HIV is a cross-cutting
issue, under the OOP without a ministerial home and so there is
urgency for it to be seriously and effectively mainstreamed wherever
possible. In order for this to happen, greater multi-sectoral
co-ordination is needed at a high level and among decision makers.
In spite of the call and commitment to mainstreaming
of HIV, it is often perceived as a separate and vertical issue
dealt with by HIV/AIDS experts through HIV/AIDS specific activities.
This perception is reinforced through the various HIV specific
structures, budget lines and projects which have been established
to respond to the disease.
The further development and implementation of
the ERS therefore provides an opportunity and imperative to ensure
that HIV issues are adequately reflected and resourced throughout
all sectors. Bearing this in mind there are a number of more specific
comments and suggestions we wish to contribute:
1. As funding to HIV/AIDS is increasing
from different sources, there is a growing demand for a common
strategic framework for the multiple actors and for links between
the poverty and development framework and the AIDS action framework.
The CAP refers to the UK's call for Action on HIV/AIDS, it should
mention the three 1's:
— one agreed HIV/AIDS Action Framework
that drives the alignment of all partners;
— one national AIDS authority, with
broad based multisectoral response; and
— one agreed country level M&E
system.
2. To promote a multisectoral response it
is essential that a good National HIV/AIDS Strategy is in place.
It is equally important to ensure that HIV/AIDS is addressed at
a higher level through GoK National Priority Setting. Once HIV/AIDS
is identified as priority or as a key development initiative (alongside
employment creation or primary education), then this priority
should ultimately cascade through to policy development, planning
and budget allocation processes.
3. An effective way of mainstreaming HIV/AIDS
and supporting an effective multisectoral response to HIV/AIDS
will be through ensuring that HIV/AIDS is adequately addressed
as part of the poverty reduction agenda and economic recovery
strategies. The objective being, to get HIV/AIDS routinely mainstreamed
into government planning, programming and budgeting processes
(ERS and MTEF). This will ultimately result in HIV/AIDS being
mainstreamed into sector strategies.
4. If DfID's primary aim over the period
of the country plan is to support the development and implementation
of the ERS, and if the emphasis is on ensuring the poverty focus
of the ERS, then HIV/AIDS should be an explicit component of this
agenda. Currently HIV/AIDS is inadequately addressed in the ERS,
and significant work will be necessary to ensure that it is adequately
addressed (not as a separate issue—but mainstreamed through
the various sectors).
5. Likewise DfID planned support to public
expenditure management, and the development and implementation
of a M&E framework for the ERS, will need to track resource
allocation and expenditure on HIV/AIDS and include indicators
to measure progress of the national multisectoral response to
HIV/AIDS.
6. The CAP does recognise that the effect
of HIV/AIDS on the economy is such that it has reduced the annual
economic growth potential, however it does not suggest strategies
to address this.
If DfID is serious about mainstreaming HIV/AIDS,
there is a need to mainstream it throughout the CAP text, rather
than highlight them in a few selected paragraphs. What follows
are some examples of where HIV/AIDS could be incorporated in the
main text:
(a) In particular the CAP would be made stronger
if HIV/AIDS is mainstreamed within sections B2 to B5 (pages 4-5)
rather than separated out in section B7—after all the impact
on gender (B2), education (B3), health (B4) from a supply (staff)
point of view could be stated more clearly that way rather than
stating it in B7 as "current rates of training of teachers,
health workers, and other key service providers will not keep
up with attrition".
(b) Will section B6 reflect the new DHS findings
of 6-8% prevalence in women and 4.5% prevalence in men or will
the CAP reflect higher UNAIDS 2002 stats of 11-13%?
(c) Section B8—last sentence "The
cost of doing business in Kenya are pushed up . . ." doesn't
mention HIV/AIDS as a cause, but as we know definitely does.
(d) Section C6: Is a key issue not HIV/AIDS
that needs to be addressed too? Especially in light of the CAP
mentioning "increase the participation of women" . .
. hardly achievable if HIV/AIDS is not addressed.
(e) Similarly in Section E HIV/AIDS could
be mainstreamed (as well as) being a key objective. For example,
how can key objective i and ii be achieved if HIV/AIDS is not
mentioned? (It would also mean "DfID supporting activities"
in part III the annual plan would have to be added in each objective.
(f) E12: if DfID continues to mainly channel
support through the NACC and NASCOP—will this ultimately
result in supporting the 80% of poor Kenyans in rural areas?
(g) In Section G the table on Page 19—Row:
under public sector lack appropriate skills, Column: Annual forecast
change, you could include the work HAPAC is doing to support NACC/GoK
to introduce a workplace policy on HIV/AIDS for the public sector—this
will be also be a significant contribution to increasing the effectiveness
of the civil service.
February 2004
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