Evaluating the International Donor

Response to the AIDS Crisis

Moon YoonPublic Health and Social Justice

Portland State UniversityDecember 2, 2008

Source: http://science.nationalgeographic.com

AIDS Epidemic in sub-Saharan Africa

11% of world population live in sub-Saharan Africa67% of worldwide HIV population72% of AIDS deaths in 200790% of HIV infected children

Source: 2008 Report on the global AIDS epidemic, July 2008, UNAIDS.

Three AIDS Donors, Three Approaches to the Crisis

Source: Oomman N, Bernstein M, Rosenzweig S; Center for Global Development. Following the funding for HIV/AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia. October 10, 2007.

President’s Emergency Plan for AIDS Relief (PEPFAR)Responsible to the US Congress and PresidentLegislation of very specific targets

Treat 2 million with ARVPrevent 7 million new infectionsSupport care for 10 million HIV patients

Allocation of funds also legislated55% treatment, 20% prevention, 15% care, 15%

orphans

Global Fund to Fight AIDS, Tuberculosis and MalariaPrivate foundation based in Geneva, Switzerland“the Fund is a financial instrument, not an

implementing entity”Provides renewable grants based on proven

performanceGovernments submit grants by establishing a

Country Coordinating Mechanism (CCM)Challenges in implementation rise most often from

capacity of Recipient Organizations

The World Bank Multi-Country AIDS Program for Africa (MAP)The World Bank exists to “help governments in

developing countries reduce poverty by providing them with money and technical expertise they need”

MAP was designed to strengthen a country’s capacity to develop a national response to the AIDS epidemic

Funds given as grants or loansBottleneck in the government system

Complex reporting requirements and bureaucracyPervasive capacity constraints in public system

ConclusionShortage of human resources is a major roadblockLack of infrastructure and resources in host

country are cited as major reasons for the brain drain

Suggestions to build up infrastructure Investigate how to develop and retain work forceNGOs should adopt the NGO Code of Conduct for

Health Systems Strengthening *Donors should publicly disclose financial data

* http://ngocodeofconduct.org/

References UNAIDS. 2008 Report on the global AIDS epidemic. (Accessed

November 22, 2008, at http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp.)

Oomman N, Bernstein M, Rosenzweig S; Center for Global Development. Following the funding for HIV/AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia. October 10, 2007. (Accessed November 22, 2008, at http://www.cgdev.org/content/publications/detail/14569.)

Institute of Medicine. 2005. Healers abroad: Americans responding to the human resource crisis in HIV/AIDS. Washington: DC; The National Academies Press