Memorandum submitted by the All Party
Parliamentary Group on AIDS
INTRODUCTION
The All Party Parliamentary Group on AIDS uses
its connections with those involved in evaluating, delivering
or designing HIV-related development programmes to seek out views
on current policy. The observations in this document do not represent
the views of every individual member of the Group but do reflect
the key questions being asked and views being raised. This short
submission also suggests some specific questions the Committee
might ask during as it takes its evidence.
1. The comparative effectiveness in tackling
HIV/AIDS through vertical funding and funding allocated to broader
health systems strengthening
Bearing in mind the considerable challenges
ahead, and that the global AIDS epidemic is still far from under
control, there is a need for Governments in the developed and
developing world continue to focus on HIV. The challenge is to
maintain this focus whilst delivering on the broader health goals,
such as providing more doctors and nurses and health infrastructure.
These broader goals are necessary for any kind of a long-term
response to HIV. HIV will not disappear if and when the Millennium
Development Goals are reached, and so the right human and capital
infrastructure to sustain service provision is vital.
However, in generalised epidemics, HIV grows
exponentially and to prevent the epidemic spiralling further out
of control a near-term HIV specific response is also crucial.
Views within the group differ as to the proper balance of vertical
and horizontal funding but there is agreement that the key questions
are:
— What will a health systems approach
mean for tackling HIV in the short and medium term?
— Are there specific indicators and
mid-term goals that can be developed to help maintain focus on
HIV whilst taking a broader approach?
2. The impact of vertical funds on broader
health systems strengthening and Interaction with HIV and other
diseases
Vertical funding systems are not inherently
incompatible with broader health system strengthening, but there
are definite pitfalls that need to be avoided such as the "poaching"
of medical staff to deal just with HIV. In many cases the influx
of HIV funding has led to better services more broadly, such as
better and increased access to pre-natal and ante-natal care,
an important need identified in the Select Committee's enquiry
into maternal health. Family Health International has some excellent
data on this from Rwanda for example http://www.fhi.org/en/AboutFHI/Media/Releases/res_RwandaStudyHIVFundingHlthSvcs.htm
Some negative impacts of vertical funding are
associated with illogical boundaries between for example sexual
health services and HIV which should, by their nature be linked.
A no-condom promotion approach for example is a serious brake
on HIV prevention. The other side of the coin is that increasing
access to condoms has much wider health benefits than just the
reduction of HIV, and this is recognised in the strategy. The
Group welcomes the closer links proposed in the strategy between
HIV and sexual health.
The Group also welcomes an approach where HIV
is linked with the diseases that are closely associated with it—such
as TB and Malaria. A more-linked up approach will deliver wider
benefits and funding should be sufficiently flexible to recognise
this.
The drive that HIV related goals can give can
help deliver on many health fronts. Again, this view reflects
calls for a balance between vertical and horizontal funding systems
but with HIV at the centre of a linked up approach.
3. Protecting vulnerable groups and the impact
of HIV/AIDS on women and children
Looking at the provision for children in particular,
this strategy has no specific funding for orphans and vulnerable
children unlike the last strategy, which set aside £150 million
for OVCs. Instead there is funding put aside for social protection
programmes. It will be important to measure the effectiveness
of this approach and the APPG encourages the Committee to ask:
— What short and long term indicators/systems
will be in place to measure the impact of social protection on
orphans and vulnerable children?
More broadly, the new strategy has a welcome
emphasis on protecting the most vulnerable groups—not just
women and children, but also MSM (men who have sex with men),
sex workers and injecting drug users. DFID also has an impressive
record on these issues and of lobbying other countries to take
a similar approach. However, the NGO sector in the UK has raised
worries with the APPG that where funding is delivered direct to
developing country governments, through budget or sector support
grants, the recipients may not take such an enlightened approach.
It is generally accepted that too much conditionality on overseas
aid is counter-productive. The Committee could therefore usefully
ask:
— What safe-guards are there, that
when using budget and sector support funding mechanisms the rights
and particular needs of vulnerable groups such as women and MSM
will be respected?
"Protecting and upholding the rights of
vulnerable groups" also features heavily in the strategy
(p59) as one of the tasks of the Foreign Office, and the strategy
promises joint working between the two Departments on this and
other HIV matters. A full enquiry into the strategy should therefore
include evidence from the FCO.
According to a recent Parliamentary Question,
the cross-Whitehall Coherence Group on Tackling HIV and AIDS in
the developing world has met just three times since 2005. The
Group would welcome more detail from the Foreign Office about
the nature of its joint working with DFID, plans for the cross-Whitehall
group, and information on whether there is any specific training
for FCO staff on HIV and whether there is any dedicated funding
for FCO commitments in the strategy.
4. The likely effectiveness of monitoring
systems in ensuring that funding announced in the strategy reaches
local level and how civil society will be involved in implementing
the new strategy
This is a particular concern and the Group would
like to raise further related questions including:
— Does an approach that channels the
majority of funds either through budget/sector support or through
multi-lateral organisations such as the EC and the World Bank
make it more or less likely that funding reaches local level?
— What AIDS and development specialism
do the decision makers in the multi-lateral organisations have
to help inform their spending decisions?
— What special infra-structure is DFID
putting in place to develop monitoring systems that are able to
track funding through such broad funding channels?
— How confident is DFID about the accountability
of these funding channels back to DFID and by extension to taxpayers.
The Group recognises that DFID cannot and should
not micro-manage its funding, especially if principles of local-ownership
are to be upheld, but that this should not undermine accountability
and transparency. It also accepts that tracing each pound through
pooled funding will be very difficult and that new types of monitoring
may be needed.
Where money flows through large governmental
organisations the involvement of local civil society in monitoring
is all the more important. Civil society has the independence
and local knowledge to deliver long-term monitoring in ways in
which a foreign donor such as DFID could never hope to do. Supporting
civil society as part of the monitoring system and ensuring that
it is genuinely involved should therefore be a key feature of
the implementation of the new strategy.
5. DFID's mechanisms for measuring the impact
of its funding for health systems strengthening
As discussed above, monitoring funding that
goes through pooled channels is difficult and the same applies
for measuring impact. This is why it is important that DFID sets
out at an early stage what it expects to achieve with the funding,
and the Group welcomes the work currently being done by DFID in
collaboration with NGOs to develop indicators. Key to the development
of indicators must be the following questions:
— If you seek to strengthen health
systems—how is a strong health system defined?
— How much can we expect to deliver
as country and how much do we rely on other donor countries?
The APPG is concerned that DFID should not be
able to blame any and every failure on the other partners in pooled
funding but equally it recognises that there will be times when
other partners are to blame. Combining shared responsibility with
a Government's individual accountability requirements to its own
people and to recipients of funding, is a potential problem when
using multi-lateral organisations. It makes early identification
of difficulties and good communication links between multi-laterals
and Governments all the more important. There is therefore an
important further question:
— How good is the communication and
accountability between the UK Government/DIFD and the multilateral
organisations that spend its money?
Despite these questions, the Group also recognises
there are important benefits to the Department's multi-lateral
approach in terms of coordination and avoiding duplication of
work and limiting reporting requirements for recipient countries.
| 
