[afro-nets] Public-Private Partnerships for Community-Based Sustainable HIV/AIDS Advocacy

["Dr. Uzodinma A. Adirieje" <afrepton@yahoo.com>]

Public-Private Partnerships for Community-Based Sustainable HIV/AIDS Advocacy
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By Dr. Uzodinma A. Adirieje
Nigeria

BACKGROUND

Public-private partnership - also called PPP or P3 - is a system in which a government service or private business venture is funded and operated through a partnership of government and one or more private sector organisations or companies, including NGOs. Advocacy on other hand is the process for altering the ways in which power; resources and ideas are created, consumed and distributed at any level, so that people and organisations have a more realistic chance of controlling their own development.

When deployed in a community, advocacy sets in motion the dynamic process of developing consensus and a mandate for action, and produces/brings together like-minded allies with shared goal(s) in order to change their ways of doing things and the ways other people and institutions perceive and or treat them. A process, condition or action is sustainable when it can be maintained indefinitely without progressive diminution of valued qualities inside or outside the system in which the process, condition or action operates and or prevails.

Within and for a community, HIV/AIDS advocacy should entail persuading and convincing people, increasing their knowledge, understanding, access, demand for and utilisation of voluntary counseling and testing (VCT) services and available antiretroviral therapies (ARVs), and even participation in vaccine trials.  It would mean deploying efforts and emphases towards the elimination of stigma and eradication of extreme poverty. It would mean activities geared towards increasing household disposable income through the creation of new employment opportunities, democratization of access to credit and establishment of income generation activities for women. 

Effective HIV/AIDS advocacy in any community must also mean fostering actions that decrease the workload on persons living with AIDS (PLWAs) and persons affected by AIDS (PABA) including widows and orphans. That is, the promotion of more local control of the resources for advocacy within the community by persons living within the community, especially decreasing the skewed distribution of income and wealth that is typically very unfavourable  to women; using emphasis on equity, socioeconomic justice and fairness. It should endeavour to address discriminations based on social, gender and ethnic/tribal or caste statuses; promote as many elements and means of sustainable development as possible; and influence community development-related actions by ensuring active participation of the people in informed decision-making. 

It must focus more on what is possible and doable within a community?s identified capacity, and particularly on how it can be done. Advocacy should ultimately raise the community?s - and its people?s - consciousness about how so important they are in using the resources and ideas available to them in creating, distributing and consuming  HIV-related goods and services within their community, thus providing them with a more realistic chance of controlling their own health and development processes.

In order to facilitate and improve community-based HIV/AIDS advocacy, a PPP would be needed to generate basic knowledge/research, participate in products discovery and development (ARVs, vaccines, condoms, etc.), improve access to available health products, support HIV/AIDS and health services strengthening and health promotion/public education, and coordinate efforts towards the regulation, quality assurance and standards of existing and upcoming products and services.

The PPP in place should adopt strategic advocacy in deploying the aforementioned information to change policies that adversely affect the lives of PLWAs, PABAs, widows, children orphaned by AIDS and other disadvantaged people within the community. This should often involve lobbying local and international development partners, governments at as many levels as possible, and local NGOs involved in HIV/AIDS, health and development. Traditional, political, business and religious institutions should also be lobbied.

In addition to enhancing the advocacy skills of members of the PPP to challenge local, national and international policies, such strategic deployment of information and resources by the PPP will strengthen the structures through which the very poor, PLWAs, PABAs, widows, children orphaned by AIDS and other disadvantaged people within the community can participate in the formulation of the policies that control their lives, including the development of strong local networks and representation on local and national civic institutions and in related activities. This writer is stating the obvious that projects which involve the people affected by policy change in developing, implementing and monitoring advocacy usually work better to achieve concrete desired change on the ground ? the essence of advocacy!.

THE PROBLEMS?.

Typically, a PPP is dissatisfied with the impact and or processes of existing HIV/AIDS programs, products and or services available in the community, and has united to initiate actions and provide needed support for themselves (including their families and employees) and others that were impacted by the spectrum comprising HIV and its related diseases; and wants to effect and or influence changes that would visibly improve the health status of PLWAs, PABAs and the community at large.

In this onerous effort, the PPP confronts a multitude of challenges including uneven and inadequate distribution of services, complexities in health services being offered, poor or lack of cohesive policy and planning, cumbersome fragmentation of services and unpredictable demands on the existing health systems with limited resources as we witnessed with Ebola, SARS and bird flu to mention but a few. 

It must also confront inefficiencies in data management within the health system especially as they relate to processes, outcomes and costs; confront deficits in the community?s knowledge of prevention, care and cure especially among poor and mostly illiterate inhabitants; understand the strategies and principles of the consumers, providers and public in relating with the health system that manages HIV/AIDS within the community; evaluate access to, quality and effectiveness of prevention and care service; and determine the imperative for change through the identification and dissemination of information, definition, identification and implementation of ?best practices?; and improve efficiency through well-coordinated decentralisation approaches [?.. to be continued]. 

REFERENCES

1.	Adirieje, UA. Public Private Partnership for Nigeria?s Development, http://phishare.org/documents/afrihealthoptonet/4267/, accessed on 17 August 2006
2.	Burrows D. Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China Cad Saude Publica. 2006 Apr;22(4):871-9. Epub 2006 Apr 5
3.	Brashers DE, Haas SM, Neidig JL. The patient self-advocacy scale: measuring patient involvement in health care decision-making interactions. Health Commun. 1999;11(2):97-121
4.	Pramming S. A partnership for a healthy future; Oxford Vision 2020, Cambridge, April 2004 
5.	Samuels, G. Public Private Partnership Issues in Communicable Diseases;
6.	Schuftan, C. The Community Development Dilemma: when are Service Delivery, Capacity Building, Advocacy and Social Mobilisation really Empowering? Comm. Dev. J., Vol.31, No.3, July 1996. 
7.	Holdren JP, Daily GC, Ehrlich PR. The Meaning of Sustainability: Biogeophysical Aspects, http://dieoff.org/page113.htm, accessed on 17 August 2006

Dr. Uzodinma A. Adirieje
mailto:afrepton@yahoo.com