7 Engagement with Civil Society
89. In the previous chapter, we explored the ways
in which DFID's Strategy will address the particular challenge
of tackling HIV/AIDS amongst marginalised and vulnerable groups.
Civil society organisations are vital to this work because they
can reach stigmatised groups and people who fear discrimination
in ways which are unlikely to be possible for state-funded agencies,
and they have proved that they can find innovative ways of providing
them with prevention, treatment and support services.
90. DFID's Strategy states that "Civil society
has a key role to play in advocating and providing services, in
particular for vulnerable populations, in strengthening accountability,
and in building social movements.[169]
However, as Tearfund pointed out in its evidence:
[…] despite the positive rhetoric in the Strategy
regarding the role of civil society, there is no clear indication
of how DFID intends to harness and support the considerable contribution
of civil society actors. This is particularly concerning as the
population groups highlighted for particular attention in the
Strategy […] are supported by a vast array of civil society
programmes.[170]
91. While witnesses were generally complimentary
about DFID's willingness to work with civil society, we also heard
that DFID's engagement with civil society in the development of
the Strategy had been variable.[171]
Nor does the Strategy clarify what DFID plans to do to improve
support to civil society.[172]
92. Civil society organisations can enhance government
accountability and transparency, influence policy through social
mobilization, act as intermediaries between communities and government,
and provide goods and services which the private sector or the
state does not.[173]
This is particularly important for the delivery of health services
as in many African countries governments are the minority supplier
of health services with most care being supplied by faith and
community-based organisations.[174]
The International HIV/AIDS Alliance argues that low levels of
civil society participation in planning, co-ordinating and monitoring
programmes can result in projects that are less likely to be responsive
to the situation on the ground, less well-targeted and which are
not rapidly scaled up.[175]
93. Alvaro Bermejo, Executive Director of the Alliance,
told us that working with civil society groups sometimes offered
a more stable and sustainable way of providing treatment as in
some countries there was greater continuity in civil society provision
of treatment than was found with government-supported healthcare.
He cited an AIDS programme which the Alliance has been supporting
in Ukraine since 2004. During that time:
[…] there have been four different governments
and seven different health ministers in Ukraine. The national
AIDS programme has changed leadership at least half a dozen times
and has been for months without leadership. The civil society
programme—and it is run by a national NGO—has continued
operating regardless.[176]
94. One particular concern expressed to us was that
there is an inherent tension between DFID's intention to work
more closely with civil society on the one hand and its focus
on health services strengthening on the other.[177]
If funding is being directed to government health systems then
less support will be available to local civil society organisations
(CSOs). National governments may not necessarily include CSOs
in the planning and delivery of services. Alvaro Bermejo told
us that:
We are seeing a greater emphasis on multilateral
and bilateral government-to-government support and the proportion
of DFID funds going to that increasing. We do not think that that
is a good HIV strategy […] we need civil society […]
to get involved in service delivery as well as having the capacity
to monitor the difficult decisions that politicians and governments
have to make.[178]
95. Médecins Sans Frontières made similar
points in its written evidence, and argued that there was a need
for direct funding for civil society organisations to increase
their capacity to deliver services and maintain their independence
from national governments:
Many countries face disbursement problems and administrative
delays through the usual government channels. Combined with weak
accountability and health systems that are poorly accountable
to their users, this can jeopardize results and benefits for the
target population and end-users. It is therefore essential to
preserve the possibility of working with non-state providers such
as civil society, PLWHA [people living with HIV and AIDS] and
NGOs. This should include direct funding, in order to promote
capacity building and preserve the independence of civil society
from government funds and influence.[179]
96. The Minister said that he could give a "cast-iron
assurance" that civil society would be full partners in the
implementation of the Strategy. Where appropriate, there would
be direct funding for civil society groups to advocate for people
living with HIV and AIDS as part of the Strategy, and there was
a "need to be looking at the investment in civil society."[180]
DFID emphasised that the Global Fund "is widely acknowledged
for its strong engagement with civil society". CSOs participate
in the strategic planning process and are represented on the Fund's
board and on its committees.[181]
97. We welcome
the Minister's assurance that civil society will be fully engaged
in the implementation of the Strategy. However, further details
are needed on how DFID will pursue this engagement, including
how much funding will be allocated to support the work of civil
society on the ground in countries with a high prevalence of HIV/AIDS
and related diseases. We request that DFID provides this detailed
information in its response to this Report.
169 Achieving Universal Access, p 4 Back
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Ev 92 Back
171
Q 31 Back
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Ev 71 Back
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Ev 70-71 Back
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Q 21 Back
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Ev 70-71 Back
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Q 32 Back
177
Ev 69 Back
178
Q 30 Back
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Ev 81 Back
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Qq 109-111 Back
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Ev 38 Back
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