[afro-nets] Where is the information to manage success?

[Peter Burgess <Profitinafrica@aol.com>]

Where is the information to manage success?
-------------------------------------------
Feedback from Bangkok


Dear Colleagues,

I have just read the following in a message from the AIDS Con-
ference in Bangkok (the full text of the message is attached at
the end).

"We now have a wealth of experience with a range of healthcare
approaches, some that have worked and some that have not. We
should all learn from these. Ignoring what we know is effective
will always bring healthcare interventions back to square one.
The result will be felt worst by infected communities, and even-
tually lead to orphaned or vulnerable children. The hope is that
the lesson of prevention does not have to be re-learned at the
cost of those least able to influence health policies."

That we have a wealth of experience may be true. But it is not
readily accessed. How exactly does one learn about what works
and what does not with the present information regime? Where is
the information? Certainly, we should learn, but how? Where is
the information located so that the learning can be done easily?
Where is the accounting and accountability and transparency?
Where are the costs set out and rigorously compared to the bene-
fits derived?

I would have liked to see the Global Fund (GFATM) structured so
that the success and failure of its funding could be seen
(transparency) and the effectiveness of its funding used as a
tool for learning. As it has turned out the GFATM has adopted
rather typical official development assistance (ODA) methodolo-
gies with a big focus on the approval process and much less em-
phasis on the results actually achieved.

It is my understanding that the performance aspect is being han-
dled by the GFATM's local fund agents (LFAs) who are meant to
have a presence on the ground, but nothing of what they do, as
far as I can tell results in information that can be used to
learn anything specific about use of funds and benefits arising,
and to learn the lessons from prior practice. To the extent that
it might exist, I do not believe it is information that is in
the public domain and easily accessible in a useful format.

What I think is being said by the delegates in Bangkok is that
the international institution sits on top of a country's coordi-
nating structure and is effectively insulated from community
level activities, and there is little hope for community level
success to get funded and expanded. Maybe I have this wrong, but
this is the impression I have.

The Afrifund Project has started to compile information about
what is being done at the community level.... because it is at
this level that performance can be costed and valued..... and it
is at this level that activities should be funded. In the corpo-
rate world this is where accounting starts to become management
accounting, and the same applies in the development context. Al-
ready the data compiled gives us the ability to begin a useful
dialog at the community level, and this dialog can serve to sort
out the priorities. Maybe with effective database driven ac-
countability it will be possible for the first time for good
small initiatives to be funded instead of the bigger, easier and
far less effective programs that have dominated use of funds in
development for years.

Sincerely

Peter Burgess
in New York
Tel: + 1-212-772-6918
mailto:peterb@afrifund.com
http://www.afrifund.com
http://www.afrifund.com/wiki/index.pcgi?page=AIDSBangkokFeedback


 >>>>>>>>>>>>>>>>>>>>>>>>
Original Posting
Subj: [partnersgf] 1st Partnership Forum:
Providing space for unheard voices

Date: 7/9/2004 10:00:40 PM Eastern Daylight Time
From: partnersgf@eforums.healthdev.org
To: Profitinafrica@aol.com

Partnership Forum providing space for unheard voices
HDN Key Correspondent Team

Delegates from Asia Pacific, North Africa and the Middle East
attending the Global Fund Partnership Forum in Bangkok this week
met together to share experiences and listen to one another.
They originated came from a wide range of countries in the three
regions, and are all involved in implementing programmes ad-
dressing HIV/AIDS.

The experiences of delegates, especially those representing af-
fected communities and civil society organisations, were often
emotional, especially as they find themselves with similar is-
sues and concerns related to the disease.

Specifically, they were strongly of the opinion that prevention
had been side-tracked by the Global Fund, which is putting more
emphasis on expanding access to treatment. The focus is too much
on antibiotics for opportunistic infections and antiretroviral
drugs.

Advocates in developing countries in particular have been push-
ing for access to treatment, creating an enormous amount of de-
mand from community stakeholders. This has put pressure on gov-
ernments to provide life-prolonging drug treatments, with the
Global Fund putting in additional budget.

This has had a domino effect in many health systems, especially
if there are insufficient trained infectious disease specialists
or doctors to attend to the needs of people living with
HIV/AIDS.

Enormous resources to train or retrain biomedical specialists
will be needed to prepare health systems to provide optimum
treatment if not comprehensive care.

There also appears to be a need to strike a balance between pre-
vention among behaviour change in vulnerable groups and in
groups practicing high-risk behaviour. Drastic moves to promote
condom use is deemed important, and non-government organisations
can play a crucial role along in this area, but resources, as
always, are seen as insufficient.

Community-based organisations had high hopes for the Global
Fund. For them it is an extra ordinary financing mechanism
driven by the principles of inclusiveness and partnership, but
is not necessarily being seen on the ground.

Genuine participation has been missing, say many delegates, and
consequently the aim of bridging the gap between prevention and
overall care and support has not been fully realised within Fund
projects. This has left intact the perception that addressing
HIV/AIDS is only about antiretroviral drug therapy.

We now have a wealth of experience with a range of healthcare
approaches, some that have worked and some that have not. We
should all learn from these. Ignoring what we know is effective
will always bring healthcare interventions back to square one.
The result will be felt worst by infected communities, and even-
tually lead to orphaned or vulnerable children. The hope is that
the lesson of prevention does not have to be re-learned at the
cost of those least able to influence health policies.

HDN Key Correspondent Team
Email: correspondents@hdnet.org

Reproduction welcomed, with source cited as follows:
[PartnersGF eForum 2004: PartnersGF@eforums.healthdev.org]